n engl j med 368;16 nejm.org april 18, 2013 1470 a loss of status and income as well as disdain from peers. Although leadership is making its way into clinical training, the workforce of the near future is already practicing. How can senior leaders enable and encourage front-line leadership among today’s clinicians? Surveys suggest that clinicians want a greater leadership role but feel unprepa...

This article examines the role of health governance in shaping the outcomes of healthcare reforms in China. The analysis shows that the failure of reforms during the 1980s and 1990s was in part due to inadequate attention to key aspects in health governance, such as strategic interactions among government, providers and users, as well as incentive structures shaping their preferences and behavi...

The most important challenge at the forefront of the national agenda is the need for health care reform. Major concerns of the current system are cost and access to care. This article discusses numerous congressional proposals and strategies for addressing these concerns. ET nurses are in a unique position to influence health care delivery. The Wound Ostomy and Continence Nurses Society has imp...

~| y electing Democrat Harris Wofford B to the Senate over former Attorney General Richard T h o r n b u r g h in November 1991, the voters of Pennsylvania proved that healthcare reform is a politically salient issue. Policy analysts, amazed that Wofford's healthcare reform message was a key factor in his election, have debated during the past few months whether this was a fluke or the precurso...

BACKGROUND In the prenatal period, women can have sustained contact with nurses and other clinicians, forming relationships that are likely to be health enhancing for both the woman and her unborn child. Yet, first trimester care use in Oregon dropped noticeably over the past decade. In comparison with Washington state, Oregon has not shown substantial recovery. OBJECTIVE The aim of this stud...

f healthcare reform is not a political activity, it's going to be an economic o n e , " predic ted James Bentley, American Hospi ta l Association (AHA) senior vice president for policy, in a conversation. A look at recent hospital trends and an analysis from Wall Street bears this out. As competitive economic pressures increase in the healthcare system, in large part fueled by the growth of man...

OBJECTIVE To identify changes in nursing practice and the nursing-practice environment that have occurred with implementation of health sector reform in five countries in the Americas. METHODS An exploratory study of selected settings in Argentina, Brazil, Colombia, Mexico, and the United States of America was conducted between 1997 and 1999 to collect narrative data from 125 professional nur...