A diverse coalition matches New York City's style.


Colorado's governor confronts hard health care choices. Interview by Jane Stein.


Dispelling myths about mental health benefits.


New York state battles with health spending plans. Interview by Jane Stein.


Women at work: the benefit implications.


Users groups: a model for data collection, analysis.


Iowa's experience with packaging hospital information.


Hospital data use in Maryland.

Hospital data use in Maryland.


Managing benefit costs with disability claims audits.


Healthy habits that pay off.

Healthy habits that pay off.


Patient, heal thyself. Preventive medicine moves into the mainstream.


Election post-mortem: Arizona hospital, business health cost fight fizzles.


Medical care reimbursement rates for fiscal year 1985.


Information regarding requirements for health maintenance organizations--HRSA. Notice; information regarding requirements for qualified health maintenance organizations. This notice amends information relating to the requirements for federally qualified health maintenance organizations (HMOs) that was published in the Federal Register on April 29, 1980. The amendment deletes the requirement for a cancellation clause in contracts between an HMO and another party performing the HMO's marketing activities.


Medicare program; payment to health maintenance organizations and competitive medical plans--HCFA. Final rules with comment period. These regulations implement section 114 of the Tax Equity and Fiscal Responsibility Act of 1982 by authorizing Medicare reimbursement for health care services to eligible health maintenance organizations (HMOs) and competitive medical plans (CMPs) on a prospective basis for those entities that have a risk contract or on a reasonable cost basis for those that have a cost contract. The regulations set forth the requirements that an entity must meet in order to be: Eligible to enter into a Medicare contract (either risk or reasonable cost) as an eligible organization; and Reimbursed by Medicare on a capitation basis (either prospectively or retrospectively) for items and services furnished to Medicare enrollees. In addition, these regulations implement sections 2322 and 2350 (b) and (c) of Pub. L. 98-369 (Deficit Reduction Act of 1984), which further amended the Social Security Act concerning payments to HMOs and CMPs.


Grants for hospital construction and modernization; federal right of recovery and waiver of recovery--PHS. Notice of proposed rulemaking. As a result of recent amendments to sections 609 and 1622 of the Public Health Service Act, the Public Health Service proposes to amend its regulations to provide for (1) written notification to the Secretary when a grant-assisted hospital is sold or no longer used as a health facility eligible for a grant under Title VI or XVI of the Act, (2) waiver of the Government's right of recovery under certain circumstances, and (3) interest on recovery amounts.


HUD board and care home regulations--HUD. Proposed rule. This rule would permit HUD to provide mortgage insurance for the construction or rehabilitation of board and care homes, as authorized under section 437 of the Housing and Urban-Rural Recovery Act of 1983, Pub. L. 98-181.


Health systems agency and state health planning and development agency reviews; certificate of need programs--PHS. The Assistant Secretary for Health, with the approval of the Secretary of Health and Human Services, amends the regulations governing certificate of need reviews by State health planning and development agencies (State Agencies) and health systems agencies (HSAs). The amendments accomplish two tasks: (1) To implement amendments to the Public Health Service Act made by the Health Programs Extension Act of 1980 (Pub. L. 96-538) and the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35), and (2) to reduce Federal regulatory burdens. Under the provisions of Title XV of the Public Health Service Act, the planning agencies are required to administer certificate of need programs consistent with the Department's regulations, under which they review and determine the need for proposed capital expenditures, institutional health services and major medical equipment. These regulations change the requirements for satisfactory certificate of need programs.


Public ready for real change in health care.


Administration taking aim at subsidies for hospitals' medical education costs.


Faulty food and shelter programs draw charge that nobody's home to homeless.


Hospitals scramble to buy malpractice coverage.


States developing data bases to track health care patterns.


Unions open to cost control, but most reject cost shifting.


Program grants for black lung clinics--PHS. Final rule. The Public Health Service hereby revises the regulations governing the grants program for black lung clinics established under section 427(a) of the Federal Mine Safety and Health Act of 1977. The revision is in keeping with the Department of Health and Human Services' desire to remove as many programmatic burdens and restrictions from grantees as possible, while maintaining program integrity.


Auditing helps cut hospitalization costs.


Insurers protest state-mandated health benefits.


Loewen v. Cariboo Memorial Hospital: a decision for a medical appeal board.


Reeling in health care data.

Reeling in health care data.


Do you know the real age of consent?

Do you know the real age of consent?


Living with cancer.

Living with cancer.


Health maintenance organizations--HRSA. Notice; qualified health maintenance organizations. This notice sets forth the name, addresses, service areas, and dates of qualification of entities determined by the Secretary to be federally qualified health maintenance organizations (HMOs).


Workload measurement update. Peer group comparisons.


Evaluation of worksite health promotion: some unresolved issues and opportunities.


Learning to survive.

Learning to survive.


Laboratory assistant certification.

Laboratory assistant certification.


Computer developments in health risk management.


The effect of critical care unit noise on patient sleep cycles.


Medical security against burglary and vandalism. With the large number of medical and pharmacy burglaries occurring every year, can any medical group practice afford to be unprotected? There is a distinct need for security against burglary and vandalism in the medical group setting. Where should the administrator go for help? Based on a discussion of the history of security, legal issues, and insurance considerations, the unique aspects of medical group security are presented and concrete recommendations made.


Investor-owned clinics--a likely trend.

Investor-owned clinics--a likely trend. The trends in today's world of health care have come together to form a suitable backdrop for the rise of investor-owned clinics. Mandated change, competition, manpower availability, consolidation, the increasing roles of capital and of management, investment interest, the success of the proprietary hospital model--all seem to point towards the emergence of this new movement and, consequently, new possibilities for administrators of medical groups. The trend is apparent, but is it viable? Success will not be easy for there are many difficult challenges that must be addressed.


A development program: an alternative way of funding capital and program expenditures. As medical groups look for new ways to acquire dollars to fund purchases of supplies, services, and capital equipment, the idea of a development program to raise funds from the private sector may become appealing. A development program can provide a mechanism for acquiring additional funds without charging patients more for medical services. The prerequisites of a successful program are: a group's commitment to the effort, establishment of proper tax-exempt status, and availability of competent legal counsel and a qualified person to lead the program. Also discussed here are the essential considerations of implementation approaches, the case statement, standard components of a program, and donor relations.


The patient satisfaction questionnaire.

The patient satisfaction questionnaire. To keep patients, a medial group must keep its patients satisfied. One helpful way to determine whether patients are happy with the care they receive is through a patient satisfaction questionnaire. In order to obtain an accurate picture of how the public views a practice, a number of basic considerations must be made: What information is needed? What is the best way to get it? What factors contribute to patient satisfaction and dissatisfaction? What layout is most likely to encourage a response? How should the survey be implemented and how can the value of the data be maximized? These and many other questions are addressed in this guide to developing a tailor-made patient satisfaction questionnaire and improving your patient retention rate.


The detail cost sheet.

The detail cost sheet. Effective management information systems are a basic need of every administrator of a medical group practice. This general discussion of the subject of cost accounting enables the administrator to develop a standard cost system and its related detail cost sheets as a management information tool. Detail cost sheets can be useful in reviewing utilization of group resources, establishing a basis for fees, setting a uniform margin of expected profit, and as a guide in negotiation of contracts with third-party payers.


Volunteer work: the myth and the reality.


Debarment, suspension, and ineligibility of contractors--DHHS. Final rule. The Office of the Secretary, Department of Health and Human Services, is amending the HHS Acquisition Regulation, Title 48 CFR Chapter 3, by adding a new subpart concerning debarment, suspension, and ineligibility of contractors. This new subpart will implement the provisions of Subpart 9.4, Debarment, Suspension and Ineligibility, of the Federal Acquisition Regulations.


3 case studies: installation of computerized appointments, a computerized chart-tracking system, and telautowriters. Problem situations are unavoidable in the daily routines of the medical group administrator. It is the method used to handle these situations that points out an administrator's skill. In the following three case studies, the problems of appointment scheduling, medical record tracking, and communication between appointment clerks, front desk receptionists, and nurses are presented. The problems are thoroughly addressed from beginning to end, through the stages of initial identification, seeking alternatives, recommendations, groundwork, implementing solutions, and analyzing final results.


Caring for an elderly relative.

Caring for an elderly relative.


The clergy: a willing but underutilized resource in the care of persons with alcohol problems.


Focus on hospice. Volunteers as the backbone.


The role of social work in hospice.

The role of social work in hospice.


Hospice in the long term care setting.

Hospice in the long term care setting.


Emerging community and public health systems--obtaining excellence through accreditation.


Hospice and home health: together in harmony or discord?


Solve your hospital's marketing problems: learn how to deploy the right components of a marketing grid.


One hospital chain's blueprint for survival.


Should you start a hepatitis B vaccine program?


Best overall performance. The HIS awards.


System installation: the user's viewpoint.


Patient education and cost containment.

Patient education and cost containment.


MEGAHIS: the 1980s and beyond.

MEGAHIS: the 1980s and beyond.


Universal data bases close 'information gap'.


A review of healthcare industry directions.


Controlling escalation. Interview by Ken Kadash.


Bar coding--where are we?

Bar coding--where are we?


Good computer--bad computer.

Good computer--bad computer.


A user based summary of market projections. A brief summary of the usage patterns of hospital based computer systems.


St. Louis businesses start review program.


Labor, management differ in cost control attitudes.


Dental insurance a success with new challenges.


Managing health care cuts hospitalization.


New solutions clean and disinfect ceilings at medical facilities.


Handwashing: locking out the spread of infection.


Maintaining quality with cost containment. How to avoid cutting product effectiveness when cutting costs.


Quality assurance for environmental sanitation in health care facilities.


Community services for community care.

Community services for community care.


Immunization procedures in Europe.

Immunization procedures in Europe.


The disordered development of day care in psychiatry.


The incidence of common infectious diseases: the weekly returns service of the Royal College of General Practitioners. This article summarizes the information collected on morbidity due to infectious disease in the UK between 1967 and 1983 by the Weekly Returns Service (WRS) of the Royal College of General Practitioners. The population data base used for this purpose now exceeds 200,000 and 40 general practices and 106 principals are included. Where comparisons are available incidence rates derived from the WRS are higher than those obtained in official notifications.


The treatment of Parkinson's disease--a consumer view.


Unemployment and parasuicide in Hartlepool 1974-83.


A survey of cost awareness among hospital medical staff.


Implementation of policies for community care--the DHSS contribution.


Smoking and illness: what smokers really believe.


Advances in mathematical models: benefits for EMS.


Out-of-hospital transfer of trauma patients. This study examined a large number of demographic, hospital, and medical factors that may influence out-of-hospital transfer for trauma patients. Data from the 1977 and 1978 National Hospital Discharge Survey were used to assemble a case-control data set of injuries (n=4576); cases were defined as transfers out of hospital and controls were discharges to home. Controls were frequency matched to cases based on overall severity, site of the most severe anatomic injury, and age. The analysis estimated the relative risk of transfer associated with different levels of the risk factors by the odds ratio. The analysis was performed twice, once for the full case-control data set and a second time for patients with severe injuries. Of the risk factors examined the only strong, consistent relationships with patient transfer were found for marital status and region of country. Individuals who were not married were at nearly twice the risk of transfer compared with married individuals; likewise patients hospitalized in the western US were twice as likely to be transferred as patients in Southern hospitals. Possible reasons for these results are offered.


An aid for diagnosing acute ischemic heart disease in the emergency room. A five-year study was undertaken to develop a valid mathematical model that could aid in diagnosing acute ischemic heart disease in the emergency room, thus reducing inappropriate admissions to the coronary care unit. The study was divided into two substudies. In the first, variables significantly predictive of ischemic heart disease were identified and a logistic function was developed and tested. In the second, a six-hospital study, the variables of the first substudy were validated and a final logistic regression was developed and tested prospectively. This model's availability proved to be successful in improving diagnostic accuracy and specificity and in reducing false positive predictive rates and admissions to coronary care units.


Modeling skill utilization among prehospital care personnel. Several models linking skill utilization rates for advanced aids and drugs used in prehospital patient management with indicators of the structural and operational characteristics of emergency providers were derived from empirical data. Because the utilization patterns for each clinical category were taken into account, different models were built for each of these categories.


Coalition perspective.

Coalition perspective.


HCA perspective.

HCA perspective.


Patient profiling.

Patient profiling.


Group mission. Which of these management philosophies best fits your group?


Chrysler perspective.

Chrysler perspective.


Gut issues in competitive strategy development.


Tracking people.

Tracking people.


Future: role medical groups/doctors?

Future: role medical groups/doctors?


Health & the doctor business.

Health & the doctor business.


Plug into consumer thinking.

Plug into consumer thinking.


Managing physicians/being managed.

Managing physicians/being managed.


Democrats reassign NHI to 'long term' goal, focus on cost control.


Lab revolution.

Lab revolution.


1984 activity indicates state lawmakers looking beyond regulation.


The experience of dying.

The experience of dying.


The right to death.

The right to death.


Free meals bring outpatients in.

Free meals bring outpatients in.


Spiritual well-being of the dying.

Spiritual well-being of the dying.


Aging and blindness.

Aging and blindness.


The for-profit revolution in healthcare.


Special events in the '80s: a case for marketing approach.


The for-profit revolution in healthcare. The art of selling foodservices in hospitals & nursing homes.


Planning the special event: negotiating the do's & don'ts. Interview by Raymond Roel.


Festival of trees brightens hospital's fund raising year.


Gifts-in-kind organization gives something for nothing.


United Way at the workplace: coping with America's needs.


Private foundation rules: what fund raisers should know. Part I.


The process of developing innovation and leadership.


Building the tiers of your resource development program.


Fund raising's future lies with creative visionaries.


Game plan tactics win when reporting to the board.


Why an auction may be the right "event" for you.


An international survey of drug information centers. A questionnaire was developed to characterize the location, operation, personnel, reference resources, and functions of drug information centers in countries throughout the world other than the United States. The questionnaire was mailed to 100 drug information centers or pharmacy practitioners (primarily faculty) in 65 countries. The majority of drug information centers responding to this questionnaire were located at and funded by university based hospitals. Most were open eight hours per day and engaged in the following activities: answering requests for information, publishing pharmacy bulletins, teaching, continuing education, and providing information directly to pharmacy and therapeutics committees. Additional information gathered from this survey included: common references and journals maintained by drug information centers, user demographics, and a request profile. Although many similarities among the information centers were found, interesting observations regarding their differences may be made. It is important that drug information centers share their experiences so that others may learn about their new and innovative programs.


Effect of ten specific questions on nationwide drug information center activity. A survey of drug information centers (DICs) was performed to determine (1) the number of requests received and (2) the amount of manpower used in answering requests for frequently sought information dealing with ten specific topics. A total of 2,968 requests for information on ten topics was received by the 41 DICs, representing 3% of all questions received. The number of requests for information on each topic ranged from 27 to 724, and over half of the DICs received at least one request for information on nine of the ten topics. A total of 1,206 man-hours was used by the DICs to answer requests for information on all topics combined. It is concluded that DICs overlap substantially in the provision of frequently sought information.


Public drug information: a telephone-based model for patient education. As one facet of a larger investigation evaluating the various means by which patients receive information concerning their medications, a telephone-based drug information service was established for selected public use. The purpose was to detail the growth and utilization of the service, characterize the type and importance of the questions asked, and compare the potential utility with that of the USP-DI patient package insert (PPI) in responding to the public's drug information requests. Availability of the toll-free number for the Prescription Drug Information Service (PDIS) was controlled by offering it only to outpatients receiving selected medicines from the pharmacy of a large university-based medical center. The PDIS was operated by clinical pharmacists who participated in completing standardized operational data forms after each drug information call by the public. Of those calls received, 91.7% were not of a serious nature and most commonly dealt with side effects, drug interactions, and drug identification. Fifty percent of first-time calls occurred within two days of the subject's visit to the pharmacy and 23.4% of the total PDIS calls were repeat contacts. Interestingly, 34% of the patients' questions could not have been answered using the standard USP-DI PPI.


Physician-administrator conflict.

Physician-administrator conflict.


Partisanship and health policy.

Partisanship and health policy.


Social support networks and the health of elderly persons.


Arizona hospital cost battle goes to the polls; voters to decide rate control issue.


Franchise regulation: closer to home than you may think.


Cheating on licensing examinations--a legal perspective.


Physician, sell thyself.

Physician, sell thyself.


Corporate-community foundations: the tie that's binding.


Future status of project review programs in health planning process remains uncertain.


The hot and healthy glow of the HMOs.

The hot and healthy glow of the HMOs.


Foreign medical graduates: credentials and licensure--III. The Missouri Plan.


Horse therapy: a special treat for children in psychiatric hospital.


Illinois chooses free market approach; Florida ties competition and budget review.


The manager as conflict negotiator.

The manager as conflict negotiator.


Application of a job diagnostic model to staff motivation.


Voluntary bar coding system developed by health care industry.


The central service role in today's hospital.


Social security benefits for lupus patients.


Sexual harassment: a problem for the health care supervisor.


The need for lupus support groups.

The need for lupus support groups.


An economical and functional nursing unit design. In mid-1983, Mary Immaculate Hospital began operating with a 44-bed nursing unit. The larger unit was designed to be functionally efficient, architecturally attractive, and cost effective. This article examines the physical and functional changes made as a result of the larger unit, and the staffs' reactions to these changes.


Reconciling high-tech with high-touch.

Reconciling high-tech with high-touch.


Hospital energy costs.

Hospital energy costs. Hospital energy costs have increased dramatically in the past decade. With the new incentives for increased operating efficiency, hospitals must now find ways of reducing these costs by conserving energy. This article discusses the energy problem, solution, and results of an energy conservation program at the Fulton-DeKalb Hospital Authority in Atlanta, Georgia.


An interview with Adrian Roberg, RN, on his experience as a director of referral services. Interview by Patrick M. Mages.


Establishing prices: one hospital's strategic response. Establishing appropriate prices for health care products has been an ongoing problem. Price increases have traditionally been based on an across-the-board percentage increase for all products. In this article, the importance of pricing and the actual pricing methodology used at Baptist Medical Center in Kansas City, Missouri are discussed.


Hospital care--where has it gone?

Hospital care--where has it gone? The past several decades have been called the economic golden years of medicine. The vast majority of health care was provided in the hospital setting. Today, however, multiple forces are at work moving health care providers to less expensive environments. This article explores the past and the future of hospital care in the United States.


Hospitals and medical staffs: allies or adversaries?


Organizing nursing homes.

Organizing nursing homes.


Hospital development. Building on a capital programme.


Data retrieval. There are statistics... and hospital statistics.


Gray Panthers speak out on a national health service.


Hospital television. Sandwell's TV eye.

Hospital television. Sandwell's TV eye.


Institution v community: is there really much to choose.


How much does it cost to go to the theatre in Cheltenham?


Private hospitals. Putting on the private charm.


For an end to ageism.

For an end to ageism.


Effective costing for community provisions.


Primary care. Reassessing NHS evaluation could prove a "blooming" success.


Data retrieval. Paying attention will reap its own reward.


NHS impressions. A new image can work wonders.


The nation grows older. Facts, projections and gaps concerning data on aging.


Hospital economies. Whipps Cross goes on its holidays.


A radical plan for patients at home.

A radical plan for patients at home.


Patient care. Will they ever learn about feelings?


Medical records. Will there be time to comply with the new code?


Control receivable days through cross training.


What is the future of the chief financial officer?


Hospital prices and the CPI: implications for managers.


Hospital cost accounting: a basic system framework.


Automating multis: the participative approach.


Cutting hospital costs with consignment purchasing.


Merger and consolidation: what is the target organization worth?


Health care and the national debt: issues for 1985.


Financial manager's notebook. Audit standard programs cut insurance audit losses.


Late discharges are really communication problems.


Today's CFO: better educated, better paid, with more responsibility. The average CFO is 41 years old with a master's degree. He (CFOs are still overwhelmingly male) earns $54,700 a year and has increasing responsibility over areas such as medical records, financial planning, internal audit, and reimbursement. The CFO is becoming increasingly interested in new business activities such as joint ventures and mergers, and is finding government regulations and reimbursement issues a less enjoyable aspect of the job.


Capital financing demands new, innovative practices. Hospitals are facing challenges in the financing of capital expenditures. Credit ratings have shifted to a lower rating category. Interest rates for long-term debt have risen, and the use of short-term variable rate debt has increased. Also, the elimination of tax-exempt financing is being considered. Clearly, capital financing is in a state of flux. With a need for low cost capital, hospital financing is in a state of flux. With a need for low cost capital, hospital financial managers should study the changing credit market and consider innovative practices in healthcare financing.


Computerized materials management--the systems of the future.


Desk diary of a hospital administrator.

Desk diary of a hospital administrator.


Treating the merger as a taxable versus tax-free combination. A key issue in any business combination is whether the transaction is to be a taxable acquisition or a tax-free reorganization. Neither structure's benefits clearly dominate. Taxable acquisitions result in greater inventory cost and depreciation tax benefits to the buyer and more tax to the seller. Tax-free reorganizations allow the seller to avoid current payment of at least some taxes but result in less favorable tax benefits to the buyer. Each merger must therefore be tailored to fit the specific needs and wishes of the parties involved.


Have you got the Griffiths factor?

Have you got the Griffiths factor?


Hospital closures. Plans and patients--crossed lines?


Nurses enhance productivity and patient care.


NHS Pinafore or From consensus to dreadnought.


How to automate the laboratory--not laboratorians.


A perspective on clinical laboratory computing systems.


Medical Center's computer improves productivity.


Healthcare CEOs and CFOs report on vendor problems.


Equal opportunities: race and the NHS.

Equal opportunities: race and the NHS.


Towards a new model of health manpower planning.


Discipline and dismissal of medical staff: a BMA view.


The medical manpower crisis--who can solve it.


Payment by results systems for managers in the NHS--an overview.


Management development in the outdoors.

Management development in the outdoors.


Job sharing--Gloucester Health Authority style.


Towards an organisation theory for the NHS?


Hospitals abroad. Putting Japan in the patient's perspective.


Back to the textbooks: a year of study.

Back to the textbooks: a year of study.


Nurses and privatisation.

Nurses and privatisation.


The realities of human resourcing: a case study which questions the utility of rational manpower planning models in health care.


Dismissals for reasons of redundancy: what the law says.


Griffiths: the general manager's contract.


General management at unit level.

General management at unit level.


Personnel management in the NHS: some evidence from Scotland.


Formal, organized materials management department growth continues.


The industrial relations training needs of NHS managers.


The use of "or equal" in specifications.


Hospitals continue to benefit from purchase price deflation.


HPM surveys the paper towel market.

HPM surveys the paper towel market.


Backgrounder. Fort Howard on paper.

Backgrounder. Fort Howard on paper.


The accreditation experience.

The accreditation experience.


The legal aspects of homecare company acquisitions.


Humana tests homecare service 'water'.

Humana tests homecare service 'water'.


Preventive medicine and employee productivity.


Insurance must offer homecare/hospice policies.


Maryland hospital based home health celebrates birthday, reviews progress.


An interview with: Linda Chaff, director of protection services.


Purchasing/vendor relations.

Purchasing/vendor relations.


Managing an effective asbestos abatement program.


Hospital patient rapes posing serious legal and security challenges.


Update on closed circuit television.

Update on closed circuit television.


A works information system to support cost effective management.


International Hospital Federation--its activities and aims.


Application of BMS technology of South West Thames RHA.


Control of materials by computer.

Control of materials by computer.


Considerations in implementing shared clinical engineering services in New Brunswick.


The development of criteria for testing hospital designs.


Getting the best from your ad agency.

Getting the best from your ad agency.


A large scale hospital in the suburbs of Tokyo.


Promises, promises.

Promises, promises.


The leading edge.

The leading edge.


Cardiac pacing practices: a survey.

Cardiac pacing practices: a survey. A profile of permanent cardiac pacing practices in the United States during 1981 has been compiled in a survey of physicians who implant pacemakers. Approximately 5,600 physicians performed about 118,000 new primary implants at 3,670 centers. Only 17% of implantation procedures were replacements, compared with 31% in 1978. Although 90% of primary pacemakers were somewhat programmable, almost half were not reprogrammed within the first three months after implantation and 30% were never reprogrammed. Most patients (85%) were followed by trans-telephonic monitoring, 68% in conjunction with private office visits. The respondents estimated that dual-chamber pacing, accounting for 10% of implants in 1981, would increase to 37% by 1985.


Marketing traps. 13 tips on how not to succeed.


Group practice: the prototype physician organization.


Attracting women. Have you got what it takes?


Myths about hospital unionization dispelled.


Rodeos to rock shows: a hospital covers spectator events.


Productivity enhancement begins with management, not employees.


Introduction to medical anthropology and the anthropology of medicine: patient care and public health.


Clinical anthropologist as therapy facilitator: role development and clinician evaluation in a psychiatric training program.


Greta and Azarcon: a survey of episodic lead poisoning from a folk remedy.


NIH cost analysis of a contract proposal.


Federal requirements for performing cost analysis of a contract proposal.


Uniform Determination of Death Act.

Uniform Determination of Death Act.


California court rules on patient's right to refuse life-sustaining treatment.


Antitrust developments. Hospital exclusive contracts and the Department of Justice vertical restraints guidelines.


Cook chill cuts costs, not quality.

Cook chill cuts costs, not quality.


Can your linen supply meet demands?

Can your linen supply meet demands?


Contract service could be your meal ticket.


Assess mental health care before it's too late.


Hospital staff sound off.

Hospital staff sound off.


The legal worries of quality assurance reports.


What doctors can expect of the hospital administrator.


Patient education relieves pre-op fears.


Surveys help diagnose organizational illness.


Cooperation in operation.

Cooperation in operation.


Finished hospital manuals...now what?

Finished hospital manuals...now what?


Attitudes towards health show a gratifying change.


Business holds keys to more competitive health care.


The education process. Determining your training needs.


Number of health care coalitions on the rise.


The Atlanta experience. The Coalition.

The Atlanta experience. The Coalition.


National business groups' views on regulation split.


Tips to improve the manager/leader's performance.


Health education intervention in the separation and divorce process. This paper argues the case for a full national conciliation service which would include the provision of anticipatory guidance on the health consequences of the divorce process. After a small empirical study on a group of women from York, evidence emerged that no such provision existed. Despite the fact that all the women belonged to, or were associated with, the One-Parent Family group in York, they all felt that some form of support agency and a health adviser would have been invaluable.


Health education in the National Health Service: the differing perceptions of community physicians and health education officers. Community physicians and health education officers (HEOs) are the two key health professionals with a particular responsibility for the delivery of health education services to the community. For this reason it is important that they achieve some measure of consensus in terms of the aims, objectives and methods employed by such a service. The results of a study based on a questionnaire and detailed interviews with both groups, indicate that this consensus is rarely achieved. It shows that community physicians and HEOs have important differences of opinion in a number of key areas, including both the level of intervention and methods employed in health education.


The scope for preventive medicine in general practice in the East End. Primary care is seen as an obvious setting for preventive programmes, but a number of studies present a negative view of inner city primary care, with criticism directed particularly at older single-handed GPs. This may not be justified. A survey of 56 of the 84 GPs in the inner London borough of Tower Hamlets, found a higher than average proportion of single-handed GPs over 60 and a high level of dissatisfaction with premises. Half said they carried out some kind of preventive programme, usually hypertension screening, and three quarters were interested in doing so. Only one practice had a patient support group, but 70 per cent thought they were a good idea. Given support and help, more GPs would consider preventive programmes and set up patient support groups.


The Arizona health care confrontation.

The Arizona health care confrontation.


Make room for Daddy.

Make room for Daddy.


Free money from the Post Office.

Free money from the Post Office.


On-the-job instruction.

On-the-job instruction.


Creative options or what your hospital can do to reduce nurse turnover at little cost.


The buying plan.

The buying plan.


Group conflict--a challenge to participative management.


How to manage hospital records.

How to manage hospital records. It has been documented that hospitals with records retention programs have 55 percent less records, spend less time on record maintenance and retrieval of records and can find records on demand when requested. This all adds up to savings in time and space and improved quality in an age when these commodities are precious resources. No other industry that I can think of has as its mainstay the need for good quality records as hospitals do. Don't pass up this opportunity to manage your records as carefully as you have been managing your other resources: money, manpower and materiel.


Marketing efforts of hospitals: result of a sample survey.


Lancaster General Hospital gift shop.

Lancaster General Hospital gift shop.


Management styles: are you an effective leader? Part I.


"I'd like to be a buyer ... but I don't understand figures!".


Displays for fine gifts.

Displays for fine gifts.


How to increase efficiency, safety and cost control in hospital infectious waste treatment. An efficient and cost-effective on-site infectious waste management program can be implemented by integrating the decontamination advantages offered by both steam sterilization and incineration. To do so requires the understanding of the interrelationship between the components that comprise the program. The physical and chemical characteristics of the various infectious waste constituents will dictate the mode by which each constituent will be decontaminated. The treatment mode will in turn dictate the packaging and containment necessary to ensure decontamination. An understanding of the operating principles, and design features of each treatment mode will further enhance treatment efficacy.


Two tiers of care: the unthinkable meets the inevitable.


Physicians and hospital-based health promotion: formalizing the relationship. Hospitals and health care organizations today are faced with a multitude of new pressures that threaten their very survival. Redirecting a threat into an opportunity requires close cooperation between a health care institution and its medical staff. One opportunity that has emerged is the development of health promotion programs, whose success depends on medical staff support.


Ethical issues dominate hospital leadership forum.


Medical staff, board, and administration relationships must change. The traditional, loosely organized relationship among medical staffs, administrators, and trustees must give way to more effective, business-oriented interrelationships if hospitals are to thrive and prosper in the future.


Competitors become allies in MRI joint venture. In spite of what first seemed like insurmountable hurdles, two competing Denver hospitals have joined together in an innovative plan to provide magnetic resonance imaging (MRI) services. Their alliance may be a model for other hospitals in the same type of competitive environment.


Informed consent: a haunting presence.

Informed consent: a haunting presence. As informed consent case law evolves, physicians and hospitals are increasingly becoming responsible for what patients are not told as well as for what they are.


The uncertain future of American teaching hospitals. Interview by Emily Friedman.


Is the voluntary medical staff on the way out?


The realities of the 'doctor glut'.

The realities of the 'doctor glut'.


What medical staffs need to know about recruiting physicians. Hospital medical staffs involved in physician recruiting face an enormously complex task. The "old boy network" is probably not the most effective way to find physicians.


The effects of the physician supply: 'I think it will get quite rough'. Interview by Emily Friedman.


New medical staff members made 'members of family'. Akron (OH) City Hospital uses a formal orientation programs to introduce new members of the medical staff to their responsibilities to the hospital.


Improvement in antibiotic use secondary to a small hospital antibiotic review. An ongoing antibiotic review was instituted in a 144-bed, community teaching hospital. The objectives were to establish criteria defining the use of antibiotics and to identify and quantify antibiotic use not fulfilling these criteria. Through medical staff review of this data on antibiotic use, utilization was then changed to conform with established criteria or was identified as an exception to the criteria. A 45% improvement in antibiotic use was noted when data from the first 9 months of the audit were compared with the second 9-month period. This report shows that a pharmacy-directed antibiotic review can have a positive effect on drug utilization in a small community hospital.


Structure and philosophy of pharmacy management using a matrix organization, Part I: a conceptual model. The resource, systems, information, and therapy management responsibilities of a director of pharmacy services are used to illustrate the horizontal decision making opportunities made available through matrix management. When compared with traditionally vertical decision models, the matrix offers the probability of broad consensus and support, but can have a risk of lowest-common-denominator determinations. The role and function of a management matrix in the hospital context are introduced and contrasted to power-oriented decision making.


Adverse drug effects: evaluation of four secondary reference sources. Four adverse drug effect abstracting services, Adverse Drug Reaction Index, Clin-Alert, Current Drug Experience Literature, and Reactions were evaluated. Each service was evaluated in terms of the total number of articles cited, cost per citation, lag time, and time requirements for searches. The Adverse Drug Reaction Index was found to retrieve the most total and unique citations. Its potential disadvantages included the longest lag time and a high overall cost for the system. Reactions provided an alternative to this service, although it provided fewer total and unique citations. However, its overall costs is less, and the lag time is shorter. Clin-Alert ad Current Drug Experience Literature provided significantly fewer citations than the other services. Both services did retrieve unique citations.


Pharmacy newsletters: time for a new approach. P & T Committees are often responsible for preparing a drug information newsletter for the purposes of disseminating drug-related information to the rest of the medical staff. A large amount of time, effort, and expense is devoted to preparing a high-quality newsletter, but, unfortunately, data suggest that the correspondence is not often read by members of the medical staff. Therefore, the drug information newsletter needs to be examined and modified periodically to meet the needs of its readers. A mechanisms for providing drug information in a "pocket-guide" form that is easily kept for future and quick future reference was developed and is described.


Minimizing waste of prepared sterile products.


The basics of budgeting for capital equipment.


Hiring patterns for non-faculty clinical staff pharmacist positions in institutions greater than 500 beds. A survey was mailed to 150 randomly-selected hospitals greater than 500 beds to determine: 1) the type of pharmacists currently in non-faculty clinical staff positions; and 2) to assess the hiring philosophy toward such positions. Seventy-two surveys were used to tabulate results. Fifty-eight per cent of the non-faculty clinical positions in the institutions surveyed are held by BS pharmacists. Top preference if rehiring was an advanced degree PharmD or an entry level PharmD with a specialized residency. However, BS pharmacists with clinical experience also ranked high in preference, showing a definite competition with advanced degree pharmacists. Personality and experience seem to become important factors. MS graduates ranked very low, unless their degree was accompanied by a specialized residency. Implications of the survey results are discussed in respect to graduating pharmacy students, academe, and pharmacists currently in the work force.


Twenty-four hour pharmacy service in hospitals with less than 300 beds--part 10. In the June 1983 issue of Hospital Pharmacy, I requested pharmacy directors in hospitals of less than 300 beds who had 168-hour a week pharmacy service to describe their service and how they obtained it. Below you will find a continuation of this feature. We plan to publish additional descriptions as they are received.


Twenty-four hour pharmacy service in hospitals of less than 300 beds.


Advantages of collective bargaining contracts for residents exist but have declined. The results of 1979 and 1983 surveys of resident physicians show that there are still advantages in terms of working conditions for collective bargaining contracts, but the advantages have lessened.


Wrongful discharge of the at-will hospital pharmacy employee. The vast majority of hospital pharmacy employees are not covered by a contract or a collective bargaining agreement and are therefore subject to the employment at-will doctrine. In recent years, there has been considerable erosion of this doctrine with increased protection of the at-will employee from wrongful discharge. This paper reviews both the statutory and judicial limits on the right to discharge an employee at-will, and discusses the implications for pharmacy management and staff. Although the laws relating to wrongful discharge will vary from state to state, the changing theories governing this process are of significant importance to all concerned.


Impact of preceptor counseling on medical resident prescription writing. A collaborative study was conducted by pharmacists and the clinical preceptor of the otolaryngology outpatient clinic of the University of Texas Medical Branch (UTMB). This study focused on decreasing the percent of legal or procedural errors made by resident physicians. During the study period all prescriptions written by house staff were reviewed by a pharmacist for compliance to previously established criteria. Noncompliant prescriptions were photocopied by the pharmacist and recorded for review by the resident's clinical preceptor. After an 8-week period of baseline data collection, residents were counseled privately by the clinical preceptor and critique on their ability to write a legally and procedurally correct prescription. The residents were made aware of their major deficiencies to enable them to correct the problems. During an unannounced 4-week period, beginning 5 months after preceptor consultation, resident prescription writing was again audited. The result, an overall decrease of 78.5% in noncompliant prescriptions, illustrates that establishing lines of communication between pharmacists and physicians can demonstrably improve health care services. If this change in the quality of prescription writing could be achieved in all of the institution's ambulatory care clinics, an annual conservation of at least $57,000 in pharmacist salaries would be realized.


Cost containment through therapeutic substitution of aminoglycosides. A therapeutic substitution policy (TSP) for tobramycin and gentamicin sulfate was implemented at the University of Texas Medical Branch (UTMB). The policy was designed by various physician-chaired hospital committees and clinical departments that collaborated with the pharmacy service. The goal was to encourage the medical house staff to use the most economical yet safe and effective aminoglycoside, without limiting the medical team's prerogative to select among alternatives within this antibiotic group. Cost data from the first 6 months of aminoglycoside use under the new policy projected an annual savings of $139,071 in drug expenditures and $242,472 in patient charges. Following the implementation of the TSP, a concurrent drug utilization review (DUR) was performed in 50 consecutive inpatients prescribed amikacin, tobramycin, or gentamicin sulfate. The objectives were to identify those aspects of prescribing and monitoring of aminoglycosides by house staff that could be improved by specific policy and/or education, and to evaluate those specific cases in which attending physician's approval allowed house staff to prescribe an aminoglycoside other than designated in the TSP. The audit revealed that house staff were compliant with 72% of the DUR criteria; however, at least one instance (mean of 5.04 +/- 2.21) of noncompliance occurred during the treatment of each patient. The most frequently encountered deficiencies were failure to monitor for ototoxicity, incorrect orders for at least one set of serum aminoglycoside concentrations, and improper dosage adjustments for those patients with renal insufficiency. In three cases, the attending physician approved house staff use of tobramycin instead of gentamicin sulfate for reasons of organism resistance, pre-existing renal impairment, and long-term treatment of osteomyelitis.


Look-alike threats to unit dose safety.

Look-alike threats to unit dose safety. Several similar-appearing (look-alike) unit dose products are shown, including ampuls, syringes, and oral drugs. These look-alikes could potentially lead to drug administration errors when one product is mistaken for another. This problem is briefly discussed and some suggestions for helping reduce the likelihood of errors are made. These include calling on manufacturers to use more varied types of packaging and to refrain from producing several different drugs or dosages in similar packaging. The examples shown illustrate the risks of mistaking different look-alike products for one another and the importance of carefully reading package labels.


The risks and payoffs of variable-rate demand securities.


Industry notes.

Industry notes.


Credit support vehicles: issues and options. A hospital must consider and discuss with commercial banks a number of questions before deciding on the appropriate credit support vehicle and the bank with which to work. Making sure that all parties agree to the major points early in negotiations results in each institution meeting its financial objectives, thereby structuring a transaction acceptable to all parties.


A guideline for establishing medication teaching groups for schizophrenic patients. Guidelines for establishing patient-oriented medication teaching groups for the schizophrenic patient are described. The importance of patient education has been well documented, although the effort and subsequent efficacy is still equivocal. Schizophrenic patients have several factors that may lead to drug default. By increasing the patient's database regarding the neuroleptic drug class, an increase in patient compliance may result. An approach to surveying existing programs, soliciting administrative support, addressing the patient, and plans for followup evaluation are outlined in a comprehensive format. It is the author's opinion that this format is highly successful and can be implemented at other institutions.


Cost analysis and pricing decisions.

Cost analysis and pricing decisions.


Four gifts guide Catholic health professionals.


The workplace as a community: promoting employee satisfaction. Because people's primary commitments lie elsewhere, the workplace will never be a true community. The workplace will be better, however, if employees show concern and respect for coworkers and if employers celebrate traditions, recognize achievement, and encourage creative thinking. Such workplace enhancement should encourage employees' participation in a shared enterprise but not substitute for workers' outside ties. To offset excessive competition, which can lead to suspicion and hostility, employers can (1) provide communication outlets, (2) faster loyalty to the job by providing attractive surroundings and benefits, (3) promote cooperation by allowing employees to participate in decision making. Family, neighborhood, and faith communities also benefit if employers acknowledge the family's importance, bring the workplace and the neighborhood together (for example, by investing in the area), and encourage church membership. Work in health care is potentially satisfying because it can meet people's need to serve others. Efforts to provide some semblance of community in the workplace will help to release the workplace's potential to provide personal satisfaction.


Surrogate motherhood: unacceptable answer to infertility. Although many see surrogate motherhood as a solution to female sterility, it produces problems with the marriage relationship, parental responsibility, and parent-child bonding. Pope Pius XII condemned artificial insemination from a donor (surrogate fatherhood) because it separates procreation from marriage. This condemnation would extend to surrogate motherhood for the same reasons: Human procreation is reduced simply to transmitting biological life rather than a Christian way of living, which is a task that requires parents' commitment to each other and the child. Many other problems make this procedure unacceptable. These include commercialization, the child's possible anxiety because of its ambiguous parentage, and the surrogate's wanting to keep the child.


Reason, courage, and grace: notes of a death watcher. Dying is strikingly private and personal, and it breaks the interconnectedness of all human life. It is at such a time that the physician's humanity must touch the unique personhood of the afflicted if the death is to be "good". A physician's duty does not rest on the medical profession's code of conduct; it consists of the physician's moral obligation to a specific person in a specific situation. That person's entire identity--not just the physical being--is assaulted by terminal illness; the emotional, familial, and social dimensions of selfhood are ravaged by the disease as surely as is the body. Each individual is involved in his or her suffering in a way that is unique and that cannot be understood or appreciated by anyone else. But the physician must try to bridge the distance that is placed around the sufferer by the dying process. And it is only with his or her own humanity that the care giver can accomplish this. That humanity should inform all decision making, and thus bring with it genuine control and comfort. In this way the patient can truly "own" his or her own death. The patient can thereby attain reason and courage, which together are the quality of grace.


Catholic theology and the "right to die". Catholic moral theology teaches that life is sacred but not absolute. Because life and all activities are subordinated to spiritual ends, it is moral to allow oneself to die when efforts to prolong life will bring no significant benefit and may even make it more difficult to finish life in peace, composure, and union with God. This is not the moral equivalent of suicide, but rather an acceptance of the human condition. In making such a decision, the distinction between morally ordinary and extraordinary means is crucial and based on the patient's total good. Ordinary means are those which offer a reasonable hope of benefit without excessive expense, pain, or other inconvenience. Extraordinary means are those which cannot be obtained without excessive burden or which, if used, would not offer a reasonable hope of benefit. Whether a medical procedure is standard or experimental does not, from a moral viewpoint, affect whether it is ordinary or extraordinary. In Catholic teaching, the patient has the paramount right to decide whether life-preserving measures will be used. If the patient is unable to make this decision, then the family should make it as the patient's representative.


Education on wheels convenient, useful for nurses.


Program for disturbed youths stresses family-centered therapy.


Canonical considerations in corporate restructuring. Religious institutes sponsoring Catholic health facilities face competitive economic pressures that impel them to seek corporate restructuring and joint ventures to fulfill their mission to the poor. They especially must look to the Church's Code of Canon Law to protect ecclesiastical goods and maintain their Catholic identity when entering such ventures. The U.S. bishops directives also assist in guaranteeing patient expectations that the health facility will observe the Church's ethical principles. Institutes first must ensure that subsidiaries will operate according to Catholic mission and philosophy. The canons delineate proper protection of assets and identify ends toward which the religious must apply temporal goods, such as supporting clergy and performing charitable works. Alienation, or conveyance of goods, is a critical consideration in such financial transactions; canons specify the institute's administrative limits and require superiors' written permission along with their councils' consent. All involved must be "thoroughly informed concerning the economic situation," show "just cause" for the transaction, and obtain expert estimates of property values. Religious administrators retain certain faith and executive obligations, such as amending the charter, appointing the board, and merging or dissolving the corporation. With the canons they help to ensure that collaborative efforts preserve the institute's corporate mission and allow religious to carry out their responsibility for ecclesiastical goods. Though alternatives to corporate ventures may be limited, options regarding how to structure and with whom to affiliate do exist. Sponsoring bodies dedicated to providing high-quality care must explore these options


Hospital program treats early juvenile offenders.


Lithotripters: noninvasive devices for the treatment of kidney stones. Guideline report.


Being creative in your marketing.

Being creative in your marketing.


Macro trends affecting long term care marketing.


Administration. Show and tell.

Administration. Show and tell.


Marketing and public relations: a combined service.


Administration. To the ear from the heart.


Providing an institutional framework for resolving ethical dilemmas.


The resident comes first: a marketing philosophy that works.


The retailing of health care.

The retailing of health care. A number of striking parallels between recent developments in health care marketing and changes in the retailing industry exist. The authors have compared retailing paradigms to the area on health care marketing so strategists in hospitals and other health care institutions can gain insight from these parallels. Many of the same economic, demographic, technological and lifestyle forces may be at work in both the health care and retail markets. While the services or products offered in health care are radically different from those of conventional retail markets, the manner in which the products and services are positioned, priced or distributed is surprisingly similar.


Computer use in long-term health care facilities.


The context and social role of specialized accreditation.


What marketing researchers expect from clients.


The Accrediting Commission on Education for Health Services Administration: future issues.


Business seeks to blend regulation with competition to control costs.


Market identification and hospital cost containment: a comparison of revenue contribution to utilization of strategic business units.


Perspectives on specialized accreditation in health services administration.


The influence of policy objectives on professional education and accreditation: the case of hospital administration.


Improving graduate education through self-study: implications for health administration education.


Specialized accreditation at the baccalaureate level: the case for professional rationalism.


Specialized accreditation: an administrative perspective.


Suction devices. A guide to emergency field aspirators.


Client satisfaction with the helping process: a review for the pastoral counselor. Surveys client satisfaction studies conducted on a variety of clinical settings and notes that most such studies indicate high levels of client satisfaction. Urges pastoral counseling centers to join in this type of evaluative research and offers specific suggestions to overcome methodological problems frequently encountered in conducting client satisfaction surveys.


Pastoral care for the institutionalized elderly: determining and responding to their need. Reports on a survey of nursing home residents and from the empirical findings of the survey outlines specific pastoral care needs, identifies vulnerable groups, and describes desired elements of visitation and ministry to the elderly. Links the elderlys' expressed current problems to effective pastoral care.


An analysis of CPE student time usage: the impact of training. Reports results of a research project on a population of 81 Clinical pastoral Education students. Correlates demographic, training, and emotional variables with time usage. Discusses and interprets data and draws implications for CPE Supervisors and for CPE training programs.


The Minnesota Couples Communication Program and clinical pastoral education. Describes the use of The Minnesota Couples Communication Program (MCCP) as part of a Clinical Pastoral Education unit's efforts to assist CPE students grow in communication skills, Notes four styles of communication and five modes of awareness and how these may lead to the establishment of more adequate communication and shared meaning. Observes that workshops using the MCCP may help pastors to initiate and improve their pastoral activities.


Grief-resolution therapy in a pastoral context. Describes the use of grief-resolution therapy within a pastoral context. Differentiates between a normal and unresolved grief reaction and outlines treatment procedures particularly suited to the pastoral caregiver.


Managing corporate cultures.

Managing corporate cultures.


The new common law of employment: changes in the concept of employment at will.


Spotting a market gap for a new product.


An up-close look at emergency medicine specialists.


The biggest malpractice sellout ever.

The biggest malpractice sellout ever.


How to finish first at the bargaining table.


Florida Hospital Medical Center, Orlando, Florida. Profile. In 1908, a 20 bed hospital known as Florida Sanitarium began serving the small farming community of Orlando primarily through traditional "rest cures" in a quiet, wooded environment. By contrast in 1985, the 1,071 bed Florida Hospital is a technologically advanced, full service medical center offering specialized surgical and diagnostic services to a greatly expanded Central Florida population. Owned and operated by the Seventh-Day Adventist Church, Florida Hospital Medical Center is today the fourth largest employer in the Orlando area, supporting a staff of some 700 physicians, 1,600 nurses and 2,400 technical, administrative and medical support personnel. Florida Hospital is located on a sprawling campus in Orlando, with the adjacent "West Campus" containing a free standing ambulatory care center and a professional office building with physician's offices and a family health center. Additionally, two satellite hospitals (Florida Hospital/Altamonte with 220 beds and Florida Hospital/Apopka with 50 beds), are located approximately 20 minutes away. A 56-bed Center for Psychiatry on the Orlando campus was completed last year, and a regional cancer center is currently under construction adjacent to Florida Hospital/Altamonte.


How to pack a lot of practice in a little office.


Malpractice: spotting cases that could blow up in your face.


How bad doctors dodge discipline.

How bad doctors dodge discipline.


How insurers get back at high-charging doctors.


A productivity study.

A productivity study. Although the study did not include all of the direct and indirect activities performed in the Processing Department, the study did provide data for the following conclusions. In analyzing the activities surrounding the collection of statistical data, it was determined that the manager was required not only to supervise, but to work in a staffing position. As a result, a supervisor was employed to assist the manager in supervising the daily operation of the department. This enabled the manager to fulfill the responsibility of overall direction of the Processing area. This study was a vehicle for building and maintaining pride and enthusiasm toward the achievement of high levels of performance in the department. The study was an instrument for establishing operational standards. By conducting a time study in each area, an exact amount of time required for decontamination, instrument processing and case cart assembly was determined. A specific time was determined for each activity, thereby providing a workload index. The study was the catalyst for developing an instrument manual with diagrams of instrument trays for increased accuracy and efficiency. Productivity studies play a significant role in establishing credibility between employee and employer in that both can establish mutual goals. Once performance is defined by measurable criteria, steps can be taken to focus on methods of improving productivity. By increasing efficiency and effectiveness, the department will attain "more bang for the buck."


Medical Electronics Buyers Guide 1985, Part 1. Chromatography; electrophoresis; electrosurgery; Holter ECG; hospital information systems; radiation detection, radiology; refractometers; respiration equipment.


One hospital's experience with EtO diffusional monitors. With the advent of the new OSHA standard for ethylene oxide, many hospitals are looking for economical and reliable ways to monitor personnel exposure. In describing the experience of one hospital which has used personal badge monitors on a regular basis, this article addresses the concerns that arise from the use of this type of monitor in the sterile processing department.


Hazard communication/right-to-know.

Hazard communication/right-to-know. The medical device and diagnostic product industry, although subject to compliance with the federal hazard communication regulation in the future, is currently facing state right-to-know requirements. The Health Industry Manufacturers Association (HIMA), has developed a training program for industry entitled, "Chemical Safety in the Health Products Industry." This program--consisting of written and video training materials--provides insight into the conduct of right-to-know training for employees. HIMA, through the training materials and in seminars being conducted on the right-to-know issue, is encouraging members to prepare compliance programs that will meet both federal and state requirements. Hospitals, too, are faced with state right-to-know requirements, and are in the process of obtaining MSDSs and preparing training programs for employees. Although future court decisions may change compliance requirements, industry and hospitals are currently working to meet the compliance requirements set forth by the federal hazard communication regulation and state and municipal legislation and regulation.


Equipment management. Biomedical instrumentation department at Pioneer Valley Hospital uses computerized equipment management.


The hospital market. A big step up.

The hospital market. A big step up.


Decontamination.

Decontamination. The soil encountered in the cleaning and decontamination process is protein in nature and relatively difficult to remove, especially if the protein has been allowed to dry on the surface. However, removal of this soil prior to sterilization is necessary in order to achieve satisfactory results--the lower the bioburden, the greater the probability of actually achieving sterilization. Therefore, when cleaning is done thoroughly and properly, visible soil and film and most microorganisms and pyrogens will be removed from the surface of the item. By providing instruments and other patient care equipment that are safe to handle or that have been adequately prepared for sterilization, you can be confident that you have made a major contribution to the provision of quality patient care in your hospital.


The artificial heart controversy: research, rationing, and regulation.


Computer security risk analysis.

Computer security risk analysis.


The home test movement shifts into high gear.


Plans to get 20% of budget cuts from health care draw protests.


Vaccine development: on the verge of a new era?


Ex-FDA official looks back on major issues.


EtO personnel monitoring devices: the state of the art. Results from a single monitor worn by an employee become a part of his record of previous EtO exposure and a measure of the conditions in the central sterile supply area. It is obviously important that these results be accurate. Random errors in the results of analytical measurements are allowed for in the NIOSH criteria for overall accuracy of a technique. The sensitivity and accuracy of devices used to monitor TWA personnel exposure to EtO are only as good as the collection efficiency of the technique and the analytical instrumentation it utilizes. The active sampling charcoal absorption tube, impinger, and Tedlar bag methods are common air quality monitoring tools within the occupational health field. In the hands of experienced industrial hygienists and analytical chemists, these devices may be used with accurate EtO collection and analytical results. Passive sampling diffusion monitoring devices obtain the same results through simplicity of use and ease of providing analysis. However, the user must be careful to follow the manufacturer's instructions exactly if the results are to be accurate and meaningful. With these facts in mind, and in light of recent studies showing continued improvements in the technique's precision, it is likely that most hospitals will turn to the diffusion monitor methods as their primary means of documenting compliance with the new OSHA monitoring standard.


Inservice for CS.

Inservice for CS.


Managing through influence.

Managing through influence.


Biopharmaceuticals: new technology unlocks the body's medicine cabinet.


Doctors meeting patient demands.

Doctors meeting patient demands.


The realm of ethics--more than issues.

The realm of ethics--more than issues.


Fee-for-service: last rites?

Fee-for-service: last rites?


Challenging ECT in Vermont.

Challenging ECT in Vermont.


HMO appeal. Could you get more care for your cash?


Smart selection. Three steps to choosing new employees.


Give your employees a pat on the back.

Give your employees a pat on the back. How does your medical group recognize the long-term service of its employees? Realizing that many of its employees had been under continuous employment for as many as 30 years, the Falls Clinic Professional Association developed a recognition program to honor that faithful service. Employees and physicians were involved in development of the program from many phases--a logo contest was held as an approach to developing a symbol that could be associated with the group and used for the awards. Presentation of the awards has become a tradition that this group eagerly anticipates and is proud to support.


The fading of firing-at-will.

The fading of firing-at-will.


What can RSS point out in accounts receivable? Either periodic appraisal or an unusual event may cause a medical group manager to analyze the group's accounts receivable system. Retrospective selective sampling (RSS) is an analysis method which tracks previously posted charges through the accounts receivable system step by step. The authors examine how the manager can make a selective sampling of charges, track those charges through the system, and interpret the RSS analysis.


Volunteers in the medical library: issues and suggestions for their use. The implementation of the use of volunteers in a medical library poses a unique challenge to the library administrator who must effectively utilize individuals who are often inexperienced with the highly technical informational needs of medical clientele. The benefits and difficulties of volunteer use are discussed along with specific issues that may occur--legal issues, the issue of volunteer use vs. paid employee, and the determination of the value of volunteers. A checklist of suggested uses of volunteers is included as well as an evaluation form that can be used to aid the library administrator and volunteer in evaluating the volunteer's performance and job satisfaction.


COLLEAGUE: a comprehensive online medical library for the end user. COLLEAGUE, from BRS/Saunders, is an online information service intended for use by health professionals. This article describes both the databases and services available through COLLEAGUE and shows specific search examples. Special COLLEAGUE features are highlighted as well as the differences between COLLEAGUE and both BRS/AFTER DARK and the BRS Search System. In addition, the role of the librarian in end user searching and future directions for COLLEAGUE are discussed.


Professionalism in a medical volunteer role: volunteers in emergency squad work.


Justifying an automated library network: concept and progress.


A nurse staffing evaluation model.

A nurse staffing evaluation model.


Capturing charges for hospital services. It is very common for group practices to miss charges for service and procedures performed by their physicians. Billing for physician fees for hospital services is too often taken for granted, and items in the areas of surgery, hospital stays, emergency room, and consultants are frequently overlooked. The various elements and steps to capturing charges for hospital services are provided here, and examples of how several groups perform this task are given.


Professional nurse staffing and primary care: a cost comparison.


Patient education: creativity or crunch.


Nursing education--nursing service: maximizing the potential.


Do not resuscitate: developing a policy.


Is a PPO in your future?

Is a PPO in your future? A medical group considering the possibility of becoming involved with a PPO faces a host of challenges. The author of this article firmly believes that medical groups today are prime candidates for this emerging alternative delivery system. The evolution and future of PPOs, advantages and disadvantages, and strategies during start-up are presented.


Location decisions made easier.

Location decisions made easier. "Should we have a facility at XYZ location?" Location plays an important role, though perhaps not a dominant one, in determining consumer patronage, and many healthcare providers are now facing major location decisions. Some of the subjectivity can be taken out of these decisions through the use of readily available demographic data from the US Census Bureau and the National Center for Health Statistics, along with a program designed for microcomputers.


Volunteers fill new roles.

Volunteers fill new roles.


Presbyterian's $427.2 million issue is its first and the largest in history.


Cafeteria plans revisited: a viable alternative.


Innovations in nursing. Neurotrauma: how a program was born.


HCA, AMI got permits from alleged scheme.


Teaching hospitals fuel expansion of consortium.


Experts say for-profit chains will buy few teaching hospitals in next decade.


Hospitals get few deals from oxygen vendors.


Women's healthcare spending new target of hospitals' ads.


Revision of tort system won't solve malpractice crisis, experts say.


Hospitals spending more money on advertising, market research.


Advertising helps more consumers select hospitals.


Facilities battle with billboards to boost their emergency care.


Analysts still at odds over impact of tax, bond reforms on hospitals.


Financing healthcare. Chains view acquisitions, will limit building projects.


Financing healthcare. Chains following new directions to raise capital for growing needs.


Financing healthcare. Teaching hospitals confident of ability to get access to capital.


Lobby group aims at quality of care.

Lobby group aims at quality of care.


'Baby boomers' a ripe market for healthcare providers: study.


Financing healthcare. Groups build reserves to fuel tactical expansion.


Financing healthcare. New financing avenues slow feasibility studies.


Not-for-profits, beware--foundation formed by sale could be short-lived.


Marketers should be idea managers: Kotler.


Ills of malpractice insurance market worsened by restrictions, rate hikes.


Children's home creates new unit for care of 'stable' high-risk babies.


Single-room maternity care seen as way to attracts patients, cut costs.


Large lithotripter facility aids patient volume, improves payback: architect.


Purchasing managers pressure vendors for supply price discounts.


Reforms will toughen policing, raise fines of California nursing homes.


Ads help consumers recall hospital; direct mail is favored ad method.


Psychological midwifery during the birth of a family. Pregnancy to Parenthood Family Center.


Intervention with sexually abused children. The Child and Adolescent Sexual Abuse Resource Center at San Francisco. Child victims of sexual abuse are being identified in increasing numbers. An appropriate and therapeutic intervention requires a trained multidisciplinary staff. This article describes the San Francisco Child and Adolescent Sexual Abuse Resource Center (CASARC), a 24-hour crisis intervention program for sexually abused children based in a pediatric setting. The training needs of medical professionals as well as community agencies serving children are discussed. Areas for new research are also presented.


How to achieve integration on the human side of the merger. Blake and Mouton use an actual case of a successful merger to show how their Interface Conflict-Solving Model, based on behavioral science principles, can be used to achieve integration. The authors outline the history of the two organizations, give illustrations of the kinds of changes that were necessary to more from the actual state of affairs within each organization to the conditions needed for synergy, and explain how the merging organizations collaborated to develop a model for the interface. The merger is evaluated from the perspective of what happened during the two years following the merger. Blake and Mouton also elaborate on the dynamics of group behavior that they took into consideration in designing the Interface Conflict-Solving Model: the effects of group members' shared history; the natural tensions that typically exist between groups that have a functional relationship and misperceptions and distortions that arise as a result of these tensions; and win-lose competitiveness instead of a win-win mentality as a shared expectation. Finally, the authors show how shared participation can overcome inappropriate and debilitating competition.


Better collections begin with clearly stated policies.


Making law the new way.

Making law the new way.


Managing bad debts in the emergency room.


Directing the post-TEFRA laboratory.

Directing the post-TEFRA laboratory. Strategies of the past are inappropriate for the future. But pathologists and hospitals who know the options and take the necessary steps can survive prospective payment.


Multiphasic health testing services: can they cure medicine of its ills? Preventive medicine could be the answer to many of the problems facing medicine, the author says. However, to be cost effective, we need to merge this new type of care with the traditional treatment of the sick that has been the foundation of health care for centuries.


Will the 'ghost of health care future' be a horror story? The choice is ours. Americans have to choose one of two possible scenarios regarding the future of health care in this country. This decision, the author says, will determine whether the "ghost of health care future" is competitive or constrictive. This article is adapted from Mr. Moore's presentation on the "DRG Fallout: Implications for the Pathologist and the Health Care System," during the CAP/ASCP 1984 Fall Meeting.


Machine readable identification systems. If bar code works in supermarkets, it should be great for medicine.


Promoting maintenance continuing education in a prospective payment environment. Maintenance continuing education plays an important role in the laboratory by assuring a baseline of technical expertise. Paradoxically, it is liable to be de-emphasized in a prospective payment environment where supervisory staff will become increasing involved with technical responsibilities. The pathologist can sustain and promote maintenance continuing education by incorporating it into the written review of work guidelines. This cost effective maneuver is easily integrated into daily activities and affords the participating staff a flexibility not possible with traditional forms of CE.


OTA issues report on medical device policy.


Manpower needs in 1990: a mildly rosy point of view.


Medical staff meeting: the Emperor's medicine. The perils of Pauline Plodd, MD.


HRIS implementation: a systematic approach.


A task-focused approach to team building.


State regulation of polygraph tests at the workplace.


Another compliance challenge for employers: The Retirement Equity Act. This ERISA update is designed to correct oversights in the previous law. It increases women's share of private sector retirement benefits by accommodating what are considered to be standard career patterns for women and by increasing the rights of spouses when it comes to employees' retirement benefits.


Corrective action: a treatment plan for problem performers.


The performance review approach to improving productivity.


Flexible benefits packages that satisfy employees and the IRS.


How we operate our prepaid pharmacy successfully.


Making performance appraisals perform: the use of team evaluation.


Selecting and managing competent managers.


Nursing poor recruitment with a marketing approach.


Clinical pharmacy: how it operates effectively in our hospital.


When a child dies.

When a child dies. The death of a child has a significant and far-reaching impact on all remaining members of the family. Each individual undergoes the process of bereavement, adjusting to this new and unwanted reality. The stages of this process include disorganization, the initial impact; the struggle of holding on/letting go, the lengthy period of keeping memories and certain aspects of the dead child, while relinquishing the child as a living member of the family; and reorganization, the integration of the loss into an ongoing life structure. Reactions to a loss of this magnitude often include a variety of normal and pathologic symptoms, some of which indicate the need for professional therapeutic intervention. In addition to professional help, there are numerous needs that can also be met by other family members, clergy, and support groups that facilitate the bereavement process. Importantly for the professionals in the service fields, the intense experience of these family members gives rise to problems and dilemmas in the helper, complicating work with bereaved individuals.


How non-MD hospital admissions will impact your practice.


"Pulling the plug": are you ready to make the decision?


Learn the basics of marketing a practice.


New MD fee system in the works.

New MD fee system in the works.


In the stretch: electronic mail.

In the stretch: electronic mail.


How to compete with for-profit medicine.


Housing for the elderly: a discussion of options.


A comparison of methods to approximate standard errors for complex survey data. Complex survey designs are characterized by multistage selections with stratification and clustering. The departure from simple random sampling assumptions requires special consideration with regard to variance estimation. Specially designed software packages exist to generate variance estimates for statistics from complex survey data. The variance estimation techniques used include balanced repeated replication, jackknife, and Taylor series linearization. Many complex surveys generate thousands of tables. The computational and publishing costs soar if estimates of standard error are required for all statistics. To decrease these costs, several alternative techniques to approximate the standard errors of estimates are available. These include the widely used relative variance curve, a method based on the average relative standard error, and the average design effect model. In this paper these three methods are compared with respect to accuracy, computational and publishing costs, and ease of implementation.


Rx for unprofitable outpatient dining: Big Mac.


Triage in neonatal intensive care: the limitations of a metaphor.


Switch to cook-chill system lowers labor costs, improves food quality for Anderson Hospital.


Understanding hospital communications systems.


Trends in hospital HVAC control.

Trends in hospital HVAC control.


Reliable in-hospital electrical distribution.


Customize life-safety systems to meet each hospital's needs.


Single-duct reheat system seals in Center's germs.


Hospital emergency system expansion--make it part of the plans.


The firing line. New limitations on an employer's right to fire employees.


The incontinence pad. Workhorse of the incontinence products.


Home health agencies with multiple programs: flexibility is key for clinical records.


Occupational health record systems: an essential component of occupational health and safety programs.


Hospice medical record documentation and management; opportunity for improvement.


Essential components of recordkeeping in a community-based geriatric setting.


Elevating ambulatory record systems: a case study.


Women's Center brings health promotion, clinical services into full partnership.


The medical record practitioner's role in developing information systems.


THRM forum: the MRP in the nonacute setting.


Access to adoptee's birth records: additional arguments.


The role of the health record practitioner in public health nursing and home health care agencies.


Review efficiently with screening techniques.


Preadmission preoperative teaching: a promoting option, but easier said than done.


Climb every ladder. Each step challenges aspiring health care executives.


Why report communicable diseases?

Why report communicable diseases?


Confronting the issues. Healthcare executives--taking charge of the future.


Advertising shapes image and attracts business.


Who is entitled to staff privileges?

Who is entitled to staff privileges?


The employee assistance program: a health promotion essential.


Is your hospital ready to join the life care business? One new form of alternative care for the elderly that more hospitals are examining is the continuing care retirement center concept. An executive with a rating agency discusses nine important factors to evaluate before embarking on this type of project.


The medical mall design as an answer to hospital cost control. Reorganizing the hospital's inpatient and outpatient services for the convenience of patients and to decrease acute care costs is becoming a necessary strategy under prospective pricing. Two architectural planners discuss the health care mall concept and the benefits of segregating ambulatory and ancillary services.


Opportunities for financing new service ventures.


For the new trustee. Executive compensation.


Trustees and physician CEOs: possibilities for partnership. Mitchell T. Rabkin, M.D., president of Beth Israel Hospital, Boston, is a member of a group whose numbers, once diminished, are on the rise again: physicians who are chief executive officers of hospitals. In this interview with Emily Friedman, senior field editor, American Hospital Publishing, Inc., Rabkin talks about why he thinks interest in physician CEOs is growing--and what boards should take into consideration when thinking about hiring one.


How to recruit an activist board.

How to recruit an activist board. The new issues facing hospitals today involve the fundamental nature of the institution. What should its mission be? What business should it be in? How should its business be conducted? Choices of this magnitude must be made at the board level. To broaden, accelerate, and reorganize the hospital's strategy for growth, the board needs activist members who understand the new environment, get involved, and mandate change. The author outlines a step-by-step process for recruiting such an activist board.


Trustee orientation.

Trustee orientation.


Financial officers at odds with some CEOs' predictions about the future of health care.


The winds of change: medical staff relations. Are hospital governing boards and medical staffs natural adversaries in the health care ecosystem, or are they partners in a common effort? Are they parallel but equal organizations with different roles and different points of view, or, eventually, must one emerge with authority over the other? This article discusses how medical staff/board relations are changing and the need for better communications between the two leadership groups.


Learning about volunteer burnout: (it can improve your retention rate).


Anti-social ethics. Health care costs.

Anti-social ethics. Health care costs.


Designing the hospital EAP: a case in point.


Human values. The evolution of the health care system.


Planning for National Volunteer Week--tips and ideas.


Volunteer recognition--a year-round responsibility.


How to prevent volunteer burnout. Interview by Donna Hill.


Defining death.

Defining death.


Perspectives. Provider-based insurance.

Perspectives. Provider-based insurance.


Perspectives. Teaching hospitals meet proprietary chains.


A unique guide to medical information.

A unique guide to medical information.


Art as therapy with an aging artist.

Art as therapy with an aging artist.


Dilemma of black community hospitals.

Dilemma of black community hospitals. This feature of Urban Health covers a wide range of topics related to metropolitan hospitals, both public and private. This month's column discusses a hospital setting with which relatively few practicing physicians are well acquainted--the Black community hospital. More than 500 such hospitals were established in years following the Civil War, but their numbers have dwindled steadily in recent decades to the point where today only a handful survive. A recasting of missions and a thrust into the middle class population are among strategies needed to halt the demise of these institutions, says the author.


Bereaved parents: particular difficulties, unique factors, and treatment issues. Little has been written on the topic of parental reactions to the loss of a child, despite the fact that there are unique psychological and sociological factors that make parental bereavement difficult to resolve. This article discusses factors involved in parental bereavement, including the unnaturalness of the child predeceasing the parents, social reactions to the death of a child, the loss of the spouse as a primary support during the grieving process, and grief-related problems with surviving children. Treatment recommendations are also presented.


Perinatal transport at Wesley Medical Center, Wichita, Kan. Fixed-wing aircraft, helicopters, and ambulances all are part of the transport system at this regional perinatal care center, one of only two in Kansas. The neonatal transport teams are made up of respiratory therapists and registered nurses.


Definitive criteria for prescribing home oxygen systems. The state of the art of oxygen delivery to ambulatory patients has evolved remarkably in the past 20 years. Oxygen is established as both safe and effective to use in selected patients with advanced chronic obstructive pulmonary disease. It has clearly been shown to extend life and to improve the quality of life in many patients. It is likely that further advances will make oxygen more suitable, acceptable, and perhaps less costly for a growing number of patients with progressive chronic respiratory diseases marked by hypoxemia and organ system damage.


Image quality and magnetic field strength in NMR imaging. The rapid proliferation of nuclear magnetic resonance imagers necessitates an increasingly critical look at system requirements. Image quality in its broadest sense must be determined for various types of imaging systems. We review here the physical determinants of image quality and present examples of images acquired at several different field strengths.


Regional recall.

Regional recall.


A neighborhood restored.

A neighborhood restored.


Rebuilding the barrio.

Rebuilding the barrio.


A private hilltop village.

A private hilltop village.


Cape Cod congenial.

Cape Cod congenial.


In the manner of a manor.

In the manner of a manor.


Getting the most from gifts.

Getting the most from gifts.


Doctors house calls.

Doctors house calls.


Job burnout: malady of the 'best and brightest.'.


Hospitals: we should be asking "Who should control health care?".


Ogilvy's advertising acumen applies to health care, too.


EtO sterilization procedures require close look.


The preferred-provider approach.

The preferred-provider approach.


The impact of contract medicine on surgery.


On the economic implications of a physician surplus.


The HMO movement.

The HMO movement.


American medicine: the power shift.

American medicine: the power shift.


Communicating wellness to employees.

Communicating wellness to employees.


The challenge of living with hospital regulation. Interview by Jane Stein.


Small business develops its own brand of health promotion programs.


Federal, state courts uphold challenges to rate-setting systems.


State legislative reforms stop short of solving malpractice problem.


High-tech moves into home market with cardiac, nutritional therapies.


The medical quandary. Technological change raises new policy questions.


A blockbuster health-care deal.

A blockbuster health-care deal.


Revision of income criteria for eligibility for uncompensated services--HRSA. Notice. This notice announces the applicability of the recent revision of the Poverty Income Guidelines to uncompensated services programs administered by health care facilities pursuant to Titles VI and XVI of the Public Health Service Act.


Goodrich searches for ways to contain CE's health costs.


Privacy Act of 1974; report of new system--HCFA. Notice of new system of records. In accordance with the requirements of the Privacy Act of 1974 we are proposing to establish a new system of records, Credit Reports for Medicaid Recipients, (Credit Bureau(s)), HHS/HCFA/BQC No. 09-70-2004. We have provided background information about the proposed system in the "Supplementary Information" section below. HCFA invites public comments by May 9, 1985, with respect to routine uses of the system.


Child abuse and neglect prevention and treatment program--HHS. Final rule. This rule contains a new basic State grant requirement to implement the Child Abuse Amendments of 1984 (Pub. L. 98-457). As a condition of receiving State grants under the Child Abuse Prevention and Treatment Act, States must establish programs and/or procedures within the State's child protective service system to respond to reports of medical neglect, including reports of the withholding of medically indicated treatment for disabled infants with life-threatening conditions. Other changes in regulations required by these Amendments will be published as a separate NPRM at a later date.


Health system agencies and state health planning development agencies; certificate of need reviews--HRSA. Notice regarding adjustment of the expenditure minimum for capital expenditures and the expenditure minimum for annual operating costs. This notice provides necessary information for each State which chooses to adjust the capital expenditure and annual operating cost expenditure minimums that are used to determine whether proposals are subject to review under a State's certificate of need program. The notice also provides guidance to assist a State Health Planning and Development Agency (State Agency) in determining the exact minimum dollar figure it will use and in seeking further information.


Weiner brings PPOs to southern Florida.

Weiner brings PPOs to southern Florida.


Wipfli vs Britten: assessing damages in malpractice.


Services and treatment for disabled infants; model guidelines for health care providers to establish infant care review committees--HHS. These are model guidelines to encourage the establishment within health care facilities, especially facilities with tertiary level neonatal care units, of committees for the purposes of educating hospital personnel and families of disabled infants with life-threatening conditions, recommending institutional policies and guidelines concerning the withholding of medically indicated treatment (including appropriate nutrition, hydration, and medication) from such infants, and offering counsel and review in cases involving disabled infants with life-threatening conditions. The publication of these model guidelines is required by section 124(b) of the Child Abuse Amendments of 1984, Pub. L. 98-457.


The computer challenge: more data, less privacy. The growth of computer use in health care settings will create gains and losses to the present state of patient care and confidentiality. Anticipating certain ethical and legal problems before they arise will help you deal with the changing health care environment.


Employee assistance programs and untested assumptions.


How professional associations serve you.


Evaluation of worksite stress management.


Negotiating with management: planning for health promotion.


Labor and corporate perspectives on stress reduction in the workplace.