The contribution of a cultural perspective in understanding and evaluating client satisfaction. Increasing attention is being given to including measures of client satisfaction as a component in the evaluation of health care services. An understanding of cultural factors that may influence attitudes and behaviors in the health care situation can contribute to the theory and measurement of client satisfaction. Through an examination of some of the cross-cultural literature, this paper delineates dimensions of the health care situation in which clients have been shown to have distinctive preferences, behavioral patterns, attitudes, and treatment expectations. A knowledge of the beliefs and attitudes concerning health and illness that are espoused by a particular cultural group can be a valuable asset in understanding how members of that group will evaluate the delivery of health care services. The examination of how cultural and ethnic differences may affect client satisfaction outcomes points to the necessity of avoiding a global measure of client satisfaction without first examining those particular aspects of health care delivery and of the measurement context that may have a predictable influence on client satisfaction ratings.


Behavioral consequences of consumer dissatisfaction with medical care. The effects of consumer dissatisfaction with doctors and medical care services on intentions to seek care and subsequent behavior were estimated using data from four general population studies. Satisfaction was linked to reported intentions regarding care-seeking behavior (choices between self-care and seeking care from a regular doctor or emergency room) in response to both minor and serious medical problems. These results were replicated in two populations with diverse sociodemographic characteristics. Satisfaction scales also predicted subsequent changes in medical care providers and disenrollments from prepaid health plans independent field tests. These results suggest that the behavioral consequences of individual differences in satisfaction with doctors and health care services are noteworthy from both clinical and social perspectives.


Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. A series of seven studies was conducted by the authors and their colleagues to produce an efficient measure of service satisfaction that can easily be related to symptom level, demographic characteristics, and type and extent of service utilization. The resulting measure, the Service Evaluation Questionnaire (SEQ) is a brief, global index that has excellent internal consistency and solid psychometric properties. Data from an extensive SEQ field study can be used as a comparison base for future applications of the two SEQ component scales, the CSQ-8 and the SCL-10. A new hypothesis has emerged from this series of studies that will guide future research: Service recipients may find if difficult to formally express dissatisfaction in the face of significant caring--however ineffectual--when the technical capacity to offer definitive treatment is not yet fully developed and when criteria for evaluating the efficacy of treatment are not yet crystal clear.


The role of client satisfaction in evaluating university counseling services. Though ubiquitously used for evaluating university counseling services, client satisfaction assessment has been hampered by inadequate instrumentation. Systematic use of a short form of the Client Satisfaction Questionnaire (CSQ) in one such center over the past 5 years is described, together with strategies to ensure maximal accuracy and utilization of results. Several method factors were investigated. Optional respondent identification was not found to reduce response rate or increase reported satisfaction compared to anonymity, while a substudy obtaining very high response suggested bias from nonresponse to the routine survey (response rate = 40%) was not great. The CSQ was found to have excellent psychometric properties and many advantages for use in student service settings. Relationships between satisfaction and a number of other variables such as demographics, precounseling expectancies, problem type and severity, counselor differences, and duration of counseling are reported. Ways such findings were incorporated in service planning are briefly discussed.


Effects of anonymity and experimenter demand on client satisfaction with mental health services. Among the methodological issues associated with the measurement of client satisfaction are those concerning anonymity of response, experimenter demand effects, and reliability of instruments. In this study, 100 inpatients were randomly assigned in a 2 X 2 factorial design; subjects were asked or not asked to sign their names to the CSQ-8 questionnaire and were asked or not asked to "tell it like it is." The reported satisfaction of those given anonymity was significantly lower but there was no effect due to demand. Furthermore, subjects in the anonymity group had lower scores on all 8 items of the questionnaire. A factor analysis of the CSQ-8 revealed one major factor; the internal consistency of the scale was .93. The CSQ-8 was found to be a useful measure of overall client satisfaction but, because ceiling effects are a pervasive problem in client satisfaction research, anonymity should be assured whenever possible.


A cross-national validation of the client satisfaction questionnaire: the Dutch experience. A Dutch translation of the eight-term version of the Client Satisfaction Questionnaire (CSQ-8) was administered to community mental health outpatients in the Netherlands (n = 110). Data analyses indicate that the Dutch CSQ-8 has highly similar operating characteristics and psychometric properties compared with the English language version. Results also indicate that one general satisfaction factor was found in the Dutch CSQ-8 data. All eight of the scale items loaded heavily on this general factor, strong inter-item correlations were found, and the scale demonstrated high internal consistency. On these grounds, we can conclude that the Dutch CSQ-8 has the same properties as the original questionnaire and can be used as such in Holland. It was also found that those clients who decided to stop therapy on their own were less satisfied than other clients. Clients who made a common decision with their therapist or let him/her make that decision were more satisfied than clients who stopped by themselves. Additional research is planned to investigate whether clients who complete treatment goals are indeed more satisfied and whether this line of research could be a means of studying the external validity of the scale.


The evaluation ranking scale: a new methodology for assessing satisfaction. Most patient satisfaction scales produce high, undifferentiated levels of reported satisfaction that fail to detect program areas that consumers do not like. Methodological problems apparently contribute to these results. An alternative procedure, the Evaluation Ranking Scale (ERS), was formulated and tested. A 2 X 3 design was employed with 246 public health center patients randomly assigned to one of two measurement techniques (ERS vs. a global measure) and one of three informational sets. A secondary group of subjects was a convenience sample of 26 staff members, which allowed comparisons of staff evaluations of the health center to patients' evaluations of the health center. Compared to the global measure, the ERS provided more specific information about particular program components, was more discriminating, and resulted in mean satisfaction scores that were significantly lower. This new approach may be a more effective technique for assessing the psychosocial effectiveness of human service programs.


Relationship of service satisfaction to life satisfaction and perceived well-being. Two procedures for gaining patients' evaluations of health services were compared: (a) the Client Satisfaction Questionnaire (CSQ-18B), a direct approach assessing the setting and services actually encountered, and (b) the Patient Satisfaction Questionnaire (PSQ), an approach that indirectly assesses satisfaction with service by inquiring about general health care attitudes. Results from 148 public health patients indicated that the PSQ produced the most acceptability problems and was tapping aspects of life satisfaction other than service satisfaction. However, the PSQ produced significantly lower reports of satisfaction. Additional comparison and interpretation of typical responses generated from the two approaches suggested, on the whole, that the CSQ-18B data provided clearer, more efficient, and more useful information for program planning and evaluation. In this study, service satisfaction measured by the CSQ-18B did not have any significant relationship to global or multidimensional (LDQ-30) measures of life satisfaction and well-being. In contrast, over a third of the variance in PSQ scores was accounted for by measures of life satisfaction. It appears that the PSQ elicits attitudes toward the more generalized health care delivery system as well as aspects of life satisfaction rather than reactions to specific services actually received.


Comparison of indirect and direct approaches to measuring patient satisfaction. One indirect (PSQ) and two direct (CSQ-18B and ERS) measures of patient satisfaction were compared across a series of psychometric, acceptability, and concurrent validity criteria. None of the three measures was significantly related to health status or demographic characteristics. Each measure performed as expected from prior research on their psychometric properties. The scales contrasted, however, in regard to acceptability, with the PSQ being much less acceptable to patients than the other two. The PSQ also produced more missing data. The results on the PSQ reflected patient inconsistency on cross-check items and patients tended to be uncertain in their responses to many items. In multivariate analyses the three measures were used as predictors of patient-rated indices of global service satisfaction. The CSQ-18B and the ERS were significant predictors of patient-rated indices of global service satisfaction, whereas the PSQ was unrelated to these indices. It was concluded that the direct and indirect approaches measure different satisfaction domains. The PSQ likely assesses more generalized attitudes about health services while the CSQ-18B and the ERS efficiently reflect opinions about the specific setting in which they are administered.


The dysfunctional side effects of quantitative indicator production: illustration from mental health care (a message from Chicken Little). In the current context of economic conservation, accountability and retrenchment from social programs, justification is required in order to maintain human service capacity. In this effort, evaluation is a key component. Yet desire to base action upon information resulting from evaluation must be tempered by increased attention to the effects of the evaluation process. All too often premature application of quantitative indicators formerly used for individual assessment and research to bureaucratic decision making produces side effects that are dysfunctional in nature. Frequently these side effects influence service delivery directly. More insidious, because they are less easily discerned, are distortions introduced into the data by evaluation pressure. These not only delay effects on service but also impair understanding of the very process they are meant to illuminate. In order to illustrate this phenomenon, the author reviews a general literature and utilized examples from mental health care. Common themes are identified and a tentative theory of side effect generation proposed.


Assessing client satisfaction among Hispanics. Data from two studies using community health center clients are analyzed to assess how a measure of client satisfaction operates when used with different ethnic populations. The eight-item version of the Client Satisfaction Questionnaire (CSQ-8) is a measure of general satisfaction with services that was developed to provide a brief, standard assessment procedure suitable for use in a wide variety of service settings. Based on the results of this survey, the CSQ-8 seems to operate about the same, whether administered to Anglos, blacks, persons of Mexican descent, or persons of other Hispanic origin, or whether in English or Spanish. There were essentially no differences among the various ethnic groups across statistical criteria of internal consistency reliability, central tendency, dispersion, item intercorrelation, or missing values. These results suggest that the CSQ-8 is a measure of general satisfaction with services suitable for use with a variety of client populations, including Hispanics.


Treatment participation and outcome in a program for problem drinker-drivers. Relationships were examined between 13 predictor variables and two criteria of improvement in a program for problem drinker-drivers. Four measures of social background (income, educations, age, marital status), four measures of psychopathology based on the Minnesota Multiphasic Personality Inventory (MMPI), one measure of general alcoholism, and four indicators of treatment involvement served as predictor variables. Two factorially derived criteria served as outcome indicators, one reflecting general improvement, the other reflecting improved social adjustment, but a failure to reduce drinking. This second factor was interpreted as indicating resistance. Analysis included partial correlation and multiple regression, from which explained variance was completely partitioned into sources unique to each predictor, and sources shared by combinations of predictors. Results suggested that with other factors controlled, treatment involvement was linked both to improvement and to resistance. Similar conclusions were suggested for social background, but slightly different ones for psychopathology and alcoholism. Psychopathology was uniquely related to improvement; alcoholism, to resistance.


The impact of citizen evaluation review on community mental health center programs. A field study of techniques for involving local citizens in the evaluation of Community Mental Health Center (CMHC) services shows that lay citizens can make recommendations that service agencies will use to improve services. Seventeen citizen groups received evaluation information from participating CMHCs and developed 310 recommendations. Seventy-one percent of these suggestions were used by the CMHCs. Staff and governing board attitudes, fiscal pressures, and other organizational characteristics affected the success of the citizen groups.


Management consulting and evaluation.

Management consulting and evaluation. The basic functions and procedures of management consulting are contrasted here with formal program evaluation. A case example further illustrates the differing approaches used in programmatic problem solving. The similarities and differences between these two professional specializations are highlighted in order to understand better the unique but complementary contribution each makes to the improvement of program operations.


Physician perceptions of medical malpractice and defensive medicine. Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.


The evaluation ranking scale: clarification of methodological and procedural issues. Compared with CSQ-8, a typical questionnaire approach to assessing global patient satisfaction, the Evaluation Ranking Scale (ERS) had equally good patient acceptability, yielded more normally distributed satisfaction scores, and results allowed comparative information about patients' evaluation of specific service dimensions. The study also addressed key questions that have emerged about the ERS procedure. Patients apparently do not distinguish conceptually between "importance" of dimensions and "satisfaction" with dimensions in the first phase (ranking) of the ERS. Results did confirm that the ERS sequence of ranking and then rating the dimensions is essential to achieving optimal utility of results. The ranking task seems to have an organizing effect on patients' approach to the rating task. This effect does not work to dictate results in the rating phase but rather seems to familiarize patients with the dimensions to be rated thereby yielding greater potential discriminative capacity for the ERS. Finally, results indicate that the ERS can be administered in a flexible fashion that yields additional information about the absolute importance of the six dimensions without loss of desired operating characteristics for the measure.


The meaning of patient satisfaction with prepaid primary health care in Israel. This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.


Identifying and measuring unintended outcomes. Unintended outcomes of governmental actions have received little attention from evaluators. The argument made here is that outcome evaluations should routinely include efforts to identify and measure unintended outcomes. A systems perspective is presented which treats governmental actions as disequilibrating intrusions into reacting systems that produce an array of outcomes, only some of which are intended. Intended and unintended outcomes can be valued monetarily, in terms of human rights, or both; specifically, outcomes having monetary value alter both the level and distribution of income while outcomes with rights value alter the level and distribution of rights. More needs to be done on unintended outcomes. The systems approach offered here requires further elaboration. Design modification that increase the chances of identifying and measuring unanticipated outcomes are needed, especially for designs based on non-equivalent groups and time-series data. Instrumentation is needed for designs based on non-equivalent groups and time-series data. Instrumentation is needed that will more accurately and sensitively register unanticipated outcomes. In the meantime, evaluators should pay more attention to theoretical predictions, the experiences of those involved with programs similar to the ones being evaluated, intercultural differences, and to unintended outcomes that originate within government itself.


Johns Hopkins Hospital president says med schools should reduce physician output.


Good news about hospital costs.

Good news about hospital costs.


Put doctors on boards, AMA president-elect says.


Hospitals, physicians in the competitive era: learning to live in a new environment.


Competition is a fact of life, status quo is not functional, AGPA chief says.


Doctors urged to work to restore lost public confidence in medical profession. Joseph F. Boyle, M.D.--inaugural address.


Hospital Medical Staff Section leader sees era of creative, dynamic tension in relations.


The use of charts: a tool for management.


Database marketing propels non-profits into new age.


Hospitals help doctors to become more involved in decisions, AHA chief says.


Institutions must routinely take market's pulse.


Ellwood's MeSH idea links physicians, hospitals in business partnership plan.


Freestanding facilities for MRI: a joint venture alternative for hospitals, doctors.


Product standardization gaining momentum as industry moves deeper into competitive era.


Quality assurance. Yardsticks evolved for patient care.


Women in the NHS. How do the mums manage?


600 volunteers recruited to staff AMI's 3 clinics at Olympics.


Kidney patient care. French lessons: at what price?


Healthy talk at the GLC.

Healthy talk at the GLC.


Mental health planning. System which doesn't take sides.


Social work records. Access--an issue on the cards.


Computers, robots may be used to keep patients home.


Making headway in Medway.

Making headway in Medway.


Training skills for community life.

Training skills for community life.


Illinois Legislature approves free market solution to cost containment.


Equipment locker lends to patients who otherwise would do without.


Health care for the elderly: turning from coordinated community-based services.


AMI discloses plans to buy Omaha teaching hospital.


So why not start a foundation?

So why not start a foundation?


Coordinating student life services to enhance wellness opportunities.


Combining wellness promotion with family practice in a university setting.


Wellness: encouraging a lifetime pursuit of excellence.


Medical self-care in a university setting.


Testing an idea before launching it can prevent pain and improve acceptance.


Health services and the Olympics.

Health services and the Olympics.


Seven mistakes CEOs make vis-a-vis health care marketing.


Hospital LEAPs into Olympics.

Hospital LEAPs into Olympics.


Playing to win. Centinela Hospital and the sports medicine game.


Cost containment through inventory control.


Olympics polyclinics.

Olympics polyclinics.


The Hospital Satellite Network: how high tech links up with serious educational programming.


Future of hospital-based nursing explored.


Carner's Codes. The good-work/fair-pay myth.


No noise: how one large city hospital is quietly winning the war against noise pollution.


Volunteer staff, hospital support free clinic for needy children.


Interview with Sr. Mary Roch Rocklage, RSM.


A commentary on "Securing Access to Health Care." Ethics Commission access report urges adequate care for all. Society has a moral obligation to provide adequate access to health care for all, concludes the President's Commission for te Study of Ethical Problems in Medicine and Biomedical and Behavorial Research in its report Securing Access to Health Care. Though the federal government's involvement is not necessary if private forces are able to achieve equity in health care delivery, the government bears the ultimate responsibility for ensuring that society fulfills its obligations. Meeting these objectives will require changes in the country's political and economic systems, which traditionally have not emphasized subordinating the individual good to the common good. The needs of the poor must take priority even at risk of burdening the advantaged. The commission recognizes that it is irresponsible to advocate equity without acknowledging the need to control costs. Greater equity can be attained only if changes in health care management practices are adopted and if decisions regarding resource use are based on social goals. Thus placing the needs of the poor first may mean a commitment to use less high-cost treatment. The report presents an opportunity to promote a more just health care policy. Catholic health care facilities, for example, can be made models of institutions that have met the needs of the poor, and they can become social justice advocates for government policies that benefit the poor and the disadvantaged.


Report of the Catholic Health Assembly.

Report of the Catholic Health Assembly.


Designing material handling and movement systems.


Perspective: the future of material management in Canada in the 1980s.


Viewpoint: hospital materiel management in British Columbia.


Human factors and industrial design in hospital materiel management.


Group purchasing and shared regional services.


Group tendering on a provincewide basis.


Materiel management--psychology of change: the people aspect.


Central dispatch--human resource planning and implementation.


Profile of a workable distribution system.


Developing a materiel evaluation and standardization committee.


Requirements for development of a computerized materiel management system.


The importance of physician-patient communication.


How should Catholic hospitals allocate ICU admissions?


CEO's challenge: balance fiscal solvency, service to poor. Competitive practices and the prospective payment system are among factors challenging Catholic health care facilities' commitment to serve the poor and elderly and to provide individualized care. To concentrate their mission on services to the marginated and thus alienate other payer groups through inability to compete in either services or price is fiscal suicide. Sponsors and CEOs of Catholic facilities are exploring creative solutions to this dilemma: Revising the mission statement. The facility may restate its goals--e.g., to provide an "adequate" level of care and technology, rather than "the best care possible;" Changing delivery methods to focus on outreach services, ambulatory care centers, surgicenters, etc.; Finding new ways of providing charity care through endowment, trust, foundation, and unrelated business income. Corporate restructuring to generate income and protect the facility's asset base is being widely studied. Because many congregations sponsor several institutions, Catholic health facilities are well positioned to enter multi-institutional systems and participate in networking as a means to save money and to market services. Catholic health care facilities must form a nationwide system of influence in the growing public policy debate about access to and rationing of health care. Before these issues are resolved; Catholic facilities will continue to feel pressure to provide services beyond their means. The chief executive officer has four particular tasks during this period: To use an entrepreneurial approach to generate funds to support the facility's mission activity; To guide the board of trustees to accept multi-institutional arrangements; To raise legislators' and citizens' awareness of the institution's fiscal challenges; To motivate the institution's staff to provide individualized, compassionate care in spite of the depersonalizing effects of DRGs.(ABSTRACT TRUNCATED AT 250 WORDS)


New management strategies help solve unique challenges in terminal care.


In what hospital activities should the personnel department be involved?


One form replaces 20 to help Christ Hospital make more productive use of social workers' time.


Use of a recording device to schedule elective admissions increases productivity.


Budgeting.

Budgeting.


Flame retardants.

Flame retardants.


Private sector overview.

Private sector overview.


Total care of the elderly.

Total care of the elderly.


Replacing flat roofs.

Replacing flat roofs.


Review of human subjects research: options available to the Institutional Review Board.


Eliminate transcribing on nursing units--a time and money saving new approach to ancillary requisitioning. Manual systems for requisitioning services are gradually being replaced with data entry terminals on the nursing divisions. These systems claim greater accuracy and timeliness of response, but the capital investment necessary is oftentimes unwarranted, as well as being cost prohibitive for many hospitals.


Computer services at the Altoona Hospital library.


Patient centered admission: saves time, speeds work flow, evens out work load.


Newark Beth Israel Medical Center: a case history in inner-city funding.


How to make your communication system less costly to operate and generate new sources of income. The concept of one total telecommunications system to serve an entire hospital is not practical. Hospitals should plan toward the establishment of an integrated telecommunications plan and network that would incorporate four or more major telecommunications support systems.


How a car safety seat loaner program furthers community relations and saves lives.


Pennsylvania program aids employers in containing costs of employee health care benefits.


How operating room personnel receive orientation training in SPD.


Patient resuscitation classification system: saves time, improves communication.


Senate passes Amendment to Child Abuse Act regarding treatment for disabled infants.


Quarterly tax report: recent case developments; new tax legislation.


Profitable computer use for nurse staffing.


Stepping back to leap forward.

Stepping back to leap forward.


The shape of things to come.

The shape of things to come.


Non-clinical staff enhance patient care.


Do you know what your lab technologist does?


Cost containment--a management approach.


Get value for your building dollar.

Get value for your building dollar.


Equipment planning--the consultant's role.


Show savings by sharing services.

Show savings by sharing services.


Patient surveys--an administrative tool.


The "wellness" alternative.

The "wellness" alternative.


Computers speed up x-ray room design.

Computers speed up x-ray room design.


Standardization of equipment plans.

Standardization of equipment plans.


Material management: on course for change? Roundtable discussion.


Materials managers, the one-minute variety.


The gift shop volunteer: staffing & training.


Big, bright & beautiful. An afternoon with a hospital gift shop manager. Interview by Judy Rosenfeld.


C. S. the cornerstone of materials management.


Communicate your self.

Communicate your self.


NJHA Council seminar: "shop smarts".

NJHA Council seminar: "shop smarts".


Merchandising collectibles.

Merchandising collectibles.


If you find it difficult to work with volunteers...


Dollars & scents.

Dollars & scents.


Meet the press. How your gift shop can make headlines.


Coney Island hospital gift shop.

Coney Island hospital gift shop.


Absenteeism. The disappearing act. Interview by Barbara Feiner.


Teaching the job to new employees.

Teaching the job to new employees.


August means Christmas planning.

August means Christmas planning.


Display as a selling tool.

Display as a selling tool.


P & T Committee roundtable discussion: Eastern region Pt. II. A series of regional roundtable discussions regarding the successful operation of Pharmacy and Therapeutics (P & T) Committees has been conducted by Hospital Formulary. Representatives from private hospitals; university and teaching hospitals, as well as Veterans Administration medical centers have participated to ensure that different aspects of P & T Committee performance are demonstrated. issues regarding committee profile, constituency, function, and mechanics are discussed, as are criteria for establishing a successful formulary within an institution. The sessions were taped, and the edited transcription is provided in the following article.


What price glory: paid/volunteer? Managers debate the problem. There are many ways of being "paid" for a job well done. Money, however, is acknowledged by our society as the primary, and in many cases only, appropriate form of compensation. Yet many hospital gift shop managers are not paid wages, though they may be producing hundreds of thousands of dollars in sales each year. It's a retailing phenomenon, and worthy of the discussion which follows between managers who are paid with money and those who choose to accept other considerations as payment in full.


Strengthening the formulary system by implementing a drug usage guidelines program. The development and implementation of a Drug Usage Guidelines (DUG) program in a 1,200-bed, federal teaching hospital are described. The program was designed to promote effective formulary control through established procedures for the review and evaluation of drugs submitted to the Pharmacy and Therapeutics (P & T) Committee for addition to the formulary. The procedures required the submission of the DUG and an oral presentation to the Committee prior to any final vote on the request. Anticipated potential benefits of the DUG program are to: (1) stimulate rational drug therapy, (2) provide reliable drug information to the professional staff in a usable format, (3) promote a thorough evaluation of therapeutic agents before approving for formulary inclusion, and (4) provide physician-generated guidelines for use as criteria in drug utilization review audits.


Eleventh District Court rejects Medicare medical malpractice apportionment rule.


The Canadian Dietetic Association brief regarding the Canada Health Act.


Cost containment through P & T committee drug utilization review. Provoked by changes that are occurring in health care, hospitals are currently formulating and implementing strategies to identify and control costs while maintaining the highest quality of care. Because drug costs account for a significant proportion of the hospital supply budget (5 to 10%), there is an increased need for the P & T Committee to become involved in the cost containment effort. This article will demonstrate how an existing program of drug utilization review (DUR) has reduced drug expenses without sacrificing the quality of care or imposing unnecessary restrictions on formulary items. Furthermore, implementation of the DUR program has not resulted in conflict between pharmacy, medical, nursing or administrative staffs within the institution.


A multidisciplinary audit of diabetic care using criteria mapping. A multidisciplinary audit of care delivered to diabetic patients was completed at the Royal Victoria Hospital, in Montreal. The audit of inpatient care was implemented using Criteria Mapping. A Criteria Map is based on decision-making logic and allows use of criteria relevant to individual patients. The Map includes 23 criteria: 18 medical, three dietetic, and one nursing. The charts of 17 patients discharged with a diagnosis of diabetes mellitus were reviewed. A score above 75% indicated that each discipline rendered adequate care. The medical compliance was 78.46%, dietetic 79.17%, and nursing 85.71%. Mean dossier score was 80.62%. The Criteria Map was highly satisfactory as an audit method; the results of the audit illustrated a need for more complete documentation of services, especially in the area of patient education.


Materials managers need to be change agents to achieve centralization goals.


Seeking justice in the real world: a further explication of value contexts. Following a brief clarification of the value assumptions of community mental health and community psychology, the error of assuming that behaviorism is less value based than other theories of man or strategies for doing science is demonstrated. First epistemological and then historical-sociological arguments are presented to show that the contribution of behavioral community psychology to the explication of values is more a function of its association with community psychology and of its relatively recent emergence as a competitor for ascendence in applied psychology than of its idiosyncratic structural characteristics. Finally, an alternative to the view that survival values should be of prime importance to community psychology is offered.


Toward the explication of the value contexts of the community psychologies. Value issues are inseparable from any scientific pursuit and they become particularly influential in the applied scientific areas of community and behavioral community psychology. The explication of value positions is one way of dealing positively with the ubiquity of value issues. The role of values in community mental health, community psychology, and behavioral community psychology are contrasted. Implicit value positions are entrenched in the terminology of community psychology and community mental health theory while theory in behavioral community psychology, because of its functional rather than structural orientation, does not contain the same level of value positions. Traditionally, value positions have been concerned with the quality of life, i.e., what makes up the "good life." However, the worldwide crises of starvation, nuclear armament, and pollution necessitates an orientation to a more fundamental type of value, i.e., survival of the species or the opportunity for life. Through the explication of quality-of-life values, the public and psychologists designing community helping programs can evaluate the compatibility of quality-of-life and opportunity-for-life values.


Community psychologies and values: the importance of being urnless. This paper is a response to the Rappaport (1984) and Attneave (1984) commentaries on the O'Donohue, Hanley, and Krasner (1984) article on the value contexts of the community psychologies. We have focused on similarities and differences between our positions and those of Rappaport and Attneave. We are all in agreement that behavioral community psychology is not value free, a point which is emphasized in our earlier paper. One of our goals was to foster the discussion of value explication and its implications for the community psychologies. The Rappaport and Attneave commentaries, in effect, have accomplished this in an excellent and exciting manner.


Development of an inservice educational program for clinical staff. Inservice education is potentially one of the most effective tools of the clinical engineer. A good technical inservice program can significantly reduce the amount of time engineers and technicians must spend on repetitive, corrective tasks, allowing them to be of greater value to their institutions in more creative ways. A complete technical inservice education program has been designed for the University of Connecticut Health Center's John Dempsey Hospital. To design such a program, one must first assess current inservice practices and any associated problems, as well as the educational needs of the clinical staff. The assessment is done by examining past equipment repair records, and by surveying nurses and other clinicians within the hospital, clinical engineers from outside hospitals, and equipment vendors. A sample program is then carried out to gather additional information and gain the acceptance and support of key hospital personnel. Based on the compiled data, an inservice program is proposed that is streamlined to maintain a desirable level of efficacy without requiring an inordinate amount of time. Quantitative analyses of costs and benefits confirm that the proposed program will have a net positive effect.


Personal support systems of former mental patients residing in board-and-care facilities. This is a study of the personal support networks of a selected group of formerly hospitalized psychiatric patients now residing in board-and-care facilities in Galt, California. Its purpose was to assess the particular forms of support available to such persons and to suggest ways in which short-comings in needed supportive interaction might be remedied. The article first reviews the circumstances of board-and-care placement. It then examines the concept of support systems and their relevance to the health and well-being of individuals. Following this, the findings of a study of 39 psychiatrically disabled persons residing in board-and-care homes in one rural California community are reported. Several recommendations are offered which illustrate two ways in which agency and community services might affect the support available to board-and-care residents.


Lack of stress-health relationships: a base rate problem? The lack of relationship between psychological or social stressors and various health indices is common. This paper presents stress and health data collected from nurses at 10 different hospitals and from food processors at eight different sites. Correlations computed in samples constructed so that the number of people affected by a particular illness is approximately equal to those not so affected were consistently higher than similar correlations computed for the entire sample of 1,934 respondents. Because correlations are affected by the base rate of the phenomenon one is studying, it is suggested that other indices such as simple percentages in affected and unaffected groups are more appropriate.


An alternative reimbursement system to encourage optimum pharmacy services.


Users and "teasers": failure to follow through with initial mental health service inquiries in a child and family treatment center. This article examines the experience of families who contacted a child and family community mental health treatment center, but then did not follow through to receive even one session of diagnosis or treatment at the agency. The paper reports the base rate for this behavior in a large (N = 2,358) sample of cases who either only made inquiry or who received treatment at the agency. The inquiry group, or "teasers," tended to have children who were older than client groups, to have relatively more behavioral and fewer personality problems, to have demonstrated problems earlier than client groups, and to have parents who were slightly older. A follow-up study was conducted with 100 inquiry and 100 client cases. The relative efficacy of telephone and written questionnaire methodologies are compared, demonstrating that the telephone approach was more effective. Client-group children were reported to be only moderately better off at the time of follow-up than the inquiry group, but conclusions about the effects of treatment are limited by the finding that many members of the inquiry group had sought treatment elsewhere after their brief contact with the agency. Implications of this study for community mental health administration and for future research in this area are discussed.


The effects of role preparation for psychotherapy on immigrant clients seeking mental health services in Hawaii. The present study sought to examine the effects of a standard role induction (role preparation) procedure on immigrant patients having their first therapy experience. Thirty immigrant clients who met selection criteria and were seeking treatment at a community mental health center in Hawaii were assigned to either role induction (therapy preparation intervention) or a placebo intervention prior to receiving therapy offered by 10 professional therapists. The effects of the role-induction or placebo manipulation were assessed by a measure of expectancy, satisfaction ratings, and data on premature termination and attendance. Results indicated that the patients who received the role preparation procedure as well as placebo patients had changed their expectations in appropriate ways by the end of therapy. The role-prepared patients, however, became less dependent on their therapist for support, advice, and direction. In addition, the role-prepared patients were more satisfied with therapy, rated themselves as more changed, and dropped out of treatment at significantly lower rates. The implications of the results for service delivery to immigrant patients were examined.


Mealtime meds: a multiple dose medication system.


Caring for regulations or regulating for care?


Managing pharmaceutical services in the long term care setting.


Drugs as a reason for nursing home admissions.


Pain management, drugs and the elderly.

Pain management, drugs and the elderly.


Legal implications of drug errors.

Legal implications of drug errors.


Architecture and long term care. The nursing home corridor.


Development of preventive maintenance procedures. A large number of in-house preventive maintenance (PM) programs, which call for varying degrees of thoroughness in the checkout of patient care instrumentation, are currently in existence throughout the country. This paper discusses the types of preventive maintenance, or PM procedures, which can be used by a clinical engineering department; the rationale for drafting different types of PM procedures in-house; and some long-term considerations affecting hospital-based inspection programs. Three types of PM procedures are described and compared: general checks; generic procedures; and, specific procedures. An outline is provided for writing a PM procedure; and, a call is made for a national guideline for writing preventive maintenance procedures.


Medication use at different levels of care.


Security: protection information resources & media.


Word processing alive and well.

Word processing alive and well.


9-1-1: antidote to amnesia.

9-1-1: antidote to amnesia.


Cutting the fog in Santa Ana. An ambulance study committee.


A significant difference. The 9-1-1 emergency telephone number.


Hyperbaric oxygen therapy.

Hyperbaric oxygen therapy.


When to say no. Eight tips for evaluating ambulance service contracts.


The etiology of loosened connections in hospital-grade plugs. The loosening of terminal connections over time in wired, hospital-grade plugs has been reported. This study was performed to determine the extent of the problem and the cause(s) of the loosening connections. Of 45 hospitals responding to the survey, 15 reported a total of 25 melted plugs. Terminal torques were measured on the plugs of ninety-nine randoMly selected medical devices; 21% of the inspected torques measured zero in-lbs. Static mechanical tests were performed on the plug terminals of five manufacturers. A maximum decrease in torque of 18% was noted over a 6-month period. The combined affects of current cycling and cold flow on the terminal torques were also noted to be about 43% over a six-month period. Loosening torques appear to be more frequently associated with appliances requiring high currents and those that are frequently inserted and withdrawn from receptacles. It is concluded that a serious problem exists with loosened terminals in hospital-grade plugs. Until a design change can correct this screw loosening, maintenance groups have a responsibility to assure adequately low wire-to-terminal resistances. A semi-annual torquing of the plug connections of critical function medical devices should be considered.


The restructuring and evaluation of the patient medical review in New York State. The dramatic increase in the number of elderly persons in the population has led to tremendous increases in the number of nursing home beds; this in turn has made monitoring the quality of nursing home care even more difficult. The authors briefly detail the development of the federally mandated periodic medical review/independent professional review, and discuss how New York State took this program one step further and improved upon it.


In-service education: a model for success. The quality and quantity of in-service education programs offered to staff members of long-term care facilities have long lagged behind that offered in hospitals, medica centers, and other sectors of the health care industry. The authors review the need for, and the problems and benefits of, in-service education in long-term care facilities, and suggest a model program.


Admission procedures in skilled nursing facilities. Little is known about the policies, practices, or procedures that affect the placement of applicants for nursing home care. Toseland and Newman report how financial resources and various forms of physical, mental, and behavioral problems affects the chances that older persons will be admitted to or excluded from nursing facilities.


Microfilm is dead: long live photo/optical image recording.


Purchasing. The front line defense in infection control.


Off-site cart exchange.

Off-site cart exchange.


Information resources management: management focus on the value of information and information work. Progressive management views information resources--all forms of stored data; people as information sources, processors and communicators; information tools--as major assets of companies in the information age. They treat and manage information resources as other valuable resources, e.g. personnel, finances, energy. The unique characteristics of managing information resources are introduced. Approaches toward the introduction of information resources management are outlined.


Impact of reductions in funding on human services programs: a symposium.


City of Faith Medical and Research Center, Tulsa, Oklahoma. The gold towers of the City of Faith command the viewer's attention as they soar into the Tulsa sky. Built by Evangelist Oral Roberts, the City of Faith combines a 60-story clinic and diagnostic center, a 30-story full-service hospital and a 20-story research center on one 80-acre site adjacent to the Oral Roberts University campus. Due in part to their futuristic architectural features, the campus and the City of Faith are one of the top tourist attractions in Oklahoma. Construction began in early 1978. The clinic, first opened in June 1981 with nine physicians, is now staffed with more than 80, all with faculty appointments to the Oral Roberts School of Medicine. The hospital accepted its first patient in November, 1981 and is currently certified for 294 beds (final plans call for a total of 777). The research center began operations last June and focuses on cancer, heart disease, arthritis, diabetes and geriatrics. Built entirely through contributions from followers of the Oral Roberts Ministries, the debt-free City of Faith is expected to cost more than $500 million when completed in 1988.


Management of medical equipment. Selection, use, maintenance and repair.


Outdates. A case study.

Outdates. A case study. In this article, the author describes how her CS department eliminated costly and time-consuming outdates by assessing, in their own facilities, the sterility of properly packaged items over a one-year period. As her conclusions illustrate, one year color-coded expiration dating saves more than money alone--it promotes a more efficient utilization of manpower and facilitates stock rotation.


A visit to Japanese hospitals.

A visit to Japanese hospitals.


Perceived value.

Perceived value.


Nonprofits, federalism, and Reagan social policy.


Reuse of single use medical devices.

Reuse of single use medical devices.


Interorganizational decision-making in response to cutbacks: a case study.


Constraints on government management strategies: challenge to local government and human service managers.


How to establish a creative climate in the work group.


Healthcare cost containment from a hospital's viewpoint.


Work unit culture: strategic starting point in building organizational change.


How to avoid wrongful discharge suits.

How to avoid wrongful discharge suits.


Institutional LMs face challenges. Preparedness is key to job security.


Pounds per patient day are rising.

Pounds per patient day are rising.


EtO sterilization.

EtO sterilization.


Hospital laundry emulates private business, adds manufacturing dept. to cut costs.


Fact, fiction and fantasy.

Fact, fiction and fantasy.


Competition in health care could ruin medical education.


If the feds don't kill health planning....maybe the states will.


What's hiding in that PPO contract?

What's hiding in that PPO contract?


Popular versus technical works in the medical library: a use study.


Will the states put a brake on emergicenters?


Pitfalls to avoid when you discuss fees.


Should you lease your staff?

Should you lease your staff? The prospect of leasing instead of hiring your staff may sound farfetched, even crazy at first, but more and more successful businesses are finding this arrangement best meets the needs of both the organization and the employees. Employee leasing can be a practical remedy for the tremendous financial burden of employee pension costs and bring many other benefits to everyone involved as well. Of course, before such an arrangement is entered, there are important legal, economic, and practical considerations to be made. The innovative idea of employee leasing is explored here in depth, with special focus on the legal angle. Helpful charts are provided which compare the costs of a defined benefit plan and a leasing arrangement.


Peer review: is testifying worth the hassle?


Pumps in medical instruments.

Pumps in medical instruments.


Local area network for the ICU.

Local area network for the ICU.


Doctor entrepreneurs: are they hurting the profession?


Evaluate your employees.

Evaluate your employees. Are the communication and feedback systems in your medical group practice in perfect working order? Is every incident, task, success, and problem handled as it occurs? Though these conditions are desirable, they are only a fantasy in today's working world. Every medical group practice, large and small, needs an employee performance evaluation program to stimulate employees to develop their full potential and let them know that their employer cares. Highlighted in this article are the benefits of a formal, written evaluation plan as viewed from everybody's perspective--the organization, the management, the administrator, supervisors, employees, and most important, the patients.


Involve physicians in marketing.

Involve physicians in marketing. Many everyday problems in medical group practice can be attacked by a marketing approach. To be successful, however, this kind of approach must have the full support of those involved, especially the physicians, since they are the principal providers of healthcare services. When marketing is presented in a broad context, including elements such as patient mix, population distribution, and research, physicians are more likely to be interested and supportive. The members of Geisinger Medical Center's Department of Cardiovascular Medicine addressed their patient appointment backlog problem with a marketing approach. Their method is chronicled here and serves as a fine example of how physician involvement in marketing can lead to a positive outcome.


Creativity and the management team.

Creativity and the management team. What is creativity? Is it an untempered gift found only in a few rare individuals? Or, is it a skill that can be developed in the people who make up your management team? As applied to medical group practice, creativity is a process through which the management team can originate ideas for responding to a complicated environment. To be effective, creativity must be fostered in individuals and in the organization. Drawing from lessons of successful corporations, the author examines the management styles which are conducive to creativity and innovation. Strong team management and proper orientation of new staff members are essential in building a foundation for creativity. To assist medical groups, key elements that are fundamental to fostering creativity in the organization are presented.


CARDIONET: the local area network for the cardiology department.


Was failure due to design or installation?


Medical Electronics buyers guide 1984, Part 3: ECG transmitters/receivers; electronic thermometers; patient scales; pumps, infusion & autotransfusion devices; transient/surge protectors; ultrasonics.


Microcomputers in the laboratory.

Microcomputers in the laboratory.


The right approach to solving problems.

The right approach to solving problems. A review of brain functioning, particularly as it relates to the use of the right brain suggests that this center of creativity is not often tapped. However, when a group of people gather to learn how to tap their creative potential, many difficult problems can be solved. As applied to solving recruiting problems, the use of creative problem-solving techniques can tap the vast potential in a medical group to find new solutions to the problems that never seem to go away. Conducting creative problem-solving sessions requires a skilled practitioner who can draw out the potential in group members. The process is not without some costs, as the authors point out, but the benefits can be well worth the effort.


Downtime: what is the real cost?

Downtime: what is the real cost?


Managing hostility.

Managing hostility. Hostility causes the breakdown of human relationships. In the workplace, it is a frequent cause of the stress which is characterized by anxiety, tension, depression, gross errors in judgment, and mental and physical exhaustion. Hostility has infectious properties, whereby it can easily spread throughout an organization creating factions and seriously impairing operations. Because medical group administrators face hostility from a variety of sources--doctors, employees, and patients and their families--they must learn to recognize hostility for what it is, and to manage it. Having researched the subject extensively, this well-published author has developed a method known as anti-hostility which not only aids in our understanding of the origin of hostility, but also provides a means for ridding ourselves and others of the disorder.


Burnout--when the doctor's bag gets heavy.


Forging a vital link in group operations. Medical secretaries play a vital role in group practice; and for maximum productivity, it is essential that they be adequately trained. At the Scott and White Clinic in Temple, Texas, a thorough examination was conducted of the medical secretary training program. Based on this, a more formal program was developed which included a series of self-directed, competency-based learning modules with built-in program effectiveness monitors. The result of strengthening this one link in the chain of group operations has been not only better qualified and happier secretaries, but also, increased overall productivity. This article contains the key to developing, introducing, implementing, and evaluating a successful medical secretary training program in your group practice.


Medical groups' suit seeks to put legal padlock on 'Baby Doe' reg.


Continuing medical education. The bandwagon loses some riders.


Buy, lease, or rent: which way to go under DRGs?


In search of an analyzer: sifting through the offers.


Exploding some myths about merit pay.

Exploding some myths about merit pay.


Compromise law passed to protect seriously ill Faith Assembly children.


Changing directions and roles in the lab.


A practical guide to instrument selection.


Guidelines for laboratory administration--Part III.


Electronic spreadsheets help hospitals pinpoint crucial costs.


Micro users must meet rigid guidelines to tap data bases.


Flexible microcomputer networks meet hospitals' changing needs.


New marketing strategies boost group practices' patient volume.


Statistics reveal steady growth in number and size of practices.


10 guidelines for success of hospital-physician partnerships.


Hospitals soak up bargains in pools of tax-exempt debt with floating rates.


Court cites 'paternalistic' Baylor for discriminating against Jewish M.D.s.


Legislation would shield PPOs from antitrust laws.


Proposal to sell SamCor is 'on the slow track'.


Strike accelerates shift of patients to outpatient services in Twin Cities.


Foundations are sowing seeds for change in healthcare system.


21% lack regular family physician; more men, youth in untapped market.


HCA/Lovelace deal signals trend.

HCA/Lovelace deal signals trend.


Re-inventing the wheelchair. Innovations in design and construction are giving the disabled a new-found sense of freedom.


Hospital's ads stress its worldwide renown.


HIDA addresses device alerts. Industry Distributors Association.


Consignment holds allure for hospital purchasers.


COPAC/Mid-America merger creates largest U.S. buying group.


No-fault physicians.

No-fault physicians.


On target. On the move. Continuing Care Associates, Inc.


Look for legal pitfalls in pacts with hospitals.


The concept of hospital corporate planning.


The capital formation environment of the 1980s.


The administrative role in planning.

The administrative role in planning.


Situational moderators of leader reward and punishment behaviors: fact or fiction? One assumption shared by many contemporary models of leadership is that situational variables moderate the relationships between leader behaviors and subordinate responses. Recently, however, R. J. House and J. L. Baetz (1979 in B. Staw & L. Cummings, Eds., Research in Organizational Behavior (Vol. 1), Greenwich, Connecticut, JAI Press) have suggested that the effects of some leader traits and behaviors may be relatively invariant; that is, have the same effects in a variety of situations. One possible class of leader behaviors which may have relatively consistent effects across situations are those known as leader reward and punishment behaviors. The first goal of the research reported here was to increase our understanding of the relationships between leader contingent and noncontingent reward and punishment behaviors and subordinate responses. Contingent reward behavior was found to have the most pronounced relationships with subordinate performance and satisfaction, followed by noncontingent punishment behavior. Neither leader noncontingent reward nor contingent punishment behavior were found to be related to either subordinate performance or satisfaction, with the exception that noncontingent reward behavior was negatively related to subordinates' satisfaction with work. The second goal of the research was to examine the effects of a variety of potential moderators on the relationships between leader reward and punishment behaviors and subordinate responses. The results of this study suggest that the relationships between leader reward and punishment behaviors and subordinates' performance are relatively free of moderating effects.


May a creditor create a third-party collection agency?


Containing costs in the blood bank by reducing unnecessary crossmatching. The author proposes that the maximum surgical blood order schedule (MSBOS) can serve as a paradigm for test reduction systems in other clinical laboratories. He begins by reviewing briefly the development of crossmatch reduction systems in hospital blood banks, explaining why they have been widely accepted, and he suggests later that the number of type and screen tests performed can also be reduced as part of the effort to curb unnecessary testing. Finally, he proposes some qualitative changes in the way the type and screen is performed, including the "clinical antibody screen" and the "modified antibody screen."


Quality control in the blood bank: how much is too much? An aid or an end? The author recalls how blood bankers lost sight of the purpose of quality control, and viewed it not as a tool but as an end in itself and a goal for the laboratory. He discusses some concepts of the quality control measures that should be followed today and pinpoints shortcomings.


CAP launches management seminars for residents.


Institute of Medicine reviews for-profit trend in health care.


A microcomputer-based clinical microbiology and epidemiology system in a community hospital. The author describes the structure of a comprehensive microcomputer-based microbiology and epidemiology system as implemented in a 150-bed community hospital. The article illustrates how the program provides more efficient, cost-effective, clinically relevant microbiology laboratory reports to clinicians. The author hopes the following discussion will lessen the reluctance of small laboratories to introduce microcomputers into the laboratory.


Process control systems--a question to be answered.


Philosophy and quality control. Workload recording--why your laboratory should be in the data bank. The CAP Workload Recording (WLR) Method is the only widely accepted and validated method for recording laboratory workload. Here, the author details how unit values are assigned, how and by whom the data are used, how to quality control the data, and why an adequate comparative data base, such as the CAP Computer Assisted WLR Program, is so important to laboratories.


American Board of Pathology answers questions about certification requirements.


Benefits. 26 ways to reduce medical insurance costs.


What every personnel manager should know about computers.


How our mobile cart enables us to implement decentralized Rx services.


Trends in clinical practice: an analysis of competencies. This study was designed to re-evaluate a comprehensive list of competencies for professional physical therapy practice that was developed, edited and field-tested three years ago. At that time, a representative population of physical therapy clinicians practising in the province of Quebec had rated 224 competence statements as to the respective levels of importance within their own professional practice. A smaller sample of these same physical therapists was again surveyed, three years later, for their reaction to the list in relation to clinical practice today. Of this group, 23 were still staff therapists and two had become administrators. The response rates indicate changes in treatment patterns with regard to cardiorespiratory conditions, electrotherapy, and prevention and maintenance programs. The changes in response rates, noted in the category of administration, can be attributed to the change in position of the two physical therapists who had become administrators. As shown in the previous study, there is still little evidence of research-related activities being carried out in the clinical field. This re-evaluation was undertaken in order to ascertain if there were changes in clinical practice occurring over time and whether or not these changes could be related to a change of position.


Observations on the use of music in rehabilitation of stroke patients. A preliminary investigation was initiated to explore the use of music as a means of improving general mobility, social interaction, and emotional stability in patients who have suffered a stroke. A literature search had revealed very little information on the use of music in the rehabilitation of such patients. The investigators videotaped a series of sessions involving group movement-to-music, group music-making, and individual movement-to-music. An individual case study in music-making was carried out as well. All videotapes were reviewed and we observed that an increase in the range and ease of movement of the patients occurred during weight-shifting activities, when appropriate music with a tempo of 58 to 63 beats per minute was used. Our observations supported the findings of recent research concerning preferred tempi for certain activities and reinforcement of movement by appropriate tempi. Other factors in our study, such as size of group, placement, cueing, and the opportunity to touch, appeared to affect the responses obtained in group situations. As the result of our observations, we have concluded that music enhances the general mobility and social interaction of patients who have sustained a cerebrovascular accident and that it may also improve a patient's emotional stability.


Effectiveness of teaching interviewing and communication skills to physiotherapy students. Recognition of the importance of effective interviewing and communication skills, and the concomitant need to teach such skills to students in the helping professions are both relatively recent phenomena in rehabilitation medicine. The purpose of this study is to evaluate the impact of the model developed at the Institut de réadaptation de Montréal (IRM model) in the teaching of interviewing skills to physiotherapy students in the clinical setting. Twenty-six final-year physiotherapy students were assigned to two groups of 13 each, one of which received structured training in interviewing skills over a four-week period while the other received no specific instruction. Analyses of the appraisals of pre- and post-test student-patient interviews--the appraisals having been done not only by the students themselves, but by the patients and the independent raters--showed that scores on each evaluation improved significantly following the students' training program. The group receiving no training showed no significant improvement. The authors conclude that a short clinical training program using the IRM model can be effective in improving the interviewing skills of physiotherapy students.


Too many volunteers? Materials that brought them in.


Industrial medical technicians. Packaging and franchising a needed program.


A training program for operation of a head-controlled electric wheelchair. A biofeedback training device providing auditory and visual feedback regarding head position in space was used to teach the head control necessary for the operation of a head-driven electric wheelchair. A case study of an adolescent with severe athetoid cerebral palsy is presented. The training program consists of four short-term goals: to provide trunk stability; to promote limb and postural control; to teach static head control; and to teach dynamic head control. The authors found that the biofeedback training device was a useful tool for teaching the head control required to operate a head-driven electric wheelchair. Among the recommendations discussed in the conclusion of this paper is the suggestion that certain pieces of equipment, such as a time-event counter and videotape equipment, would be very useful tools for collecting objective information about the patient's progress.


Promoting via radio PSAs.

Promoting via radio PSAs.


A change for the better. Redesigning a physician newsletter.


Patient book.

Patient book.


Airing wellness (and illness). Building image with professional programs.


Sweetening the market share.

Sweetening the market share.


Revising a patient handbook.

Revising a patient handbook.


The Grundel that ate Cleveland.

The Grundel that ate Cleveland.


Finding the fifth "P".

Finding the fifth "P".


No emergency room.

No emergency room.


Hospital calendar with a bonus of schools.


Physician referrals.

Physician referrals.


Cabbage Patch dolls receive staff appointments.


Volunteers, grandmothers and kids.

Volunteers, grandmothers and kids.


Economic awareness.

Economic awareness.


T. Bears plan invasion of American hospitals.


A wellness map for children.

A wellness map for children.


How can I use electronic advertising media more effectively?


Supervisory safety training.

Supervisory safety training. Supervisory Safety Training is one very important aspect of a complete safety effort. If done efficiently, it enables the supervisor to understand and fulfill his/her vital role as the company's front line safety representative to the workforce. However, in order to do this job effectively, a great deal of careful planning must precede the development of the training program used.


OSHA news. New ethylene oxide standard.

OSHA news. New ethylene oxide standard.


Helping to choose a nursing home.

Helping to choose a nursing home.


The future of human services. Pulling together or tearing apart.


Hazard communication in the workplace.

Hazard communication in the workplace. Hazard communication is made up of several basic concepts and key elements. The concepts of risk management, product information, documentation, employee training and compliance are individually discussed providing a basis for developing a program. An important part of any program is effective implementation. One key element, the Material Safety DAta Sheet (MSDS), is used to illustrate the preparation, review, and distribution of hazard communication information. Guidance is given to adapting the MSDS model to the other key elements of purchased products information, special warnings, toxicology summaries and technical bulletins.


Noncompliance in clinical medicine.

Noncompliance in clinical medicine.


Child sexual abuse: effective case management by a multidisciplinary team.


The art of consultation and referral.

The art of consultation and referral.


The importance of confidentiality in a private practice setting.


Analyzing results of the 1983 cost-of-risk survey.


IRS denies exemption to hospitals' SI trust.


Dovetailed medical plans offer tax favored benefit option.


Resurrecting the art of risk control.

Resurrecting the art of risk control. The author defines risk control as the process of minimizing accidental and other extraordinary losses by anticipating and preventing unplanned events. Loss control, on the other hand, is defined as the process of minimizing accidental and other extraordinary losses by containing unplanned events after they occur. By these definitions, many people who think they practice risk control are actually practicing loss control. A few people who practice loss control are actually practicing risk control.


The experience of sponsoring a parents anonymous group.


Opening the closed doors: the duty of hospitals to treat emergency patients.


Needs of female patients in a veterans psychiatric hospital. The psychiatric and medical care of female veterans is reviewed in this report of 69 interviews at a veterans psychiatric facility. The data suggest that female veterans are satisfied with care in general but are less satisfied with certain gender-related components of care. The author reviews the facility's responses to the findings of the study and makes further suggestions for change. The rising proportion of women in the armed forces makes health care for this group an important issue.


Building alliance between the family and the institution. A social work model for building a family-institution alliance as distinguished from a therapeutic alliance is presented. The model is based on a conceptualization of the family's needs at four successive stages in the early period of its relationship with the institution, beginning with the family's decision to admit a family member and concluding with an assessment of the type of therapeutic alliance indicated for the family. A review of the pertinent literature is also presented.


Aligning for survival: Sante Fe healthcare systems.


Self-help and the elderly.

Self-help and the elderly.


The coercion of labor by mental health professionals.


Cancer treatment at Baptist Hospital in Miami.


Fund-raising at the workplace.

Fund-raising at the workplace.


Improving productivity in the health care institution.


The key to successful psychiatric programs.


Rare-earth imaging.

Rare-earth imaging.


Infection control. Managing needlesticks.


Preparing for the challenges. Future perspectives from THA's new chairman.


Georgia Heart Clinic: cardiac rehab in a rural setting.


Regional not-for-profit systems: can they compete with national investor-owned firms? The relative competitive advantages of regional and national systems are summarized in Figure One. As illustrated, each type of system has unique competitive advantages at the corporate level. While it is difficult to state that either system has distinct advantages that place it in a superior position relative to the other, it seems that in the short-run investor-owned systems have operating characteristics that may result in more efficient internal functioning because of more centralized control over resource allocation and performance systems, greater possibilities for economies of scale, and greater access to capital. However, it was previously noted that growing pressures from government and the business community will lead to tighter constraints on the profitability of investments in the health care sector. The possibility of this shift suggests that the access to capital advantage enjoyed by investor-owned systems may not continue. Additionally, regional systems that are part of larger affiliated organizations such as the Sun Alliance and the Voluntary Hospitals of America are developing means to pool their access to debt funds, thus reducing the cost of capital for member institutions. The group purchasing contracts developed by these large systems also have resulted in significant savings. The distinction between regional and national systems on centralized control are becoming less pronounced. Investor-owned systems are seeking to determine how they might best decentralize selected decisions to be more responsive to local markets while not-for-profit regional systems are recognizing that they must centralize selected decisions to obtain more efficient, rational operation. The long-run outlook suggests that the competitive advantages that have been identified will become less pronounced and that both systems will survive in the marketplace.


Results from the 1983 survey of surgical technologists.


Leverage through knowledge. Part 1.

Leverage through knowledge. Part 1.


The impaired staff physician.

The impaired staff physician.


Too little aid for AIDS.

Too little aid for AIDS.


Computers in health care: microcomputers are appearing all over hospitals.


Liability for peer review and privilege suspension.


Interchange: developing an HMO.

Interchange: developing an HMO.


To buy or not to buy technology: applying the new formulas. Because hospitals are under increasing pressure to contain costs and yet continue to provide high quality patient care, trustees must be able to make cost-effective technology acquisition decisions. The author discusses the major factors that affect technology purchasing decisions, from information gathering to internal considerations such as financial constraints and the hospital's long-range goals. He also examines the expected effect of prospective pricing on technology management and decisionmaking.


Equipment purchases: getting the answers to "how much will it cost". Today, capital equipment purchasing decisions can no longer be based simply on price. Governing boards, in evaluating such requests, need to be aware of such factors as life-cycle costs, space and utility requirements, and projected market need.


The shifting roles of CEOs and trustees. Recently, the American College of Hospital Administrators (ACHA) competed studies on both the evolving role of the hospital CEO and how CEO performance is evaluated. This is the first of a two-part series of articles based on those studies. In this first article, the authors review the historical roles of both CEOs and trustees, how those responsibilities differ today according to the type of institution, what CEOs see as their ideal role, and the guidelines for action that the ACHA recommends for CEOs as a result of its study. The second article, which will appear in the August issue of Trustee, will focus on the ACHA's study of how CEO performance currently is being evaluated, what factors are included in such evaluations, who is responsible for them, how they are being conducted, and how to make the CEO evaluation process more deliberate, measured, and fair.


Becoming a trustee.

Becoming a trustee.


As I see it: political expertise.

As I see it: political expertise.


Marketing: handle with care.

Marketing: handle with care. Because hospitals offer the public a unique product--health care--they must be extremely careful how they market their services. The authors discuss current attitudes toward health care marketing and the ethical considerations that must temper the marketing strategies of voluntary, not-for-profit hospitals.


Positioning marketing in the hospital's power structure. Although hospitals are increasingly recognizing the importance of marketing, many have difficulty assimilating what has been primarily an industrial concern into a health care environment. The author explains the function of marketing in health care, the outlook and expectations of a good marketing executive, and why hospital management and the medical staff may have difficulty accepting marketing and the expectations of the marketing executive.


Structuring a bonus program.

Structuring a bonus program.


Rethinking your capital strategies.

Rethinking your capital strategies.


Radiation exposure to the surgical technologist.


CEO evaluation in the 1980s. Part 2.

CEO evaluation in the 1980s. Part 2. This is the second of two articles on how to evaluate CEO performance. (The first article, which discussed the evolving role of the CEO, appeared in the July issue of Trustee.) Using a recent study by the American College of Hospital Administrators, the authors discuss the evolution of CEO evaluation and present some steps that boards and CEOs can take to make the process more deliberate, measured, and fair.


Facility-owned stable is the center of activity.


Controlling food service costs.

Controlling food service costs.


A trustee views the pros and cons of a hospital management contract. A hospital trustee describes the circumstances behind his hospital's decision to enter into a management contract, the criteria the board established for the selection of a management firm, and the problems and successes that have resulted from the hospital's management contracting decision.


In search of a balanced capital base.

In search of a balanced capital base.


HMOs for the elderly.

HMOs for the elderly.


As I see it: a hospital is a hospital.

As I see it: a hospital is a hospital.


Feeder aides ease work load; perk up residents.


VA defends secrecy in review; MD sues, facing 'gag order'.


Rationing care justified medically.

Rationing care justified medically.


NIH: inside nation's top health lab.

NIH: inside nation's top health lab.


The importance of staff involvement in volunteer program planning.


How to match volunteer motivation with job demands.


Federal programs facing stresses.

Federal programs facing stresses.


Services tailored to aged patients.

Services tailored to aged patients.


Considering the many facets of volunteer/union relations.


Perspectives. Business gets tough on costs.


Guideline aim is to reduce imaging rates.


Pre-admission review: context and content.


Baltimore's experience in pre-admission review.


Baltimore: traditional programs and a response to emerging needs of public health.


Sensible approaches for trying times. Medicine and health care.


Violence and trauma: priority public health problems.


Memphis: the status of public health issues and programs.


Who cares for the ineligible?

Who cares for the ineligible?


Detroit: major public health concerns and a look toward the 'nineties'.


Hospital care for the medically indigent in Oklahoma City.


Comprehensive community care for the chronically mentally ill in an era of deinstitutionalization.


Interorganizational cooperation and decision making autonomy in a consortium multihospital system. This paper discusses interorganizational relationships within one type of multihospital system, a consortium. Reasons for the development of this type of system are presented. Hypotheses are proposed explaining how the general strategic-level decisions of hospitals may be influenced as a result of consortium affiliation.


Program profiles. Elderly problem drinkers and alcoholics.


Toward improving treatment services for alcoholics of advanced age.


Detection of gynecologic cancer in urban communities.


Education and practice: is competency-based education closing the gap? This paper reviews Competency Based Education, CBE, defining competence as a complex network of knowledge, performance and attitudes. It reviews methods for competency identification and validation, emphasizes assessment at all learning levels, highlights proponents' and opponents' views, points out possible legal implications and makes recommendations for the administration of CBE programs.


Perspectives. Intervention and treatment of elderly alcoholics and problem drinkers. Interview by Millree Williams.


Practice patterns of Doctor of Pharmacy graduates: educational implications. The purpose of this study was to evaluate the appropriateness of the predominantly clinical PharmD curriculum in light of actual employment patterns of PharmD graduates. Data were gathered via a survey of PharmD graduates from the seven post-baccalaureate programs active since 1972. Respondents were asked about their employment patterns and characteristics; about their formal education in the areas of management, statistics, and research methods; and to indicate whether they had completed residencies or fellowships. The results indicate that many PharmD graduates are employed in positions requiring considerable nonclinical skills, especially management skills. The results further indicate that few respondents have completed formal education, residencies, or fellowships which would prepare them for management or other nonclinical positions. Consequently, it appears that PharmD programs should require considerably more management training and education in order to adequately prepare their graduates for the positions open to them.


Poison control center liability.

Poison control center liability.


Educational programs offered by colleges of pharmacy and drug information centers within the United States. The purpose of this investigation was to determine the scope of drug information educational programs offered by formalized DICs and colleges of pharmacy to pharmacy students. Data were collected from surveys mailed October and December 1982 to 120 institutions known to be active in disseminating drug information as well as the 72 colleges of pharmacy located in the United States and Puerto Rico. A total of 109 questionnaires (91 percent response rate) were returned from the DICs, and 67 questionnaires (93 percent response rate) were returned from colleges of pharmacy. Seventy-four of the DICS and 63 colleges of pharmacy indicated that they provide required and/or elective didactic or experiential drug information training for pharmacy students. These experiences were offered predominantly to fifth year baccalaureate candidates and PharmD candidates. Thirty-two colleges reported that drug information training is a required component of baccalaureate externship-clerkship experiences although most students receive fewer than 40 hours of training. Forty-seven DICs and 20 colleges are affiliated with ASHP approved residency programs. The amount of drug information exposure each resident obtains was highly variable. This survey indicates that many of today's pharmacy students may not be receiving sufficient drug information training to respond to the drug information needs of other health professionals and the lay public.


More on cost containment. Part II.

More on cost containment. Part II.


Public health in San Francisco: "increasing demands for relevant services".


Description of a skills oriented health ethics program. Continuing change requires that the primary goal of ethics education be the development of competencies to address changing ethical issues. To develop the skill of critical ethical thinking, a two component model was developed. The first component is a two semester hour course in ethical theory. This component is analogous to the theoretical component of a science curriculum and it emphasizes that ethical theory, like scientific theory, is held hypothetically, subject to revision and replacement as it develops in response to "data." The other component, a one semester hour course in health ethics, is designed as the "laboratory" in which theory interacts with ethical problems in health-care situations. Skill development takes place by requiring students to find and defend solutions to ethical dilemmas by applying and refining ethical theory. the ethical issues addressed include but are not limited to current issues in pharmacy. The ongoing evaluation of this model by external evaluators from the funding agency, local consulting faculty, and students has consistently emphasized the value of concrete involvement in cases concomitantly with the exposure to ethical theory.


WMA public relations.

WMA public relations.


Medical ethics declarations.

Medical ethics declarations.


The financing of NMR equipment.

The financing of NMR equipment. Cost-containment regulations and possible legislative changes in the tax area are creating new environments for the acquisition of nuclear magnetic resonance (NMR) systems. Shared services, management groups, and free-standing clinics are being established. Creativity in financing will be required to assure the cost-effectiveness of NMR services.


Facility report. Department of Medical Imaging and Radiological Sciences at Vanderbilt University. This department is presented as an academic prototype to meet the health care and research challenges of the next decade. Composed of four separate divisions (diagnostic radiology, radiation oncology, nuclear medicine, radiologic sciences) with appropriate sections, it is organized according to the concept of an integrated basic science-service facility.


Is small beautiful if it isn't viable? The case of nursing homes. The optimal size of nursing home is examined in the light of overseas and Australian research evidence. The economic optimal size nursing home was found to be in the range of 45-55 beds for a sample of proprietary New South Wales homes in 1978-9 where average weekly expenditure per bed was minimised. However, this did not take into account a number of other important social and environmental factors as well as costs of travel and the quality of care provided or the characteristics of patients. When these factors are considered, evidence suggests that larger than average homes have the economic advantage. Smaller adapted residences, or those incorporating group living design, may be more homelike for residents but at slightly higher cost. Thus there is unlikely to be one single optimal size of home but rather a range. The final selection of scale is therefore a matter of striking a compromise between these and other factors in each situation.


A new way to fund public hospitals.

A new way to fund public hospitals.


Hospital smoking policies in Victoria: no improvement since 1980. A study of 132 hospitals in Victoria, of size 50 beds or more, was carried out during 1983 in order to find out their smoking policies so that assistance could be given to the Health Commission of Victoria in formulating policies about smoking in hospitals. The results were not encouraging; there had been no significant improvement in attitudes towards smoking or in non-smoking policies since a comparable study was carried out in 1980, indicating that there is much work to be done within hospitals in this field.


Interview with Dr. Sidney Sax. Visiting Fellow, Department of Political Science, Research School of Social Sciences, Australian National University. Interview by Jonathan Tribe.


Psychosociobiological decompensation (PSBD) in health services administrators: an historical oddity. Text of a videospeech.


Survey of discharge efficiency in a major teaching hospital. This paper reports the results of a one week survey of discharge efficiency in a major teaching hospital in New South Wales. All discharges during the survey week were analysed to determine the reasons for delays. THe results indicate that delays are due principally to slow turnaround in delivery of discharge medications (where required), delays by nursing staff in ordering discharge transportation, and tardy arrival of discharge transport once ordered. The paper describes follow-up action taken to reduce delays.


New health service strategy.

New health service strategy.


Hospital sets standards of neighborliness and quality.


Radiology equipment maintenance in a smaller hospital.


Using pen and ink.

Using pen and ink.


Quality control in diagnostic radiology at Mayo Clinic. During the past five years in the department of diagnostic radiology at Mayo Clinic, a quantitative quality control program has been developed and expanded. Its goal is to assure consistent image quality while minimizing exposure to radiation and reducing costs wherever possible. The key to the program is the collection of quantitative data, ie, each parameter is evaluated by an objective, not a subjective, measure which is accurate and repeatable even if the measurement is made by various persons. Operating levels and control limits have been established for all measurements, with the control limits set so changes are quantitatively noted before changes occur in the images presented to the diagnostic radiologists.


Video at every step. A Florida knee center offers patients a number of unique services--including tapes of their own surgeries.


Speeding information exchange. Two systems expedite information transmission both within and beyond institution walls.


CanSur: from acronym to actuality.

CanSur: from acronym to actuality.


HMOs: injection of competition.

HMOs: injection of competition.


The American Joint Committee on Cancer.

The American Joint Committee on Cancer.


Tumor registries: a hospital's assurance of quality patient care.


Dr. Hanlon reflects on 15 years of challenges and changes. Interview by Heinz R. Kuehn.


Prescription for cheap drugs. Congress aims to encourage generic alternatives to brand-name medicines.


Troubled hospitals: poor patients or management?


Managing medical costs through small area analysis.


Consumers' group asks: "Whose life is it anyway"?


The labor factor.

The labor factor.


HMO competition for Wisconsin's state employees.


Illinois saves through reducing nonacute hospital care.


For-profit hospitals' success keyed to capital, says Howard. Interview by Jane Stein.


Federal investment needed to establish appropriate norms for health care.


Florida blends competition with regulatory safety net in landmark legislation.


Reviewing performance appraisal policies can lead to improved worker health.


Exclusive contract case sets important antitrust precedent, considerations.


Community resources provide small business with health promotion options.


Cost issues underscore need for long-term planning to avoid "chaos".


Grants for nurse practitioner traineeship programs--PHS. Interim final regulations. These regulations set forth requirements for grants to schools of nursing, medicine, and public health, to public or nonprofit private hospitals, and to other public or nonprofit private entities to meet the costs of traineeships for training nurse practitioners. A trainee must sign a commitment with the Secretary to practice full-time as a nurse practitioner in a primary medical care health manpower shortage area, designated under section 332 of the Public Health Service Act (the Act), for a period equal to 1 month for each month of traineeship support, after completion of the training. If this obligation is not fulfilled, a trainee must pay back traineeship support. The purpose of these regulations is to respond to the comments on the 1980 interim final regulations and to conform 42 CFR Part 57, Subpart AA, with the Paperwork Reduction Act of 1980, Pub. L. 96-511, and with the Omnibus Budget Reconciliation Act of 1981, Pub. L. 97-35, which requires, among other provisions, that the Secretary provide, by regulation, for the waiver or suspension of the repayment obligation under certain conditions. In addition, other minor changes have been made and Office of Management and Budget (OMB) numbers are cited in those sections which have approved reporting and recordkeeping requirements.


Health care for the uninsured.

Health care for the uninsured.


Designation of health services areas and health systems agency application information--HRSA. Notice designating health services areas in Ohio. This notice is issued to announce the establishment of ten health service areas for the State of Ohio and to provide information on the application procedures to become a federally designated and funded health systems agency.


Medical facility construction and modernization--PHS. Final rule. Sections 603(b) and 1620(2) of the Public Health Service Act require the Secretary to prescribe by regulation general standards of construction, modernization, and equipment for projects assisted under Title VI and Title XVI, respectively, of the Act. Since the Title VI and Title XVI grant and loan authority have expired, there is no need to retain the standards in regulations. Projects for which applications were approved or grants awarded under Titles VI and XVI, but for which full project reimbursement has not yet been made, will be subject to continuing compliance with the "Minimum Requirements of Construction and Equipment for Hospital and Medical Facilities" as incorporated by reference in 42 CFR Parts 53 and 124 at the time of initial approval. This Rule amends Part 124 of Title 42, CFR, by removing provisions relating to minimum standards of construction, modernization, and equipment of hospitals and other medical facilities. Similar provisions in Part 53 were deleted earlier.


Privacy Act of 1974; report of altered system of records and new routine uses Privacy Act instructions--SSA. In accordance with the Privacy Act (5 U.S.C. 552a(e)), we are issuing public notice of our intent to make changes to the system of records entitled "Master Beneficiary Record (MBR), 09-60-0090." These changes are prompted by implementation of provisions of Public Law (P.L.) 98-21 (the Social Security Admendments of 1983, hereinafter referred to as the Amendments). We are amending the categories of individuals covered by the MBR to include individuals (nonclaimants) whose former spouses apply for or receive benefits based on their earnings and the categories of records in the MBR to includes data relating to the amount of tax withheld on the benefits of nonresident aliens. Additionally, we are proposing to establish new routine uses of MBR data in accordance with 5 U.S.C. 552a(b)(3). The proposed routine uses provide for disclosure to the Department of the Treasury for determining the Federal tax liability on Social Security benefits and, as necessary, to deposit in the Social Security Trust Funds the tax withheld on the benefits of nonresident aliens. We also are making minor revisions to the MBR notice. We invite public comments on this publication.