Six steps for establishing a successful health promotion program. Well-designed health promotion programs meet a variety of long- and short-term hospital commitments to: 1. Hospital employees. For hospital employees, making health promotion part of the strategic plan puts the hospital in a leadership posture, serving as a role model within the community. 2. Businesses. Health promotion helps decrease health care costs and impacts favorably on the bottom line by increasing productivity through a reduction in absenteeism. 3. Medical staff. The time a physician spends getting a patient to lose weight or stop smoking is generally not cost effective. However, offering health promotion programs gives the physician a "prescription" that can be issued to patients allowing more productive use of physician time. 4. Community residents. Offering health promotion activities to community residents can only improve the health of the entire community. As one hospital administrator stated in a conversation with the author, "When they walk in the front door for a health promotion program and have a positive experience with a quality program, we know that they, their friends, neighbors and business associates will all think of us at other times." 5. The Board of Trustees. Dr. William L. Weis, C.P.A., an associate professor at Seattle University estimates that an organization's "annual cost per smoker" represents a loss of approximately $4,611. Offering health promotion programs provides an excellent way to aid the hospital's cost containment and productivity efforts. Should health promotion activities be part of your strategic plan? By utilizing the six phased-in steps outlined here, it is possible to maximize the opportunities while minimizing the risks typically associated with starting up a health promotion program.


What does a bar of soap have to do with health care marketing? In today's competitive health care market, product/service marketing will become the key to survival. This article introduces a new way of using an established marketing concept. Product/service marketing is based on promoting services that fulfill a number of requirements, including being highly visible and a foundation for the later development of an overall marketing plan. Choosing the products/services to be marketed and developing the marketing program are discussed.


A successful physician marketing program. Cardinal Glennon Memorial Hospital for Children in St. Louis is the site of an active and successful physician marketing program. Through two specific programs, one directed at private physicians on staff and the other at referring physicians outside of St. Louis, Glennon has realized many benefits, including increased utilization. Glennon's marketing program and specific marketing techniques are detailed here.


Land sales. Law of the land.

Land sales. Law of the land.


Fire precautions. Foreground to a fire.

Fire precautions. Foreground to a fire.


Personnel management. Cuckoo in the nest.


Joint planning. The missing element.

Joint planning. The missing element.


Patient participation. Much like an elastic stocking.


Social work. Clients' consumer rights.

Social work. Clients' consumer rights.


Manpower planning. Occupational hazards.


Griffiths inquiry. Will 85 per cent principle work?


Communications. Tackling problems.

Communications. Tackling problems.


Health education. Oiling the publicity machine.


Selling of the private sector.

Selling of the private sector.


Centre Eight: medical architecture. Medical Architecture Research Unit.


Griffiths Report. Waiting for the call.

Griffiths Report. Waiting for the call.


On the spot advice.

On the spot advice.


Whose finger on the audit button?

Whose finger on the audit button?


Cleaning services: trading places.

Cleaning services: trading places.


Self-help begins in the home.

Self-help begins in the home.


Cleaning services: waiting to clean up.

Cleaning services: waiting to clean up.


Catering management: savings on a plate.


When does a resignation become a dismissal?


Danger: NHS at work.

Danger: NHS at work.


Hazards at work. Planning to cut a string of perils.


Rural services. Half way hospital.

Rural services. Half way hospital.


Land--the jewel in the crown.

Land--the jewel in the crown.


Dual key health aids.

Dual key health aids.


Chicago's hospital crime busters.

Chicago's hospital crime busters.


Birth of a district plan.

Birth of a district plan.


Unit management. Coming to terms with realities.


Planning without panic.

Planning without panic.


How to beat the burn-out.

How to beat the burn-out.


Turning the member into an expert.

Turning the member into an expert.


Scant sources of learning.

Scant sources of learning.


Centre eight student update. Major developments in the NHS over the last year.


Mental health services. Planning a change for the better.


Griffiths report. Ironing out the differences. Interview by Peter Merry.


Birth of a social work specialist.

Birth of a social work specialist.


NHS resources. But is it value for money...?


America's bedside bills.

America's bedside bills.


Crown cars for community care. Association of Health Service Treasurers.


Appraise me, please! The plight of young administrators in the NHS.


Oh no--not appraisal again.

Oh no--not appraisal again.


Networking--the neglected resource in training and development.


Once more with feeling: the Griffiths Report and personnel.


The manpower performance indicators.

The manpower performance indicators.


Interview with Sir John Donne, Chairman of the NHS Training Authority.


Health care industry salary figures show anesthesiologists as highest-paid.


Home health care of AIDS patients instills unneeded fear in personnel.


Five million Americans are in need of home health care, say HHS estimates.


N.Y. elderly abuse program focuses on problem-solving.


The expansion of respiratory therapy into home health care is new, long overdue.


Health and Human Services Secretary Margaret Heckler talks home health.


AARP survey shows Americans support alternative health care.


Intermediary representative misinforms provider, U.S. Court of Appeals judge's decision may change view on 'little guy vs. big government'.


Duplication in medical records is a problem; how to avoid it at your home health agency.


AIDS and the home health care industry--Part II. AIDS is incurable and kills 75 percent of its victims within two years.


Fired employees are suing and winning. Here is what to do for better protection.


Final hospice regulations lower rate for reimbursement.


Marketing: a dirty word?

Marketing: a dirty word?


Child care proving inadequate, home health agencies are getting involved.


Accident and emergency services in the Department of Lot et Garonne, France.


Examining activity in operating theatres.


Seventy ways to cut costs.

Seventy ways to cut costs.


Health administration in Zimbabwe. The search for a system.


Reorganisation in Scotland--the end or the beginning?


The role of the health authority: one district's approach to monitoring.


Hospital nursing establishments and costs.


Management at unit level.

Management at unit level.


Reform of the mental health law--2.

Reform of the mental health law--2.


Too many eggs in one basket? The one hospital district.


1984 innovators catalog.

1984 innovators catalog.


Local authority disposal of hospital waste.


ECG lead checker.

ECG lead checker.


Common courtesy: the ultimate barrier to entry. Part II.


Entrepreneurship: its place in health care.


Health care manager's notebook. Turnaround management.


Transport fleet costs cut--experience with LPG.


Model program explores cancer rehabilitation process.


Support group for cancer patients provides help, information.


The Clarence Herbert case: was withdrawal of treatment justified? Clarence Herbert, 55, stopped breathing following routine surgery in August 1981. Though a respirator restored his breathing, the lack of oxygen had caused severe brain damage, and Mr. Herbert was in a coma. Whether he could recover beyond a vegetative state was not known. Two days after her husband was placed on the respirator, Mrs. Herbert authorized the withdrawal of all life-support means. Mr. Herbert died six days later. Charges of murder by deprivation of treatment against the two attending physicians were dismissed in a lower court, a decision that was upheld in the state appeals court. Because court accounts are unclear, it is impossible to judge whether withdrawal of treatment was moral in this case. This case, however, raises a question about life-sustaining treatment in general. What is the moral criterion for withdrawal: quality of life or quality of treatment? The quality-of-life principle removes the obligation to take life-sustaining measures when a person's life does not or will not meet certain standards. Quality of treatment permits the withdrawal of even minimally burdensome treatment if it is considered useless. Though the California case appears to rest on these principles, withdrawing treatment from a person in a permanent coma, such as Mr. Herbert, implies that the quality of life is so low that life is not worth preserving, if the patient has no potential for conscious life, others have no duty to preserve it. This judgment may be acceptable in a terminal case when treatment truly is useless; however, withdrawing treatment that is useful in prolonging life cannot be justified.


Factoring ethnic diversity into the health care formula.


Ethics Commission examines moral distinctions in using life supports. Deciding to Forego Life-Sustaining Treatment, a report of the President's Commission for the study of Ethical Problems in Medicine and Biomedical and Behavioral Research, examines four common medical-ethical distinctions. The report highlights the 1980 Declaration on Euthanasia and closely follows Catholic moral teaching on the following. Death by action versus omitting to act. The commission rejects the idea that a physician who fails to act should not be held responsible for a patient's death. Failing to resuscitate, for example, or to take other steps to prolong life, are just as much causes of death as a lethal injection. The health profession's traditional duty to act on the patient's behalf precludes any distinction between acts and omissions. Withdrawing versus withholding treatment. Acknowledging that initiating treatment may create an obligation to continue treatment, the commission suggests that distinguishing between withholding and withdrawing could encourage undertreatment and overtreatment. Fear of being unable to withdraw unsuccessful treatment could lead to physicians' failing to treat patients who might benefit from the therapy. Ordinary versus extraordinary means. The commission upholds this distinction. It suggests, however, that the phrase "proportionate versus disproportionate" better describes the moral issue involved in selecting treatments that, in relation to their expected benefits, impose no excessive burden on the patient or family. Regarding intended versus unintended consequences, the commission departs from Catholic tradition. It fails to acknowledge the significance of physicians' intentions. What matters instead, according to the commission, is whether physicians act within their authority as defined by society. Thus, the commission suggests, the use of pain medications that may cause death can be socially and legally acceptable.


Carner's codes, Chapter 12. Reputation: years to build, seconds to destroy.


Unrelated business income tax: an update. To meet spiraling costs, tax-exempt hospitals increasingly are operating businesses unrelated to direct patient care. Knowing which activities may be open to challenge by the Internal Revenue Service (IRS) is essential to avoid the unrelated business income (UBI) tax. Three criteria must be met for an activity to be taxable as UBI: It must constitute a trade or business; It must be regularly carried on; and It must be unrelated to the organization's exempt purpose. The Internal Revenue Code and IRS rulings clearly exclude the following areas from UBI taxation: Activities performed by unpaid volunteers (e.g., hospital auxiliaries' fund-raising dinners and bazaars and the operation of thrift stores); Operations conducted for the convenience of the organization's members, students, patients, or employees (e.g., gift shops, cafeterias, coffee shops, parking lots, lounges, vending machines, pharmaceutical sales to inpatients and emergency room outpatients, and research activities for students' benefit; The sale of merchandise that has been received by gift (e.g., flea markets, baked goods sales, book sales, and rummage sales); Investment income such as dividends, interest, annuities, royalties, certain rents, and capital gains from the sale of investment assets; Gifts or contributions made directly to the facility; and Bingo games that are conducted commercially. Areas which may be subject to UBI taxation, or in which there have been controversial or contradictory court rulings, include: Pharmaceutical sales to the public or private physicians' patients; and Laboratory services provided to private physicians for treating their patients. IRS private letter rulings, though not precedential, have excluded from UBI taxation the x-ray income from a hospital's branch facility and rental income from property leased for use as a clinic or medical office building that is substantially related to the hospital's exempt functions. Private letter rulings have subjected to UBI taxation the income for a professional standards review organization's private review activities and debt-financed income from property that is not substantially related to the organization's exempt purpose.


Human resource development. How three hospital systems get top performance from their managers.


Older alcoholics: professional, family education programs aid treatment. The identification and treatment of older alcoholics often are complicated by negative stereotypes and inaccurate information about the aging process. these misconceptions may result from incomplete statistical data, lack of attention to the subjects of alcoholism and aging in medical and gerontological journals, disagreement concerning the disease's origin and treatment, and conflict over whether to differentiate between alcoholism and alcohol abuse. In recent professional literature, however, some of these concerns are being addressed. A wider dissemination of information is essential for health professionals as well as for alcoholics and their families. Both groups must understand the changes associated with aging so that existing programs for alcoholism treatment can be adapted to serve the elderly. Results of an informed, enlightened attitude toward older alcoholics would be: Awareness that alcoholism--at any age--is a treatable disease; Increased attention to the special communication and mobility needs of the elderly; Availability of printed and audiovisual materials about aging and alcoholism in locations where older adults gather; and The training of family members and health care workers in alcoholism identification and intervention.


Program helps nurses develop spiritual care skills. Recognizing the registered nurse's (RN's) important role in providing spiritual care, the Catholic Health Association of Wisconsin has created a program to prepare nurses to identify and respond to patients' spiritual needs. The program features instruction in theological and ethical issues and a three-month practicum, during which nurses evaluate their abilities to incorporate an awareness of spirituality into professional practice. A patient questionnnaire enables an objective measurement of the program's effect on nurses' care-giving skills. The program's ultimate goal is to formalize the RN's role as a member of the spiritual care team in the Catholic health care facility. The program represents not only an opportunity to contribute to the RN's professional growth but also to advance the Catholic health care mission.


Why should Catholic hospitals promote abortion, sterilization alternatives?


Subacute care program focuses on rehabilitation.


Volunteer dentists serve low-income families.


Food service company contracted by hospital is responsible for sales tax.


Management succession plan prepares for change.


Employee benefit encourages adoption as abortion alternative.


Signs of organizational decline.

Signs of organizational decline.


How can PPOs control prices without violating antitrust laws? Preferred provider organizations (PPOs) have caused concern because they raise the question whether providers can establish mechanisms to control the price of medical care without violating antitrust laws. The U.S. Supreme Court recently decided in Arizona v. Maricopa County Medical Society that the practices of a physicians' organization which set fee schedules by majority vote constituted price fixing because "independent competing entrepreneurs" made the agreements. The decision implies that PPOs must carefully structure collective efforts to set prices in order to avoid unlawful agreement among competitors. To avoid antitrust exposure, hospitals may independently determine prices and contract individually with providers, or they may act as brokers for individual physicians, establishing fees and claims-processing procedures and then contracting with physicians who agree to these requirements. Setting fees independently may be difficult, however, since hospitals need to know what payment physicians will accept. Thus some physician involvement is probably inevitable. No antitrust liability results, however, if individual physicians are sampled in an information-gathering process but do not collectively set fees. In addition, a PPO that is structured as a partnership or other joint arrangement involving true risk sharing should withstand antitrust challenge. In recent business review letters, the Department of Justice approved two different PPO structures: A Hospital Corporation of America subsidiary would contract (nonexclusively) with providers, hospitals, and third party payers to treat the third party payers' beneficiaries at discounted rates. The charges would be negotiated individually with each physician and hospital. A management consultant firm would act as an intermediary between providers and third party payers, negotiating patient discounts but not participating in fee setting. A PPO need not be structured in every respect like these programs. Individual situations vary, and with sound antitrust advice, PPOs can avoid legal pitfalls.


Alienation and reconciliation: caring for the elderly. Reconciliation is one way of caring. Our society fosters alienation among the elderly, and the result is that we are all losers as we miss the unique contributions that the aged can make. To bring about the reconciliation that God desires, health care institutions must join together in calling for public policies that protect the elderly's human rights; ensure that care systems and structures help to integrate the aged as a vital part of the community; and work to change attitudes (among both the young and the old) about old age's role, meaning, and purpose. Most important, those who care for the elderly must rely on God to strengthen them to make in their own lives whatever changes reconciliation requires.


Environmental design boosts patient, staff morale.


Theology links Christian ministry with God's call. Catholic health care ministry originates in and is shaped by the theme of call in the Old and New Testaments. To be specifically Catholic, health professionals and facilities must define their ministries according to the values expressed in this theological tradition. Sponsorship. The opportunity to provide health care enables religious communities to contribute to God's ongoing creation process and to reiterate Christ's call to minister to others. Although health care facility sponsorship thrusts religious communities into the arena of big business, the abandonment of the health care mission could be considered a betrayal of evangelical values. Quality of life. The implicit concern for human dignity that distinguishes Catholic health care facilities should be evident in personalized patient care, just working conditions, and a commitment to healing in the civic community. Stewardship in ethics. The development of business policies and procedures and institutional responses to social change should be carefully considered in light of the Catholic understanding of loving covenant and the Christian way of life. Shared ministry. Health care facilities have played a leading role in implementing the Second Vatican Council's vision of ministry. Sponsoring communities' continued willingness to share responsibilities with laity will be imperative in meeting the health care demands of the future.


Shared hospital services: study report.

Shared hospital services: study report. The study of shared hospital services reported in this article was conducted to determine the magnitude of shared administrative and clinical programs, what institutions participate, and most frequently shared services. To ensure that hospitals with different characteristics and in various areas were represented, the investigators mailed questionnaires to 1,731 of the nation's 5,987 short-term, acute care general hospitals in nine census regions. Responses indicated the following trends: Not-for-profit hospitals outrank other types of hospitals in using shared services. About 90 percent of hospitals with 200 to 499 beds shared services. For almost all categories of services, a percentage increase occurred in the number of hospitals participating in shared programs. The three most shared services were purchasing, data processing, and insurance programs. Hospitals shared more administrative than clinical services. According to administrators' responses, cost containment was the most common reason for sharing services. As the pressures to control health care costs increase, the investigators predict that hospitals will share more clinical services. Shared services decrease unit cost, however, only when providers have an excess capacity.


Hospital returns to social security but retains alternative benefits plan. When passage of the Social Security Amendments of 1983 required Holy Redeemer Hospital to return to the Social Security system on Jan. 1, 1984, the hospital examined alternatives to nonprofit hospitals' mandatory participation in the program. With a consortium of hospitals, it launched an unsuccessful lobbying effort to convince Congress to accept other options: deferring the return for several years, exempting hospitals that had left the system, or "grandfathering" nonprofit hospitals' employees. By Oct. 31, 1983, the hospital decided to forgo efforts to amend the legislation and made preparations for returning to the system. Employees were notified that they could continue to participate in the alternate plan (a tax-deferred annuity) or leave their account inactive until withdrawal at retirement. The plan's provisions that allowed withdrawals only under extraordinary circumstances were amended to permit withdrawals at any time. In addition, the administration introduced flexible benefits--a "cafeteria plan"--to allow participants to choose among certain taxable and nontaxable benefits that best fit each individual's life-style.


Should Catholic hospitals encourage low tubal ovum transfers?


Hospital must give insurance carrier timely notice of lawsuit.


Physicians must follow hospital policy limiting number of therapy providers.


Health care practice must reflect Catholic values.


The role of organizational procedures in the resolution of social conflict. Employee-employer conflict can arise from the expression of social issues within an employment organization. Recently, public support for non-discrimination in employment has led to the existence of external forums--regulatory agencies and the courts--that allow appeals for complaints of discrimination by protected groups. This paper examines the role of organizational procedures for conflict resolution where individuals have the option of appealing to an external forum. Through the analysis of internal grievance procedures and external charges in three urban hospitals, the paper explores the origins and expressions of employee-employer conflict in the areas of discrimination, the impact of an internal system on the rate of external charges, and the general relationship between internal and external forums of conflict resolution.


Fat group: a SNAP-launched self-help group for overweight women.


Survey of grants activities at selected children's hospitals.


Court of Appeals denies government access to records in case of Baby Jane Doe.


Appellate Court upholds a state cost-containment program against labor law challenge.


AHA files motion to have Baby Doe regulations declared invalid.


Washington State Supreme Court protects quality review committee records.


HHS "clarifies" Hill-Burton recovery rules.


U.S. Court of Claims dismisses proprietary hospitals' claim that return on equity reimbursement is unreasonably low.


Indiana passes PPO Law in its 1984 legislative session.


Maryland Court of Appeals upholds state rate-setting agency action in favor of hospitals.


Catering department feature.

Catering department feature.


New Q.A. guidelines raise new questions.


Training helps staff warm up to computers.


Put quality patient care on-line.

Put quality patient care on-line.


Going corporate.

Going corporate.


Unit dose: it's feasible and reasonable.


Consider micro standardization.

Consider micro standardization.


Commissioning notes from one hospital.

Commissioning notes from one hospital.


Designs with a difference.

Designs with a difference.


It pays to share services.

It pays to share services. It may not be a new concept but more and more hospitals today are realizing that shared services is one of the most efficient and cost effective ways to operate. For some, it is the only way. Although it can be applied to pharmacy, food service, certain medical procedures and diagnostic services, the department which probably derives the greatest benefits from a shared or central service is the laundry. Two recently completed western facilities, Hospital Laundry Services of Regina and Calgary Hospitals Regional Laundry, mark a new era in laundry service. Using state of the art technology, modern energy conservation systems and equipment, efficient operating measures and sophisticated building design, plants such as these are quickly replacing outdated hospital facilities and equipment. And despite some dissatisfaction among hospital employees and occasionally patients, the cost savings alone prove that the future of shared laundry services is imminent.


Building controls lead to energy payback.


Reusables vs. disposables.

Reusables vs. disposables. The question of whether to use disposable or reusable laundry and linen products is one that hospital managers have had to answer with increasing frequency over the past few years. Although it may ultimately depend on individual user or patient preference, each type of product does have its own advantages and disadvantages. On these two pages, a comparison of disposables and reusables is presented from the point of view of a major linen supplier and the director of the Canadian institutional laundry managers association. They discuss the benefits, and downfalls, of each with regard to costs, storage, convenience, disposal and infection control.


Cook-chill meets diversified needs.

Cook-chill meets diversified needs.


Protect yourself with effective security. Hospitals have always been responsible for providing a "reasonably safe environment" for patients, visitors and staff. There are moral, legal, practical and profitability motives underlying this attitude. However, this responsibility has been reinforced by the increasing number of legal actions being brought against hospitals for breach of their duty. Hospitals are under pressure to increase existing security budgets to address the volume of complaints. The purpose of this article is to identify problems in existing hospital security systems and propose some potential solutions. Security has been defined as a "system of safeguards designed to protect the physical property of the facility and to achieve a relative ... (reduction in the probability of detrimental incidents) ... for all persons interacting within the organization and its environment". The goal of hospital security services is to reduce the institution's various vulnerabilities. These vulnerabilities have been divided into two major categories, personal safety and loss prevention.


Are you capable of serving Kosher?

Are you capable of serving Kosher?


Employee assistance--the right approach.


Use computers to enhance food service.

Use computers to enhance food service.


Do you care what people think?

Do you care what people think?


Making an entrance. Renovation at the Mayo Clinic.


Throwing a curve. Inviting interior for the non-ambulatory patients of Magee Memorial Rehabilitation Center in Philadelphia.


California building development leaps ahead.


PIQuA winds down.

PIQuA winds down.


Surveys look at characteristics, challenges of internists, young and old.


Results of a poll: who is the new breed?


An internist is an internist is an...

An internist is an internist is an...


Special summary: results of ASIM's public opinion poll on internists.


Women's experience of their first visit to a hospital antenatal clinic.


How have people changed their health behavior?


1983 central service supervisor survey.

1983 central service supervisor survey.


Home care involvements a new horizon for buyers.


Associations 'vital' to materials professionalism.


Equipment management.

Equipment management.


Texas center solves lost charges problem.


A 'maverick' speaks--again.

A 'maverick' speaks--again.


It works--risk management and drug-induced disease.


How can I correct and control incorrect invoices received from vendors?


Product standardization: can it be accomplished--Part II.


NME scores chain first with single-source film.


Small chains face different problems.

Small chains face different problems.


Choosing the right telephone system.

Choosing the right telephone system.


Query ASHMM: What types of items are good choices for buying on consignment?


Query ASHMM: ... an information system for the department of materials management ... What is the best method for procuring hardware and software?


Monitoring materials management service: a return to 'basics'.


The annual fund.

The annual fund.


Centralization helps CMC contain costs.

Centralization helps CMC contain costs.


Fund raising in the 1980s: the challenge to hospital administration.


How professions can affect the direction of education for their members.


Evaluation of a family practice teaching program in a nursing home.


Federally funded health administration research--a new era?


The Irish health system: a Canadian perspective.


The personalized quality assurance program.


Managers speak out on volunteers.

Managers speak out on volunteers.


The role of hospital administrators in multihospital systems.


Ethics: a management tool? A profile of the values of hospital administrators.


The John Belville House.

The John Belville House.


Reiteration of problem definition in health services administration.


Administrative ethics and the health services manager.


The need for professional administrators in rural hospitals.


Planning the small hospital gift shop.

Planning the small hospital gift shop.


Use of general (tertiary) reference sources in a university hospital-based drug information service. This study was performed to determine the types of requests received and clientele served by a university hospital-based drug information service. A further objective was to determine which general (tertiary) reference sources best meet the needs of the service. The results revealed several trends in utilization of the service. The study also indicated that a relatively small number of general (tertiary) reference sources were useful in answering a large percentage of requests. The information obtained has allowed more efficient utilization of funds for purchase of reference sources. It also proved useful in the development of guidelines for training of individuals in handling requests for drug information.


When you go to market.

When you go to market.


Potential extension of strict products liability to hospitals: P & T committee liability. Members of Pharmacy and Therapeutics (P & T) Committees and materials managers should be aware of the current trend of court decisions to extend strict products liability or liability without the showing of fault, to hospitals and providers of health care services in favor of innocent consumer-patients. Traditionally, a hospital's defense if charged with strict liability (in tort) was that its primary business is to provide services and not sell products. Recent Texas strict products liability judicial decisions have questioned, but not resolved, whether or not a hospital does sell or legally introduce a product into the stream of commerce. Since it is the function of materials managers, or in the case of pharmaceuticals the P & T Committee, to make the decisions on products that will be used in the hospital, the precedence established by the Texas cases portend further judicial extension of strict liability to providers of health care services.


The request for proposal as a tool for computer selection. The process of selecting a computer vendor can be time-consuming and somewhat tedious. Due to the large number of vendors and varying types of promotional material, it is difficult to decide whose systems should be scrutinized in greater detail. The Request for Proposal RFP process provides a means of standardizing each vendor's response and limiting the number of full proposals which must be evaluated. Further, the vendors' responses are tailored to the needs of the department.


Improvement in drug utilization in an ambulatory care setting by the use of drug profiles for physicians. The purpose of this study was to determine if the use of drug profiles could improve drug utilization in an ambulatory care setting. Four clinics were provided drug profiles on each patient for a 6- to 9-month period. Evaluation of drug utilization and physician response to using the profiles was performed. The data indicated that, after the profiles were introduced, there was a reduction in the total number of medications and duplications in a majority of patients studied. In addition, physician time spent in reviewing the drug history was significantly reduced. Overall, the physicians who were surveyed felt that the profile helped them and improved patient care. These data support the conclusions that the integration of drug profiles within an ambulatory care setting can improve patient care and help the hospital with large outpatient workloads to realize significant savings.


Fair use versus fair return: copyright legislation and its consequences. The purpose of this article is to examine the ramifications of legislative recognition of the concept of fair use in the Copyright Act of 1976. The fair use concept, while of small consequence in its normative origins, has turned out to be the foundation of the most perplexing and divisive issues in the new legislative guidelines governing copyright. Legislative recognition of the concept of fair use, coupled with enormous growth of a new technology--extending from xerography to on-line database systems--creates de facto exemptions to both the intent and content of new copyright guidelines. The issue is not one of limiting use or suppressing information, but of mechanisms for safeguarding the rights of copyright holders, be they authors or publishers, and insuring the free flow of information by providing a proper return on both intellectual creativity and capital expenditures. The authors argue that the elimination, or at least curtailment of fair use doctrine, coupled with an increase in technological approaches to reporting of secondary use of copyrighted material, will benefit all sections of the knowledge industry. Authors will receive proper royalties on use; publishers will be able to sell more books and journals at lower prices; and librarians will be liberated from extensive chores such as monitoring usage or determining fee schedules and transferences. The issue is one of fair return--an issue obscured and ultimately subverted by fair use.


Action research is formative: research at Saskatchewan Hospital, 1957-61. The author has examined the five lines of research started at a mental hospital between 1957-61 to determine their immediate effects upon practice and subsequent citations in the literature. Three lines of research combining basic and applied studies affected practice and research as measured by literature citations. One line of basic studies of perception and psychopathology influenced research but not practice. Applied studies of perception and psychopathology influenced research but not practice. Applied studies of staff organization had immediate application but disappeared from the professional literature in a short time.


The changing profile: affiliates of the American College of Hospital Administrators--1973 and 1982.


Japanese management: implications for healthcare administration.


Phases of progressive burnout and their work site covariants: critical issues in OD research and praxis. The term "burnout" represents a significant perspective on how people respond to their work, but the attention paid to this phenomenon has largely been clinical and often anecdotal. In this article, the authors seek to expand the analysis of burnout in ways that permit comparative analysis, especially in large populations. This study specifically addresses three questions. First, does a paper-and-pencil instrument isolate domains of burnout that are relatively consistent between people-intensive work and the broader range of activities found in a commercial enterprise? Second, can we develop phases of progressive burnout? Third, can we test the efficacy of the burnout phases by searching for regularities in a panel of 22 variables commonly thought to tap the important facets of the work site? The author's analysis shows that we can answer these three central questions affirmatively, though occasionally with complex and potentially significant qualifications. The results of the analysis provide further evidence of the usefulness of a convenient instrument for measuring burnout and also suggest that behavioral scientists will find valuable a phase model that distinguishes regular and robust covariation by using a panel of variables thought to tap the important aspects of organizational life.


Food intake of institutionalized women over 80 years of age. Food intake of 30 women over 80 years of age and residing in a long-term care facility was determined for a five-day period using the weighed intake method. Purposes of the study were to examine the contribution to nutrient intake of foods from eight major food groups; to characterize intake by time of day; and to examine the effect of age on nutrient intake. The results indicated that intakes of calcium, thiamin, vitamin A, zinc, and protein were below recommended levels. Analysis of intake by food group revealed that the grain group was the primary source of energy and many nutrients. Percentage consumption of foods in this group was significantly higher than that of vegetables or meat and alternates. Analysis of intake by time of day indicated that more energy was consumed at breakfast than at dinner. Advanced age was negatively correlated with overall dietary adequacy, although the distribution of energy intake from the eight food groups did not change with age. Implications of the results, for these subjects and similar groups of elderly, are discussed.


Doing good and doing well: ethics, professionalism, and success.


The Canadian Nutrient File.

The Canadian Nutrient File. Rapid Calculation of the nutrient content of foods and diets requires a current, easily accessible data base. The Canadian Nutrient File is a computerized information bank containing average values for nutrients in foods available in Canada. For easy accessibility, it contains subfiles for food names, nutrient names, and nutrient amounts. Users of the data should appreciate the limitations of this multi-use file.


System service provision and client service utilization in public sector, human service organizations. Service provision and client utilization at the catchment area level were studied to provide data relevant to (a) comprehensiveness of care, (b) client behavior with human service organizations, and (c) management and policy in times of fiscal decline and/or scarcity. Four human service organizations and 3529 clients seen over a six-month period were sampled. At the system level, data revealed a 100% duplication rate by the four organizations for nine service categories. At the individual level, 7% (n = 250) of the clients were multiorganization users and of these, only 150 received duplicated services. Implications of these data for comprehensiveness of care, utilization and provision duplication, human service system impetus and future research were discussed. Overcomprehensiveness of service provision may be a problem. At the client level, more research on differences between the multiorganization user who does and does not receive duplicated services is needed.


Implications of an interactive encoding system for ICD-9-CM.


Assessing a CMHC's impact: resident and gatekeeper awareness of center services. One accessible measure of the impact a community mental health center has on the community it serves is the awareness levels of both residents and gatekeeper groups regarding the center's existence and services. This broad-based study was conducted with university students at no cost to the center and included 436 residents and 175 gatekeepers. The results indicated that awareness levels for community residents and gatekeeper groups were 34% and 53%, respectively, but varied dramatically as a function of how the awareness questions were phrased. The overall awareness findings generally supported those of other studies and were discussed in light of potential normative levels, methods for conducting surveys of this nature, response rates, and the increasing need to justify existence given the diminishing funding situation.


Evaluating day-care for chronic psychotics: goal attainment versus symptom-attitude change.


Grow where you are planted.

Grow where you are planted.


Daleview residents demonstrate leadership.


Involvement a tradition at St. Regis.

Involvement a tradition at St. Regis.


"Wake up" service gives community head start.


The making of a resident community theater.


Recognizing the human potential.

Recognizing the human potential.


Bachelor grandpa.

Bachelor grandpa.


Lou-Del's "Aunt Sue": author, historian, lecturer, friend.


Home and health care.

Home and health care.


People need to give.

People need to give.


File, storage, retrieval methods & media.


Microcomputer policy.

Microcomputer policy.


1984 salary survey.

1984 salary survey.


National EMS burnout survey.

National EMS burnout survey.


The 600-run limit.

The 600-run limit.


1984 ambulance survey.

1984 ambulance survey.


How much is too much? The pressure is on, and paramedics are feeling the squeeze.


The unruly patient.

The unruly patient.


CPR goes to work.

CPR goes to work.


PC emergency.

PC emergency.


State regulation and ALS.

State regulation and ALS.


Collective bargaining in the health care industry: implications for the long-term-care administrator. Union are turning their attention to the health care industry, a move that could have significant implications for long-term care administrators. The authors discuss the evolution of the health care amendments to the National Labor Relations Act and analyze what this means for the long-term-care administrator.


Automated systems in long-term care facilities: utilization in California. A random sampling of skilled and intermediate care nursing facilities in California suggests that facility managers have entered the computer age, but that the microcomputer's possible contributions to nursing home management have remained largely untapped.


Patient advocacy services in long-term care facilities: ethnic perspectives. More and more nursing home ombudsman programs are being implemented as institutions strive to improve the quality of life for the institutionalized elderly and to increase communication between the institution and the community. Abraham and Monk review how different ethnic groups perceive the New York City Nursing Home Patient Ombudsman Program.


Item analysis of the primary measures of music audiation in elderly care home residents. This study described the responses of 180 elderly care home residents on the Tonal and Rhythm subtests of the Primary Measures of Music Audiation test (Gordon, 1979). Separate analyses on each subtest yielded a mean score, a standard deviation, two reliability coefficients and their corresponding standard errors, a frequency distribution, and item difficulty and item discrimination indexes with individual item response distributions. Tonal item errors seemed due to subjects' inabilities to discriminate small interval changes in melodies, while rhythm item errors seemed due to subjects' inabilities to discriminate changes in duration or changes in complex rhythm patterns. Any generalizations or implications are primarily confined to female, Caucasian, elderly care home residents because of the restricted population sample used in the study. Even so, implications are that institutionalized elderly persons may have difficulty learning or performing music which requires discrimination of small interval changes, duration changes, or complex rhythm patterns. Music with marked changes in pitch or duration and with simple rhythm patterns should facilitate successful musical experiences.


Music programs for the institutionalized elderly in a midwestern metropolitan area. This investigation concerned the status of music programs in licensed nursing homes in St. Louis, Missouri. Data were obtained by means of a mailed questionnaire, interviews with selected administrators, and visits to selected homes. Almost all of the institutions surveyed offered musical activities for their residents. In many instances, these consisted largely of recreational singing or visits to the institution by outside performing ensembles. In a few instances, more complete music programs were offered, in which residents benefited not only from the use of music for recreation but also from its educational and therapeutic potential.


The Bowie-Dick type test...the discrepancies between theory and practice.


Special feature: Dr. John Bowie comments on the Bowie and Dick test.


The Bowie-Dick type test...are there alternative ways?


United Kingdom Department of Health and Social Security. Health Technical Memorandum 10 (1980).


A Markov sensitivity model for examining the impact of cost allocations in hospitals. The cost allocation process in hospitals typically entails an accounting step-down procedure whereby costs are allocated from non-revenue producing service centres to revenue centres. The resulting revenue centre costs are then compared with the third party (Blue Cross, Medicare, Medicaid) allowable costs. Any costs in excess of the allowable costs are not reimbursable. This procedure has been conceptualized using a Markov chain in a recent journal article. The purpose of this paper is to demonstrate how the Markov model may be used to assess the impact of various changes in the original data without having to recalculate the entire step-down process via a Markov model or any other procedure. The changes include an alternate step-down model, a different cost allocation basis for one or more service centres, and the expansion or contraction of one or more service centres.


Information management and information technologies: keys to professional and business success. Personal computers, spreadsheets, decision support software, electronic mail and video disks are just a few of the innovations of information technology which attract the attention of information professionals and managers alike: they are all concerned with the rapidly changing face of information technology and how to cope with a changing competitive environment, personally, and for the benefit of their companies. This paper is the first in a monthly series which tries to illuminate some of the factors and changes which shape our future as professionals and managers. In so doing, it guides and motivates the reader to become "information literate," a prerequisite for personal advancement in an information-based economy. This first paper outlines the relationship between technological innovations, use of information tools and information management and what to consider in order to benefit from the information revolution. It explains the risks of becoming professionally obsolete and alerts the reader to get personally involved to remain or become "information and computer literate."


San Francisco General Hospital.

San Francisco General Hospital.


The new role of microcomputers.

The new role of microcomputers. Microcomputers have emerged as a truly valuable tool for business, largely due to the development of high-quality software. This article discusses the most logical methods of selecting a microcomputer system and certain points to keep in mind when doing so.


Integration of different technologies into efficient information systems. Part 3. Offices and businesses may be functionally described as information systems in which people, supported by information tools, perform goal-oriented information work. This article shows how the efficiency of support depends on how well applicable technologies can be integrated into systems and how well these systems can be adapted to the needs of a particular organization. Descriptive illustrations show how different technologies are integrated to perform information system functions (e.g., word, data and image processing as well as financial data and records management functions), and how all these technologies depend on compatibility and coordination in integrated systems to serve decision support functions of management and planning.


Religion in the psychiatric hospital: a reassessment. Surveys from a perspectival model the place of the chaplain in the psychiatric hospital in terms of the multidisciplinary mental health team and its workings; historical patterns that have guided mental institutions' explicit or implicit contracts with religion; definitions of the scope of chaplaincy; the symbolic nature of religion; and the prevailing diagnostic neglect of religion and of the patient's personal agenda.


Association for the Advancement of Medical Instrumentation. Recommendations for the Bowie-Dick type test.


Subsidizing the affluent: the case of medical education. State and federal funds are important sources of revenue for medical schools, and a strong case can be made for public support for these institutions. Although the federal role is more widely known, the states in fact provide the bulk of direct support for medical training. The nature of aid from the two sources differs in significant ways. Most federal aid supports research or patient care, but much of state aid goes to support unconditional tuition subsidies. The primary beneficiaries of these subsidies are relatively affluent nonminority students who are beginning lucrative careers in the medical field--careers that would be lucrative even if no subsidies were provided. Nor does it appear that general subsidies are needed to attract poor and minority applicants. While targeted loans and scholarships to individuals may be justified, general tuition subsidies are not.


Sterile service--American style.

Sterile service--American style.


A renewed employee right to privacy.

A renewed employee right to privacy.


The National Labor Relations Act: a potential legal constraint upon quality circles and other employer-sponsored employee committees.


The impact of Falcon on Title VII class action litigation.


Hazards associated with returned and field serviced medical devices and equipment.


Worker participation and its potential application in the United States.


Nine ways to network (or you don't have to be Italian to be a Machiavelli).


Hepatitis B.

Hepatitis B.


The emperor has no clothes...or sterilization quality assurance revisited.


Interviewing. Part I.

Interviewing. Part I.


Sterilization indicator inks.

Sterilization indicator inks.


Chemical indicators.

Chemical indicators.


OSHA's voluntary protection program.

OSHA's voluntary protection program.


Work attire.

Work attire.


Setting up an in-house program for the rehabilitation of burnout victims.


The database industry today: some vendors' perspectives.


Focus on...reusables vs. disposables.

Focus on...reusables vs. disposables.


Effective management of information: how to meet the needs of all users.


The need to define an aseptic barrier.

The need to define an aseptic barrier.


Hospital linen conservation program reduces usage by 1 1/2 lbs. per patient.


Florida hospital makes compromise between reusable and disposable wrappers.


Musical medicine: the newest specialty.

Musical medicine: the newest specialty.


Strategic marketing of volunteer programs for social causes.


Health costs: we can't control what we can't see.


A new partner in peer review: big business.


How many doctors are cheating their way into practice.


The nominating committee: essential to the organization.


Why doctor-policing laws don't work.

Why doctor-policing laws don't work.


There are six basic steps to avoiding a malpractice suit.


Tough new rules for the privileges game.


How treating by telephone rang a malpractice bell.


Selecting the right physician for your group. Effective recruitment and selection of physicians for a medical group practice depends on an objective assessment of the group's needs, philosophy, and organizational style, and an objective assessment of all candidates in relation to these factors. While emphasis in the hiring process is traditionally placed on a candidate's medical skills, there are other considerations which should be of equal concern in order to get the best possible organizational "fit": personality, family situation, behavioral style, and organizational philosophy and orientation. The utilization of behavior assessment methods borrowed from the applied management and behavioral sciences can enhance recruitment objectivity, member satisfaction, and retention.


The hospital market: two books dominate.


Man vs. microbes--grappling with resistance.


Increasing the profitability of the clinical laboratory. The clinical laboratory is often found in the basement of both the physical plant and the medical group's priority list. By closely examining the uniqueness of the laboratory, its volume, fees, productivity, and supply costs, the astute administrator may find a profit center previously unnoticed.


Firing without fear.

Firing without fear.


U.S. health policy: where the candidates stand.


Measuring patient satisfaction.

Measuring patient satisfaction. Though there is some controversy concerning how much weight patient perceptions should be given, there is no question that they must be considered. Focusing on patients in the ambulatory care setting, the author offers practical notes on measuring patient satisfaction based on her experiences at five sites over the past eight years. General methodological considerations are provided, including where and how to interview patients, as well as specific examples of types of measurement instruments and the results to be obtained. Findings of satisfaction surveys can be useful in altering the services provided in an effort to more adequately meet patient needs.


Clinical trials: in search of medicine's gold standard.


Justice without juries. Setting up formal channels for complaints can resolve employee grievances.


A look at management roles and operating environments of medical schools. In order to reach a better understanding of the many complexities involved in the management of schools of medicine, in 1980-81 a survey was taken of deans of medicine and department chairs of medicine, surgery, and family practice at US medical schools. The major attributes of the managerial work environment are identified and provide a foundation for further inquiry into the overall operating effectiveness of schools of medicine.


Evaluating the new microbiology instruments.


A personalized newsletter for your group.


Updating a neglected laboratory.

Updating a neglected laboratory.


Microbiology work cards: preprinting gets the message across.


Have you had your six-month proficiency checkup?


Media quality control: an unnecessary evil.


An on-line cost analysis system.

An on-line cost analysis system.


Improving lab productivity: the search for strategies. Part II.


Workload recording by microcomputer.

Workload recording by microcomputer.


Orienting the new supervisor.

Orienting the new supervisor.


Using projectional analysis to reach your staffing goals.


Resolving staff conflicts through team building.


'Capital' ideas help improve services.

'Capital' ideas help improve services.


Laid-off PCHA workers trained for job hunt.


A survey of Michigan's new lobby act.

A survey of Michigan's new lobby act.


Hospitals serve more than the sick.

Hospitals serve more than the sick.


Albion, Michigan: one hospital's economic impact.


Design and construction. Make room for computer terminals.


Insurance is used to lure bond buyers.

Insurance is used to lure bond buyers.


Hospitals embrace customer relations.

Hospitals embrace customer relations.


Design and construction: space management. Hospitals eye excess capacity and plan to improve productivity.


Informed consent: M.D. or hospital duty?


Time, money run out for Carecard.

Time, money run out for Carecard.


American, VHA shape buying pact in image of contested agreement.


Healthcare investments help HCA keep on top of industry innovations.


Hospitals' PPOs face hard times.

Hospitals' PPOs face hard times.


Stonerock--Trustee of the Year. Interview by Donald E. L. Johnson.


Hospitals eager for a larger share of growing home healthcare market.


Board shouldn't buck CEO's high pay.

Board shouldn't buck CEO's high pay.


Hospital shoehorned into tight site.

Hospital shoehorned into tight site.


Cut in banks' credit rating shows hospitals' risks with letters of credit.


Hospital bonds' track record trips up critics who contend bonds are risky.


Credentialing sparks antitrust suits.

Credentialing sparks antitrust suits.


2 alliances to join forces, later merge.


States' cost-cutting plans dissected.

States' cost-cutting plans dissected.


Hospitals work with M.D.s to smooth MeSH partnerships' rough edges.


How will CEOs fit into healthcare puzzle? ACHA studies future roles.


For-profit psychiatric hospital firm will seek niche in small urban, rural areas.


Presbyterian spins off new business.

Presbyterian spins off new business.


Employers tout HMOs to workers, but lack proof of plans' cost savings.


Consignment inventory program cuts 29% from supply prices: study.


Intermountain follows trend, adding alternative services to acute care base.


Hospitals gear programs to elderly.

Hospitals gear programs to elderly.


State legislative outlook. Some hospitals fight rate setting, others design own pay schemes.


Purchasing 'super groups' tripped up by competition between members.


Triangle design saves time, money.

Triangle design saves time, money.


Government hospitals. Private-pay patients are helping public hospitals stay out of red ink.


Government hospitals. $65 million sale of county unit swirls amid politics, emotion.


Lutheran coalition eyes national system.


Credit downgradings, financial woes could hurt hospitals' sale of bonds.


Government hospitals. Will elderly overload VA system?


Becoming for-profit helps not-for-profit providers cope with financial pressure.


Court quashes Humana building bid.

Court quashes Humana building bid.


PA tertiary care center goes regional.

PA tertiary care center goes regional.


Managers with participative skills will thrive in cost-conscious market.


Company attracts clients nationwide by cutting hospital costs up to 23%.


Albuquerque hospitals are even more competitive after suspension of regs.


Joint ventures. Hospitals, M.D.s test cost-cutting potential of lab cooperative ventures.


Alternative services. Emergicenter accreditation devised.


Alternative services. Hospitals launching hospices may save money by working with experts.


Emergency unit fine-tuned for elderly.

Emergency unit fine-tuned for elderly.


Second annual Multis compensation survey.


Risky business. PPOs present greater financial, actuarial risk for sponsoring multis.


Hospitals eye potential for DME dealer alliances.


Evaluating CEOs rates a concerted look.

Evaluating CEOs rates a concerted look.


White & White et al, vs. AHSC--as the Appeals Court saw it.


More PTs leaving hospitals means jump ball for dealers.


The year in preview: government sees device industry up with economy.


'Alternate care' leaders point to dramatic gains.


Bigger role for HIMA seen in shaping public policies.


Dealer finds success in a hospital's bed.


Distributor survey: Martin Simpson's quarterly digest.


How shaky is the handshake agreement?

How shaky is the handshake agreement?


Fitness Center's club theme builds, strengthens employee morale.


Health network plan to insure multistate companies.


Battle brewing over health care in Arizona.


Pacific Mutual takes the lead in using preferred provider concept. Interview by Alfred G. Haggerty.


Organization and implementation of a disaster drill for health care facilities.


Park Lane Medical Center--developing successful physician partnerships.


Unit dose distribution improves accountability.


Survey advises: "Stress the 'osteopathic' in osteopathic hospitals".


Diversification--a strategy for the '80s.


"Be a tree, not a leaf.".

"Be a tree, not a leaf.".


The acquisition experience.

The acquisition experience.


Job stress and job performance controversy: an empirical assessment. This study examined the relationship between job stress and employees' performance and withdrawal behavior among nurses (N = 440) in two hospitals in a metropolitan Canadian city on the east coast. Job stressors assessed included role ambiguity, role overload, role conflict, and resource inadequacy. Employees' performance was operationalized in terms of job performance, motivation, and patient care skill. Withdrawal behaviors assessed were absenteeism, tardiness, and anticipated turnover. Multiple regressions, curvilinear correlation coefficients, and canonical correlations were computed to test the nature of the relationship between stressors and the criterion variables of the study. In general, data were more supportive of the negative linear relationship between stress and performance than for positive linear or curvilinear relationship. However, the stressor role ambiguity did exhibit a monotonic nonlinear relationship with a number of criterion variables. Employees' professional and organizational commitment were proposed to moderate the stress-performance relationship. However, the data only partially supported the role of the moderators.


Bankruptcies--a potential source of dollars.


Quality circles in the clinical laboratory. The success of the quality circles in Japanese industry has led many American firms to institute the circles into their operations. A few hospitals have also done this, but little has been published about quality circles in the clinical laboratory. This paper describes briefly the structure and function of the quality circles and discusses their possible role in the laboratory.


Hospital unbundling: seize the opportunity. As hospital restructuring becomes more frequent, therein lies an opportunity for pathologists to establish regional laboratories, either independently or as joint ventures with hospitals. The author discusses some of the pressures to unbundle, and steps that pathologists can take to meet this challenge.


Avert catastrophe--consider preceptorial training.


Hospital blood banks: crossing fine cuisine with fast food.


Microcomputer basics, Part IV: Using microcomputers in pathology. Microcomputers are invading every aspect of life including the practice of pathology. This last in a series of articles is designed to help neophytes make effective use of these new tools. This article describes how microcomputers can be used in pathology and provides guidelines for deciding what processes are worth computerizing and for selecting software. No specific program is recommended.


The color photography of gross specimens. A method of color preservation and photography of gross specimens is presented in this article. The natural color and physical consistency of the preserved specimens assure "true to life" color photographs. The author explains how his institution's system of combining the Autopsy Review Conference with the photography of specimens saves much staff and employee time since the final gross descriptions and dissections are accomplished concurrently with the photography. A systematic method of photography is illustrated which eliminates most of the exposure determination functions that are time-consuming and subject to error.


Choosing film for your camera.

Choosing film for your camera.


Are enterostomal therapists patient educators?


Patient education coordinator's consultation corner.


A hidden benefit of quality circles.

A hidden benefit of quality circles.


Unlock the mysteries of the annual report.


Proposed competencies for patient education coordinators.


New challenges in patient education.

New challenges in patient education.


Five common problems in color photomicrography. The practical mating of the modern microscope and automated camera has been successful. Many time-consuming photographic procedures have been reduced to a minimum in the process. The pathologist can obtain color photomicrographs with minimum knowledge of optical theory or photographic procedures. However, there are several problem areas which require special attention to ensure a constant flow of good photomicrographs. This article reviews and offers solutions to five common problems in photomicrography.


The team that works together earns together.


Why health care costs keep rising.

Why health care costs keep rising.


Health education methods. Sharing a diagnosis.


Beyond today's compensation and performance appraisal systems.


Performance appraisal and the Age Discrimination in Employment Act.


How we practice pharmacy in the U.S. Coast Guard.


New drug data sheets quickly update our hospital staff.


Why drug information is a vital part of comprehensive services.


Confidentiality of prescription information.


Comparison of consumer-oriented books on medications. Consumers increasingly want to be informed about the processes involved in their own health care. Health professionals may be called upon to recommend appropriate consumer-oriented sources of information. To assist the health professional in making a rational recommendation, 15 currently available consumer-oriented books on prescription medications were compared with respect to readability, number of drugs covered, completeness of drug monograph information, price, and other factors. Mean readability scores, reported as a reading grade level, ranged from 9.2 to 14.3. The number of drugs covered by these books ranged from 135 to 1,200. Monograph completeness scores were assigned by determining the percentage of information from a standard reference's drug monograph covered in each book. The lowest percentage completeness score was 21.4%, while the highest was 76.7%. Prices for the books ranged from $2.50 to $19.95. Regardless of the relative priorities placed on these factors, a consumer or health professional may use the objective and descriptive assessments of this study to make an informed decision when choosing among consumer-oriented sources of medication information.


Computerized management information system. One agency's experience.


A computerized tracking system for deinstitutionalized clients.


Doctors house calls: how a hospital operates this new program.


Heart hike.

Heart hike.


Developing trustees. Literature and video with value.


Med-card madness.

Med-card madness.


Capturing supervisor rating policies: a way to improve performance appraisal effectiveness.


Situational effects on the communication behaviors of pediatric residents. The variation in communication behaviors of pediatric residents in different interview circumstances was examined. Twenty-three residents were videotaped in three simulated counseling sessions. Two of the sessions entailed counseling a mother of a toddler with multiple handicaps during a well-child visit. The third, which took place between the other two sessions, entailed informing a new mother that her child has Down's syndrome. The residents' performances were evaluated using a subjective rating scale and an objective frequency count of behaviors. Analysis of variance demonstrated significant effects for both observation scales. Spearman correlations were not significant between any of the situations. The results suggest that residents' communication behaviors vary with the type of counseling situation.


Seminars for specific targets. Women's issues...shared with men.


Marketing health promotion.

Marketing health promotion.


Making advertising work. A checklist for hospitals.


Meeting the media.

Meeting the media.


Out-"spokesmen" physicians recognition.

Out-"spokesmen" physicians recognition.


What's in a name?

What's in a name?


Town meeting.

Town meeting.


Coloring book. Counseling and cheering burned kids.


Employee giving campaign.

Employee giving campaign.


Working with PR interns.

Working with PR interns.


Public relations: a marketing opportunity. What is it?


The colour-coded badge system.

The colour-coded badge system.


A glorious calendar.

A glorious calendar.


Hospital employee safety and health: current problems and practices. Part I. The problem.


Computer tracking systems.

Computer tracking systems.


Microcomputers and the safety and health professional.


Hospital employee safety and health. Part II.


The evolution of PPOs.

The evolution of PPOs.


Tips and warnings from the experts. What's the latest in malpractice?


What you should have in your group contract.


What's ahead in health care legislation?. Interview by C. Colburn Hardy.


Just who are the bad doctors?

Just who are the bad doctors?


What to do if you're denied staff privileges.


Senior companions: an unrecognized resource for long-term care.


The progressive patient care program: a referral model of long term care.


Investor-owned hospital chains apparently see psychiatric hospitals as boom area.


Minn. review panel helpful in cases of treatment refusal.


Trends in number of psychiatric hospitals, services, costs, staffing uncovered by NIMH survey.


Status of patients' rights to refuse drugs 'confused'.


Managing that managerial monster--power!


Wellness Center breaks all the rules--and breaks even within four months.


Promoting employees' health: are we doing all we could?


Maintenance cost control of high technology hospital equipment.


Accountability and slices of pie.

Accountability and slices of pie.


Radiology insurance programs: a manager's viewpoint.


Clancy of Yale.

Clancy of Yale.


On telling patients the truth.

On telling patients the truth.


The technique of breast-feeding. Patient education in primary care.


Balance of trade: Chicago's Northwestern Memorial Hospital teams profit-making with not-for profit foodservice.


Serving the seventies. Meal programs for the elderly, together or at home.


A modified single-breath DLCO apparatus. A modified apparatus for measuring the single-breath carbon monoxide diffusing capacity of the lung (DLCO) is described. The modification permits simultaneous measurement of all lung volumes and capacities. In a comparison of conventional and modified devices, no significant differences for the measures of DLCO and total lung capacity were found.


Blood gas proficiency testing.

Blood gas proficiency testing.


How formal appraisal systems work.

How formal appraisal systems work. The success of a respiratory therapy department depends on the performance of its personnel, and its managers are charged with ensuring that employees meet departmental expectations. One means to effect change is through a formal performance appraisal system.


Gottlieb Hospital's lifesaver menu improves patient diet.


Evaluating alternatives to insuring group health plans.


Self-study: organizational resource in staff development preparation.


Managing the nitrous oxide risk is no laughing matter.


Reminiscing: how it can help confused nursing home residents.


The clinical subject: adolescents in a cleft-palate clinic. The paper examines the format and some interactional dilemmas of outpatient consultations in a clinic for cleft lip and palate. Three problems are addressed. First, the adolescent patient's status as a 'consumer' is problematic: it is ambiguous whether they can be entrusted with decision-making on their own behalf. Second, there is the problematic status of parents' rights. Third, the policy implications of these problems are raised in relation to the conduct of 'child-centered' medicine. It is suggested that socializing the clinic may reinforce, rather than undercut, professional dominance.


Discourse processes and the social organization of group therapy sessions. The social organization of group therapy sessions held in a community mental health center is investigated by analysing transcripts of audiotaped and videotaped sessions as well as ethnographic data (field notes and interviews). After describing the structural (i.e. hierarchical and sequential organization of activities during sessions, discourse processes by which group members accomplish this structure are examined. Analyses of participants' communicative strategies provide insights into the cognitive and behavioral components of the interactive competence required of group members. In contrast to findings of previous research on group therapy, interactive control is found to be distributed among certain clients as well as the therapists.


Problems in the conceptual framework of patient satisfaction research: an empirical exploration. Survey research into patient satisfaction has been responsible for developing a number of related concepts concerning the ways in which patients evaluate the health care that they receive. Recently doubts have been expressed as to the adequacy of this approach for understanding how patients anticipate and respond to medical encounters. This paper reports a study of patients attending neurological outpatient clinics. The results suggest that the conceptual framework deriving from patient satisfaction research provides only partial and sometimes misleading insights into the perspectives of the patients studied. The paper concludes that patients' varying concerns with regard to their illness need to be more directly considered in explaining different responses to medical consultations. This approach enables a more sensitive evaluation of health care from the patient's point of view.


Moral problems and ethical issues in prospective human gene therapy.


The fetal patient and the unwilling mother: a standard for judicial intervention.


Hospital saves annual $52,800 with new lamps and ballasts.


Emergency lighting systems, codes may not be enough.


Even the sun needs help: a solar-assisted heat pump.


A model for linking families to their institutionalized relatives.


Computer committees can save money.

Computer committees can save money.


A view of the human resource function.

A view of the human resource function.


Evaluating hospital information systems.


Alcoholism treatment: surviving the transition.


The computer contract: good protection.

The computer contract: good protection.


Computer systems: installation and training.


Office automation: value for the hospital.


MIS and effective hospital management.

MIS and effective hospital management.


Corporate negligence: the encroaching cloud of hospital liability.


Forum. Two views in the debate over commercialized medicine.


Perspectives on medical records.

Perspectives on medical records.


The medical record manager as a supervisor.


Assessing the hospital manager: a tool for self-improvement.


The budget as a management tool.

The budget as a management tool.


Quality control circles as a management tool.


Quality circles in the hospital setting.


Assessment tools for evaluating human potential.


Liability for failure to obtain informed consent.


Written communication as an important management skill.


Quality control of diagnosis and procedure coding.


Projecting a professional self-image.

Projecting a professional self-image.


Mental Health Code revisions clarify confinement procedures.


Ethics and the hospital.

Ethics and the hospital.


Ethics vis-a-vis ethical behavior.

Ethics vis-a-vis ethical behavior.


Discoverability of peer review committee records: an update.


The synergy of fiscal systems and staffing requirements.


Meeting your legal obligations to monitor medical staff practice. There is often a fine line between what board members determine to be proper oversight of medical staff practices and what the medical staff perceives as improper interference with the private practice of medicine. The approach discussed in this article is designed to give both board members and physicians guidance in respecting one another's territory.


Emergency room drugs.

Emergency room drugs.


Organization, administration and the environment.


Development/public relations: a dialogue. Interview by Juliet George.


The importance of profitability.

The importance of profitability.


Why boards need fresh information, not warmed-over management reports. To exercise leadership, boards need information that is exclusively prepared to help them fulfill their unique responsibilities. This article examines, in view of our changing economic environment, what kind of information the board needs to receive, how often it should be forthcoming, in what format, and how to assess it.


Taking the mystery out of the consultant selection process. Underestimating the importance of the selection process for consultants can increase the hospital's chances of receiving unsatisfactory results. In this article, the author discusses techniques for ensuring that the hospital chooses the "right" firm for the "right" job.


Smooth sailing through board meetings: practical hints for new chairpersons. The author has some practical and useful suggestions for chairpersons to help keep board meetings running smoothly and efficiently, from the physical arrangement of the room to the formulation of and adherence to agendas.


Two more administrators' views of the top planning issues of 1984.


As I see it: duty to vote in the interests of the hospital.


Looking for a business partner? Shake hands with the medical staff. During these days of increased competition and dramatic changes in payment systems, pursuing business opportunities in cooperation with local physicians is becoming increasingly important. This articles describes the efforts of Health Central System, Minneapolis, to promote new partnerships with its hospitals' medical staffs at both the local hospital and the corporate level.


Private-pay patients: the key to financial success.


Nursing home promotes referrals from social workers.


The pharmacist in adult day care centers.


Elderly's retirement funds to replace government aid.


Medical publications: confusion over cuts.


Creating long-term pricing for continuing care centers.


A reimbursement alternative.

A reimbursement alternative.


Imaging technology--the vision and the reality.


When lawyers second-guess doctors.

When lawyers second-guess doctors.


Researchers find third of facilities slipping into 'red'.


U.S. Medicine interviews William E. Mayer. Interview by Nancy Tomich.


Perspectives. Doctors: how many are too many?


Medical ethics and hospital staff.

Medical ethics and hospital staff.


Designing for reduced operating costs.

Designing for reduced operating costs.


Towards expanded and collaborative hospital care.


Environmental and functional quality in hospital buildings.


Ward evaluation: St Thomas' Hospital, London, and subsequent developments.


Effective planning and management of hospital buildings.


An economical approach to the provision of hospital beds and the design of wards.


Hospital design in big cities: Moscow.

Hospital design in big cities: Moscow.


Do the laws on confidentiality obstruct hospital efficiency when EDP is introduced?


Data processing in the medical sector.

Data processing in the medical sector.


The Stockholm County Health Care System.


Older people: problem or resource?

Older people: problem or resource?


Humanistic and psychological aspects of acute geriatric hospitalization.


Hospital based helicopter programme: rationale and impact.


The Presbyterian Village North experience.


Health care in cities of the Third World: the situation and some ideas for low cost solutions.


Triangular concentrate--focus on an area health care system.


Local health initiatives.

Local health initiatives.


Development of city health services by an academic department.


Reorganisation of urban health and medical care.


Mingling decision making metaphors.

Mingling decision making metaphors. Organizational decisions provide conceptual playing fields wherein scientists adhering to rival theories based on different metaphors skirmish in-decisively. Organizational decisions, however, are also empirical arenas wherein practitioners espousing discordant theories-in-use reconcile their differences pragmatically. Practitioners' decision-making metaphors encountered while studying capital budgeting suggest how disjoint perspectives are assimilated and shifts from instrumental to symbolic actions are triggered. Implications for decision theories are discussed, and potential benefits of incorporating practitioners' knowledge into organizational science are considered.


Synergy, influence, and information in the adoption of administrative innovations. The adoption processes of two related administrative innovations in the private sector dealing with employee health are examined. Results of multiple logistic regressions using survey data on a sample of Illinois firms suggest that these two innovations are synergistically linked, such that the adoption of one increases the likelihood of the subsequent adoption of the other.


Criteria for grouping nursing subunits in hospitals. Data from 135 nursing subunits were used to identify a set of organizational variables that best explained the grouping of activities into nursing subunits in hospitals. Relatively strong support was provided for technology as a basis for grouping nursing subunits; characteristics of the hospital, including its type, size, and location, also were relevant.


Contextual model of leadership influence in hospital units. Using Kerr and Jermier's (1978) taxonomy of substitute and neutralizer variables, the contextual model indicates that the staff nurse's education, group cohesion, and work technology substitute for the head nurse's leadership behavior by having direct and indirect effects on job performance. The hospital's administrative climate appeared to neutralize leadership influence.


A longitudinal analysis of the antecedents of organizational commitment. From longitudinal data from 129 nursing department employees, organizational commitment was found to be antecedent to job satisfaction rather than an outcome of it. Furthermore, several other variables were found to be causally related to satisfaction but not commitment. Implications of unsubstantiated assumptions regarding causes of commitment are discussed.


The psychology of the withdrawal process: a cross-validational test of Mobley's intermediate linkages model of turnover in two samples. A study investigating the validity of Mobley's (1977) model of the intermediate linkages in the turnover decision process among employees working in two diverse settings yielded a pattern of results generally consistent with the model. However, except for commitment to the organization, regression analyses failed to double cross-validate either within or between samples.


The production and cost of ambulatory medical care in community health centers.


Equilibrium and disequilibrium in markets for general practitioners: new evidence concerning geographic distribution of physicians.


The state of the art of cost-of-illness estimates.


Economic cost of illness: decision-making applications and practical considerations.


Cost implications of hospital unionization: new estimates and a review of recent research.


Private medical practice in France: facts and policies.


Health insurance and the unemployed.

Health insurance and the unemployed.


Options, incentives and employment-related health insurance.


Some observations on the recent recession's effects on the Detroit area health care system. The author points out that a study of the impact of unemployment in the Detroit area produced several unexpected findings and that today it is not clear what effect the recession had on securing health care by unemployed persons or on utilization of emergency rooms or outpatient clinics as alternatives to customary medical medical services.


Can urban hospitals afford care for the poor?


Hospital participation in competitive markets for ambulatory care: implications for reimbursement policy.


Who shall live? Who shall die? "No treatment" orders and guidelines. For more than ten years the medical profession, the legal profession, and perhaps thousands of patients and their relatives have wrestled with the issues of therapy withdrawal, removal of life-sustaining machinery when recovery is hopeless. This major article presents a wide range of insights useful for the individual physician, the hospital governing board, the nurse as well as for policy and lawmakers who confront this issue.


Cultural background and medical care.

Cultural background and medical care.


The financial structure of urban and suburban hospitals.


The challenge: designing buildings for older Americans.


A unique hospital unit for total care patients.


A seminary becomes a residence and community for the elderly.


Old buildings have something new to give to the elderly.


Recruiting children from alcoholic families into a peer education program.


Elder cottages. A new feature on the housing horizon.


The growing link between health policy and the nation's economy.


Epidemiological Bulletin 2. Changes in alcoholism treatment services, 1979-1982.


The special environmental needs of magnetic resonance. The addition of a magnetic resonance (MR) unit to a hospital radiology environmental poses many unique considerations. Large magnetic fields present health and safety considerations as well as a hostile environment for data recorded magnetically. Radio-frequency shielding is necessary to eliminate a source of background signal that interferes with patient examinations. Magnetic shielding may be necessary in some instances to prevent low-level magnetic field exposure of persons with artificial cardiac pacemakers. Superconducting magnets are heavy and large and may give off large amounts of helium which can temporarily replace the air in the magnet room. Possible solutions to these environmental requirements are presented.


Computers in radiology. Interfacing with peripheral devices. A fundamental part of building a computer system is control of and communication with peripheral devices. With use of graphics display terminals, video image digitizers, and array processors as examples, the basics of peripherals are discussed as they affect radiologic applications.


Book-of-the-Year Award encourages members to keep learning.


Roper sparks a storm. McClelland Report ruffles feathers.


Row brewing at Royal Brisbane.

Row brewing at Royal Brisbane.


Sweeping change to mental health services proposed.


The FTC's role in health care.

The FTC's role in health care.


The status of surgical manpower.

The status of surgical manpower.


Question: who will play God?

Question: who will play God?


Health promotion facilities for company use.


Antitrust law and medical staff decisions: can a hospital conspire with its medical staff?


Competition between physicians and limited licensed practitioners: some issues and implications.


Matters of faith and death. Courts move against parents who deny children medical care.


A fitness program that was designed to fit.


Film storage and retrieval systems. Room for one more? Since storage space, silver, and personnel time are each precious commodities, the need for solutions to problems in film storage and retrieval is great. In this article, radiology administrators and technologists describe retrieval systems in use at their institutions and discuss the desirability and advantages and disadvantages of microfilming. The technique of digital image storage, which is expected to have wide use once the technology is fully developed, also is described.


Disability management key to cost savings of 3M.


The multiple roles of business in efforts to cut health costs. Interview by Jane Stein.


Coalition provides small business clout to cap costs, share corporate costs.


A continuum for evaluating risks and benefits of ionizing radiation. Most texts and studies analyzing risks and benefits of ionizing radiation use a "risk-comparison" method in which the benefits of ionizing radiation are not considered. This article describes a method designed to weigh both risks and benefits.


Common woes for Australia and NZ.

Common woes for Australia and NZ.


Corporation plays major role in development of PPOs.


Lessons learned from a PPO. Problems with third party administrators caused a provider based PPO to reorganize.


Minnesota's coalition style: broad based, purchaser perspective.


The "selling" of an HMO.

The "selling" of an HMO.


Alternative delivery arena evokes mélange of approaches.


Questions employers need to ask about preferred arrangements.


A bargaining position: cut costs, not benefits. Interview by Jane Stein.


Military, employers share health care cost containment concerns, reform strategies.


Wisconsin health care reforms blend tighter regulation and competition.


Assistance programs have broader scope to include a range of corporate problems.


Antitrust risks posed by PPO development activity can be avoided with care.


Alternative delivery systems: what are the risks?


Alternative and standard delivery should focus on effective care, not costs.


Across-the-board price control seen a threat to competition.


Creative regulation designed to stimulate competition.


All-payer systems pose both promise and problems.


Is rationing by age ever morally acceptable?


Building blocks for health care reform.

Building blocks for health care reform.


Coalition spirit in Iowa cements health system reforms.


Effective data review holds key to cost control. Interview by Jane Stein.


First round success with rate-setting leads to renewed state interest.


Applying antitrust laws to hospital acquisitions, mergers can be difficult.


Testing the waters with competition vs. regulation.


Is there a market for expanded health benefits options for small business?


A new war on health costs.

A new war on health costs.


Medicare program: revised criteria for defining a skilled nursing facility when determining spell of illness status--HCFA. Notice of HCFA ruling. This notice announces a HCFA Ruling that establishes revised criteria for defining a skilled nursing facility under section 1861(j)(1) of the Social Security Act when determing a beneficiary's spell of illness status.


Privacy Act; exempt record system--HHS. Final rule. The Office for Civil Rights of the Department of Health and Human Services maintains a system of records entitled "Complaint Files and Log. HHS/OC/OCR." The Department is exempting this system from certain provisions of the Privacy Act, 5 U.S.C. 552a. The exemption is authorized by subsection (k)(2) of the Privacy Act, which applies to investigative materials compiled for law enforcement purposes. The Office for Civil Rights (OCR) is authorized to gather information for civil and administrative law enforcement purposes pursuant to several statutes requiring nondiscrimination in programs or activities receiving Federal financial assistance. In order to maintain the integrity of the OCR investigative process and to assure that OCR will be able to obtain access to complete and accurate information, the Department is exempting this system, under subsection (k)(2), from the notification, access, correction and amendment provisions of the Privacy Act.


Federal Old-Age, Survivors, and Disability Insurance; coverage of employees of private nonprofit organizations--SSA. Proposed rules. These proposed rules implement sections 102, 321, 322 and 323 of Pub. L. 98-21 (the Social Security Amendments of 1983). Generally, these provisions: (1) Mandatorily cover for Social Security purposes employees of private nonprofit organizations; (2) Provide additional Social Security coverage for certain work performed outside the United States (U.S.); (3) Provide coverage under the Social Security program for certain foreign earned income; (4) Provide special Social Security insured status requirements for certain nonprofit organization employees covered as a result of these amendments; and (5) Provide Social Security coverage for employment and self-employment that is identified as "covered" for purposes of title II of the Social Security Act (the Act) by the provisions of a totalization agreement between the U.S. and another country.


Many employees hike deductibles, premiums.


Stouffer says it is not seeking PPO discounts.


Few employers say they obtain utilization data.


PPO only part of employers' cost-control effort.


Benefit sleuths discover bogus health claims.


Tips and techniques dating of multiple-dose vials.


A performance appraisal system for clinical pharmacy services.


The National Association for Home Care 1984 position paper on legislative and regulatory issues. A blueprint for action.


Senator's Cup Tennis Tournament benefits home care plans of Arizona's Hospice of the Valley.


Controlling antimicrobial use in the hospital: a demonstration study on pneumonia.


Elder abuse: the hidden American scandal.


Government primer.

Government primer.


Marketing hospital services. The time has really arrived for the industry to enter the arena.


Ethical considerations in research with children. The author discusses the nature of research in a therapeutic context, the documentation required by a review committee, the problem of proxy consent for children and other 'incompetent' individuals, the balance of risk-to-benefit, and the protection owed by society to its most vulnerable members. Opposing views are presented regarding the ethics of involving children in research. The difficulty of assessing risks and benefits is acknowledged while upholding the right of parents and guardians to receive full disclosure of information upon which to base consent. There is a role for serious ethical inquiry in the search for agreement on what is right. Life implies relationships and mutual obligations. Research involving children raises ethical questions for the physician-researcher, the parents, other hospital personnel and society at large.


Know thyself: the starting place for systems planning.


Establishing a clinical pharmacokinetic service for gentamicin in a community hospital. To assess the feasibility and acceptability of a pharmacy-based clinical pharmacokinetic service for gentamicin, serum gentamicin levels were measured by radioimmunoassay in 44 patients hospitalized during a three-month period in an acute-care general hospital. Serum levels measured pre- and post-infusion were used to estimate pharmacokinetic parameters and optimum dosage regimens for individual patients. Based on serum level measurements of gentamicin, 30% of patients required no dosage adjustment, 23% an increase in dose and 47% a decrease in dose. Of the 30 changes recommended, 83% were implemented by physicians. Monitoring serum levels and adjusting dosage reduced the number of patients with sub-therapeutic and toxic serum levels. Adjusting dosage with the aid of serum levels appeared to be most useful for the elderly patient or the patient with impaired kidney function. Initial choice of dosage regimens for patients would be improved by appropriate use of the Hull and Sarubbi dosing nomogram (with certain modifications) or method of estimating pharmacokinetic parameters. The Hull and Sarubbi method was considered preferable to the dosing recommendation of 1.1 mg/kg at an interval of eight times the serum creatinine value. Excellent physician acceptance of a gentamicin serum level monitoring service was demonstrated in terms of the physician's usage of the service and implementation of the pharmacist's recommendations. A multidisciplinary approach involving medicine, pharmacy, nursing and laboratory staff was essential for successful operation of the pharmacokinetic service. However, the responsibility for the development and overall coordination of the pharmacokinetic service should remain with the pharmacist.


Management's perspective on medical office computerization. Part II.


Implementing office automation in the healthcare profession.


Cart exchange control: a case history.

Cart exchange control: a case history.


Burnaby Hospital food management system--a case history.


Health education is a key to lowered health costs.