The P & T Committee Part 2: involvement by pharmacy, medical, and nursing personnel. An active and enthusiastic participation by all members of the P & T Committee greatly improves committee effectiveness and productivity. Specific responsibilities for the physician, pharmacist, and nursing members of the committee are presented and discussed. In addition, the importance of open communication among committee members is reviewed. Examples of problems that may develop and suggested solutions are also presented.


The impact of an evaluation of hospital accreditation. One of the conditions under which public hospitals in New South Wales were allowed to participate in the Hospital accreditation program was that the program itself be evaluated. The evaluation was funded by the W.K. Kellogg Foundation of Battle Creek Michigan, USA. This article describes the principle results of the evaluation and assesses the impact that the evaluation had on the program and relevant decision makers.


Patterns of doctoral education among nurses and the development of nursing as a profession.


Twenty-four hour pharmacy service in hospitals with less than 300 beds--part 1.


Using a microcomputer to support an I.V. admixture service. Acquisition of a microcomputer and a high-speed printer enabled the authors' pharmacy to automate the production of I.V. additive labels. This automation freed 0.5 FTEs of pharmacy personnel time for other duties. This low-cost microcomputer and printer has proven to be sufficient equipment for the support of an I.V. admixture program with time-saving and cost-saving applications.


Hospital labor cost savings in dispensing analgesics: controlled versus noncontrolled. Indications for some nonsteroidal anti-inflammatory drugs as analgesics in mild to moderate pain have contributed to their increased usage in hospitals. Since controlled substance drugs with lower acquisition costs have been the mainstay of analgesic therapy, it has been questioned whether there are possible cost of distribution advantages in using a noncontrolled substance instead of a controlled substance analgesic. The difference in labor costs involved in dispensing the oral noncontrolled substance, ibuprofen, as compared to the oral controlled substance, acetaminophen with codeine, was investigated using time and motion study techniques. Results indicate that at Bronson Methodist Hospital, there was a +0.79 labor cost savings involved in the daily dispensing of six doses of the noncontrolled substance versus the controlled substance analgesic.


Uses of ambulatory health/mental health utilization data in organized health care settings. A follow-up assessing uses of findings from NIMH-supported research on health and mental health services utilization in organized health care settings revealed a range of applications across the study sites. The research, conducted primarily for national policy purposes, had an impact on study sites in the following areas: clinician perceptions and attitudes about mental health services provided; program directions; fiscal policy; and further related research. Research team composition and dissemination of study findings are discussed in relation to the applications made.


Office automation technology and functions: an overview. Office automation is the progeny of technological imperatives coupled with bureaucratic realities. Advances in computer, photographic, and telecommunication technologies have made it possible to collect, edit, store, distribute, and copy documentary information at ever decreasing cost. The need for training, acceptance, cooperation, and effective use of the technology has filtered out many proposed systems. This article describes the opportunities and limitations inherent in the technologies, focusing on media conversions and equipment compatibility. It also describes the differing needs of convenience users and dedicated users, document preparers, and archivists. The systems that are emerging for use within organizations are compared to systems for use in communication between organizations.


Characterization of the research papers of U.S. medical schools. An investigation of the relationship between National Institutes of Health (NIH) funding and the quantity and nature of biomedical publications is reported for 120 U.S. medical school complexes. A correlation of 0.95 was found between the amount of NIH funds received and the number of biomedical publications from the medical schools. Medical school ranks based on bibliometric measures were found to correlate at the 0.80-0.90 level with ranks based on peer assessments of the schools. The characteristics of the medical school papers varied with the type of school. The average citation influence per paper increased with the publication size of the schools. This was true even when factors such as public versus private control, geographic region, average research level (from basic to clinical), and subject emphasis were controlled. The positive relationship between number of papers from a school and its citation influence holds within individual research levels and within subfields.


Human communication needs and organizational productivity: the potential impact of office automation. Much of what white collar workers do in offices is communication-related. White collar workers make up the majority of the labor force in the United States today and the majority of current labor costs. Because office automation represents more productive structured techniques for handling both written and oral communication, office automation therefore offers the potential to make organizations more productive by improving organizational communication. This article: (1) defines communication, (2) identifies the potential benefits to be realized from implementing office automation, and (3) offers caveats related to the implementation of office automation systems. Realization of the benefits of office automation depends upon the degree to which new modes of communication may be successfully substituted for traditional modes.


Intervention in a loosely organized system: an encounter with non-being.


Old and new models for office automation. The emerging generation of office automation systems combines new and existing software and procedures. While managers may be able to select from a broad array of software tools, they may also be required to use certain others. This article discusses organization design as the context for office automation; mature computer-based systems as one application of organization design variables; and emerging office automation systems as another application of those variables. The article concludes that Management Information System models developed for mature systems may be helpful where the use of software application is required for the individual worker; diffusion of innovation models recently developed for computing systems may be helpful where the type of software is optional for the individual worker.


Nurse scheduling with a microcomputer.

Nurse scheduling with a microcomputer.


Family practice after-hours telephone use.


Measuring patient waiting time in a practice setting: a comparison of methods.


Economic analysis of a dental hygienist in the hospital.


Ambulatory cardiac services in a free-standing facility.


The organization of a pain center.

The organization of a pain center.


The Hazard Infant Care Project: problems of innovation and continuity.


Health policy implications of treatment differences among physicians.


Hospital-based ambulatory care: organizational issues for academic health centers.


Looking at consumer relations Minnesota style.


Community benefits from resident fund-raiser.


Community relations in a public non-profit nursing home.


Legislative Work Day gives policymakers first-hand look.


Volunteer escorts smooth resident move.

Volunteer escorts smooth resident move.


A reporter's view on nursing homes. Interview by Michael R. Codel.


The ombudsman and the nursing home: a healthy alliance?


A consumer perspective.

A consumer perspective.


Nursing home design for community relations.


The physician's role in caring for the elderly.


The what and why of consumer relations.

The what and why of consumer relations.


At Good Samaritan, quality comes first.

At Good Samaritan, quality comes first.


Consumer advocates and nursing homes: a success story.


The challenge of organized advocacy.

The challenge of organized advocacy.


Grandparents Day.

Grandparents Day.


Toward a working partnership.

Toward a working partnership.


The proper way to live: remarks on the teaching of hospital administration.


Epidemiology: application to health services.


A consultant's perspective on needed executive behavioral modifications and health administration course content.


Employment patterns of baccalaureate health administration program graduates. Baccalaureate education for health administration has a rather short history. However, the growth in both the number of programs and graduates indicates that it is an established concept. The data base provided by the survey of baccalaureate graduates will be instrumental in the next phase of the AUPHA project: the identification of academic programmatic structure and content necessary to provide the foundation of competency for baccalaureate health services administration education.


The role of research in health administration education.


Alternative compensation incentives for stimulating improved productivity.


State of the art in health care management simulation games.


Review of professional society role delineations for health services administration curriculum design applications.


Reorganizing the Latin American health sector: a contribution to education in the administration of health services.


Health planning education: a study of its current status.


Health administration education.

Health administration education.


Professional education.

Professional education.


Computer management of prehospital information.


The diabetic patient. New methods of control bring fresh hope.


Back to basics. Measuring the effects of continuing education.


Picking a winner. Candidate selection process for paramedic training.


Billings, collections and accounts receivable. Part 2.


Cultural considerations.

Cultural considerations.


System status management. The strategy of ambulance placement.


Creating financial stability. Part 3.

Creating financial stability. Part 3.


Characteristics of the extended care patient in a VA neuropsychiatric medical center.


Enhancing long-term care education by building relationships between university faculty and administrators.


Traveling dentistry.

Traveling dentistry.


A fund raising protocol for augmenting nursing home revenues.


Microfilm and the law.

Microfilm and the law.


Online COM catalog to revolutionize library service and efficiency.


Project ELF (Eliminate Legal size Files): the 25% solution to business expenses!


The economics of information processing.


SOM: a redefinition of a concept and a market.


Focus on human factors when managing change.


The impact of digital storage on micrographics storage.


The nursing home resident: some legal considerations.


Micrographics standardization in the United States.


The grapefruit diet.

The grapefruit diet. According to major research studies, 50 percent of all distributed data processing is really distributed document delivery. Up to 70 percent of all telephone calls do not reach the intended party, resulting in what has been aptly called, "telephone tag." Electronic mail is a rapidly emerging technology using computers and telecommunications networks to transmit notes, messages and documents instantaneously. Online information systems for document management, distribution and retrieval is an area of electronic mail far more powerful. Computer teleconferencing, as it is often called, allows for ongoing meetings online with persons from remote locations without regard to time zone limitations. This article will focus on the definitions of computer teleconferencing and other new "online" technologies, and how they will impact document development, management and distribution. It is based on the author's presentation at the 1983 NMA Annual Conference & Exposition in Philadelphia.


Selling new technologies to top management.


The user-vendor partnership: a successful marriage of convenience.


Electronic filing in the '80s.

Electronic filing in the '80s.


Office automation . . . the human equation.


Religious mainstreaming of mentally retarded clients into the community.


A psychological and faith approach to grief counseling.


Standards: a view from the past and prospects for the future.


Pastoral initiative: why wait for George/Georgia to do it?


An analysis of pastoral counseling supervisors: their identities, roles and resources.


Putting a price on radiation.

Putting a price on radiation.


How nonprofits grow: a model.

How nonprofits grow: a model. When nonprofit organizations operate in a field of service that might otherwise be provided by government or by for-profit organizations, such as schools, hospitals, or museums, their decisions on the type and amount of services to be delivered are motivated by factors that are quite distinctive. Because they must operate on a break-even basis with revenues raised on a voluntary basis, nonprofit organizations typically take on activities from which they derive no satisfaction in order to subsidize activities that they regard as of higher value. As a result, the mix of services they offer and the charges they impose will generally be quite different from those of a government institution or a for-profit organization.


Why most private hospitals are nonprofit. In recent decades, restrictions that have been imposed on hospitals organized for profit have served to restructure the industry, generating a constant trend toward nonprofit organizations. Small proprietary hospitals in particular have disappeared while corporate chains have come to dominate what is left of the for-profit hospital sector. The trend toward nonprofit hospitals is not explained by the failure of the health service markets and is not the result of a desire to serve the public interest more effectively. Although a number of arguments have been advanced to explain the shift, the hypothesis that seems most consistent with the existing evidence is that the nonprofit form of organization serves most effectively to strengthen the restrictive character of the market for physicians' services and thereby to serve the individual economic interests of the physicians.


Public or private health services?

Public or private health services? For many years economists writing on the delivery of health services dusted off the traditional promarket analyses of textbooks and applied them uncritically to the health care industry. Specialists in health care today are far more cautious. From the medical side there has been an increasing interest in the economic implications of health care organization and medical practice. Good research drawing on the skills of economists and other specialists is rapidly growing. This research offers little support either to those who reason abstractly from a market ideology or to those who are uncritically committed to socialized health care.


Social mobility and the interpretation of social class mortality differentials. The discussion of health inequalities in Britain (e.g. in the Black Report) has been conducted largely on the basis of social class mortality differentials measured by achieved social class and not by social class of origin. It is shown in this paper that social class mortality differentials by achieved social class are not invariant to the rate of social mobility and that the use of them is likely to result in a biased measure of trends in health inequalities when the absolute rate of social mobility varies over time. It is further shown that if, as is likely, health status is a factor systematically affecting the probability for an individual of upward or downward social mobility, then an increase in the rate of social mobility may well result in constant or widening social class mortality differentials by achieved social class even if the differentials are narrowing when measured by social class of origin. It is claimed that this process may well explain why the observed social class mortality differentials, which are measured by achieved social class, have not fallen in Britain during the post-1945 period.


The hospital accident and emergency department: what is its role? The problem over the use of accident and emergency departments is portrayed in terms of a typical conflict between professional and lay needs. However, in contrast with the more common image of the professional hospital doctor successfully developing both structural and interactional strategies for maintaining professional dominance over the patient, it is argued that the structural characteristics of the accident and emergency department pose control problems for the profession. These control problems have been exacerbated by developments in other areas of the health service and have led to the development of policies which emphasize both clinical and social elements of patient need. Although there is apparent recognition by providers of the importance of taking into account patient need, the proposed policies are based on professional images of how patients 'ought' to use the service. What is clearly lacking is comprehensive data on how the public and the community wishes to use the service and how they actually use the service. Data from national and local studies on patient felt needs and patient demand for the hospital accident and emergency departments are presented and the implications for policy are discussed.


Education and health care: does the industrial model still exist?


Third party insurance follow up.

Third party insurance follow up.


A matter of semantics.

A matter of semantics.


Business services procedures manual.

Business services procedures manual.


Employment discrimination in management by objectives systems.


Competing for health care dollars.

Competing for health care dollars.


General compensation policy.

General compensation policy.


Start priming for the fight to control our fees.


Nurses don't get mad. They get even.

Nurses don't get mad. They get even.


Power for medical instruments.

Power for medical instruments.


Medical Electronics buyers guide 1982, Part 4: Balances and microbalances, blood cell counters, blood chemistry, blood coagulation, blood gas, blood pH, heart rate meters, hematocrit, recorders.


Stimulator enjoined from interstate commerce as "relaxacizor", without medical supervision.


Ultrasonics for medical diagnostics. Part 6--Quality assurance.


Ambulatory cardiac monitoring.

Ambulatory cardiac monitoring.


Power protection for biomedical equipment.


Leprosy--a physical disease with a mental problem.


Stress management. What do you do to relax? Stress has been identified as a leading cause of disease in our society. The dynamics of the healthcare administration profession cause managers to be easy victims of this contemporary disorder. Many people realize that an antidote to stress is leisure-time hobbies. To find out what managers do with their leisure time, MGMA conducted an informal poll of Association members. Their responses were enlightening, interesting, and sometimes amusing. Some managers share similar interests, while some are quite unique.


Councils for Health Promotion.

Councils for Health Promotion.


Accounts receivable post discharge procedure.


Computer output microform catalog readers.


Rx for those hiring headaches.

Rx for those hiring headaches.


Pharmacy needs "accountability statutes".


Study confirms efficacy of helicopter ambulances.


The pharmacist as prescriber: update on a California experiment.


Why medical groups are in the best position to control costs. Part 1.


'Baby Doe' hotline signs come down after ruling.


Physicians compete in shade of hospital satellite clinics.


The selection of cathode ray tube (CRT) terminals for library applications.


The bibliographic utilities: progress and problems.


Z--from theory to practice.

Z--from theory to practice.


Collision course.

Collision course.


A "QUEST" for productivity.

A "QUEST" for productivity.


Productivity--mandate for management.

Productivity--mandate for management.


Managers rate their skills.

Managers rate their skills.


A branch clinic planted firmly in the community. LP Medical Specialists decided to open a branch clinic in response to pronounced community need. While building a branch clinic facility was initially intended for future implementation, the community's immediate need prompted the group to establish the branch in a temporary facility. By leasing a vacated school building which was transformed into a medical clinic through the addition of demountable partitions, the group was able to expand its services and establish its image as a caring provider in the community--all while justifying expenditures that would not detract from the group's plans to build a future permanent facility.


Emergicenters. Opportunity or threat?

Emergicenters. Opportunity or threat? Political, social, and economic pressures on the healthcare industry are resulting in the development of new approaches to the delivery of quality health care to consumers. One of the newest responses to these change forces has been the development and proliferation of freestanding emergency centers. This article examines the underlying causes behind their development, describes the distinct services and strengths of the "emergicenter" concept, and shows how medical group practices can turn a potential competitive threat into an opportunity for future growth.


The nonproductive senior employee.

The nonproductive senior employee. A common and difficult problem for medical group managers is what to do with the long-term employee who is suffering decreased productivity. In light of the legal, humanitarian, cost, political, and many other considerations of the situation, the author discusses the available alternatives--retraining, transfer, early retirement, and termination.


Team management.

Team management.


Awakening to office automation.

Awakening to office automation.


Business office productivity: a practical program for improvement.


Delicate delegation.

Delicate delegation.


Landscape planning for good looks and affordable maintenance. Attractive landscaping can contribute considerably to a medical group's overall image. There is more that goes into landscaping property than selecting greenery that suits the design of the building. Landscaping is a living thing that must be maintained. Unless it is properly planned and attended, the expensive greenery can become an eyesore.


Significance of earnings gulf between fee-for-service and HMO physicians questioned.


Theory "Z" or "E"?

Theory "Z" or "E"?


How to cut costs--tips for all times.

How to cut costs--tips for all times.


Don't buy digital archiving systems yet, but keep tabs on developments.


Healthcare heads for revolutionary changes in organization, delivery.


Hospital boards should abandon medical staff 'self-governance'.


CFO post may become pivotal.

CFO post may become pivotal.


Prepare for 'sobering' layoffs.

Prepare for 'sobering' layoffs.


Georgia may slam on the brakes to MedFirst's booming business.


Network expands groups' markets.

Network expands groups' markets.


Novice risk manager becomes a pioneer.

Novice risk manager becomes a pioneer.


Buying role gains importance.

Buying role gains importance.


Vendors shift software to micros.

Vendors shift software to micros.


Dietary units cite purchasing, delivery in efforts to pare costs.


Hospitals must mint attractive pay plans that also comply with tax code.


Court shields 'blindfolded' records.

Court shields 'blindfolded' records.


Future looks bright for 4 companies issuing stock to finance expansion.


Tax changes may hike equipment costs.

Tax changes may hike equipment costs.


HHS task force calms Congress.

HHS task force calms Congress.


Preferred providers: aggressive payers push Twin Cities hospitals to the wall for discounts.


Companies spurn providers' PPOs.

Companies spurn providers' PPOs.


CA's rush to form PPOs shows move toward 'pure and simple' competition.


Clinics prepare growth strategies to strengthen their magnetic pull.


Health care at critical junctures.

Health care at critical junctures.


Experts see declines in X-ray good outlays.


Marketing hospitals to the public.

Marketing hospitals to the public.


The relationship between productivity and cost containment.


Productivity and the voluntary effort.

Productivity and the voluntary effort.


The place of marketing in hospital management.


New approaches in the urban setting.

New approaches in the urban setting.


The concept of productivity.

The concept of productivity.


Productivity through sharing.

Productivity through sharing.


Increasing patient satisfaction.

Increasing patient satisfaction.


The new medical arts approach.

The new medical arts approach.


Marketing to physicians.

Marketing to physicians.


The future of vertically linked organizations.


Medical center innovations.

Medical center innovations.


Institutionwide productivity measures.

Institutionwide productivity measures.


Productivity and the administrator: an agenda.


The importance of the market.

The importance of the market.


Improving buyer acceptance.

Improving buyer acceptance.


The administrator and productivity.

The administrator and productivity.


Marketing the hospital to government agencies.


Marketing: an emerging management challenge.


Health care containment works, survey shows.


Lawmakers act on jobless health care and high costs.


Mental health cover not costly: Rand study.


House will vote on bill to provide health insurance for unemployed.


Influencing the employee relationship.

Influencing the employee relationship.


A hospital reorganization examined.

A hospital reorganization examined.


Interdepartmental relationships and the patient business office.


The network. A hospital positioning strategy.


The pathologist and the hospital clinical laboratory. In this article, the author conceptualizes problems in pathology through the perspective of a wide angle lens. He explores how the role of the clinical pathologist evolved into what it is now as well as what, in his view, it ideally should be. The author encourages his peers to analyze, critique, and comment on the opinion he sets forth in the following pages.


Maintaining control of accounts receivable.


Comments of the American College of Pathologists on proposed regulations on payment for physician services in institutional practice.


Standards for laboratory accreditation.

Standards for laboratory accreditation. After years of review by all of the CAP resource and other committees and councils, the Commission on Laboratory Accreditation developed a revised Standards for Accreditation of Medical Laboratories (Last revision, 1974). They were approved by the House of Delegates and, in the February issue of Pathologist '82, comments were solicited from the entire membership. Presented in the following pages are the final Standards for Laboratory Accreditation, which the Board of Governors adopted as CAP policy at its Sept. 2-4 meeting in Traverse City, Mich.


Metamorphosis of a dinosaur or the future role of the clinical pathologist. Proposing that pathology reorganize, the author introduces a role model for clinical pathology that contains skills and capabilities not currently offered in the clinical practice of medicine. This proposed rebuilding of a clinical discipline, to avoid continued degradation of the pathologist's role in the practice of medicine, will require teaching institutions to instill a new concept of clinical pathology, and the author pinpoints the tool that will be required to make this urgently needed transition to a new type of practice.


Can the laboratory director find the pathologists he needs? Is the pathologist seeking a job the kind of pathologist the laboratory director wants to hire? The author of this article emphasizes that all pathologists, not just residency training program directors, must be aware of changing needs if new pathologists are to possess the necessary qualifications for practice in the 1980s and 1990s.


Avoiding legal challenge.

Avoiding legal challenge. Protection from medical lawsuits requires that pathologists and laboratory staff adhere to certain standards and policies. Moreover, at this crucial time for pathologists, it is important that those who wish to develop a clinical consultant practice understand the additional factors that become relevant. The author discusses the physician-patient relationship, including informed consent, emergencies, patient records and confidentiality, and offers some general recommendations.


Competition for the health dollar: the pathologist's share. Price competition in health care services is the wave of the future. Undeniably, the rate of increase in health care costs must be reduced. Federal and state regulations designed to contain these costs have not proven effective. In this article the author explains why he believes open competition is the solution to this critical problem, and how Public Law 97-248 will help bring about this movement.


Supply and demand: how many pathologists are needed? Three different approaches have been used to determine what the supply and demand of pathologists will be in future years. Reviewed in this article are the three manpower studies and the surprising results they yielded.


View of the young pathologist: a wavering future. What will be the fate of future generations of hospital-based pathologists? In the next few years, the author of this article foresees a new breed of MD emerging from the laboratory. This up-and-coming pathologist must be a skilled practitioner of medicine, yet one who wears many hats. He must have earned the respect of his clinical colleagues, kept abreast of the rapidly changing technology at his disposal, and discovered a balance for the role pathology must play for the patient and society.


Survival of a specialty.

Survival of a specialty.


Alliance--one response to non-profit needs.


Associations tomorrow--educators or brokers?


Acquisition alternatives for capital equipment. Today, with the high cost of laboratory equipment and the ever-increasing rate of obsolescence, it is important for laboratory directors to be aware of the alternatives for acquiring capital equipment. The author of this article reviews five mechanisms for acquiring capital equipment for hospital laboratories and discusses advantages and disadvantages of each.


Annual report of a pathology department. In this article, the author explains the management and public relations benefits of the Annual Report, who should prepare which components, and what professional, technical, and financial information each component of the report should contain.


Focusing on the laboratory, not the computer. Much time and effort is spent comparing laboratory computer systems; the process is not unlike that of shopping for an automated chemistry analyzer. But the authors believe too little effort is expended in examining and understanding the laboratory functions that are to be computerized and, as a consequence, computer purchases fail to reach expectations. Here, they emphasize the importance of evaluating laboratory functions, particularly the area of communication and record keeping.


Brooklyn Oncology Patient Education Program.


Helping patients accept personal responsibility.


Challenges and prospects in cancer patient education.


Information processing: the role of memory.


Status of patient education: notes from the trenches.


Patient education: specialty or sub-discipline?


Anticoagulant pt ed.

Anticoagulant pt ed.


Self-efficacy theory.

Self-efficacy theory.


Starting a patient newsletter.

Starting a patient newsletter.


FECs offer high quality care and convenience.


Can't find a doctor? Try an ambulatory care center.


Why MedFirst Physician Care is best for you and your family.


Here's what an independent nurse practitioner can offer.


Need family-oriented care? Try a family practice center.


A hospital emergency department is still best for acute care.


Why informed consumers are choosing HMOs.


What's new in CT scanning.

What's new in CT scanning.


Individual health counselling and education: emerging directions from current theory, research, and practice.


National needs for support of categorical programs of patient care and patient education.


Using attitudes and subjective norms to predict pharmacist counselling behaviors. This field study examines the applicability of the central components of Fishbein and Ajzen's model for the prediction of behavior to the medication counselling activities of community pharmacists. The findings from a sample of 40 pharmacists provide support for the attitudes-subjective norms model. Both the attitude and subjective norm measures are significant predictors of behavior for verbal instruction provided and the length of encounter time. Each of the other behaviors examined--written instruction provided, monitoring activity, and pharmacist approachability--is weakly to moderately influenced by one of the two independent variables.


Compensation and benefits: prescriptions for reducing health care costs.


Recruitment.

Recruitment.


Let management development score for your organization.


Communicating through the news media.

Communicating through the news media.


Preventing and defending EEO charges.

Preventing and defending EEO charges.


Job application forms: a hazardous employment practice.


The other side of the smoking worker controversy.


Realities of successful employee discipline.


Developing a readable employee handbook.


The design and evaluation of alternative work schedules.


A primer on self-funding health care benefits.


Worksite health promotion can be cost-effective.


Morale management.

Morale management.


Trade-off analysis finds the best reward combinations.


TEFRA: how employers plan to cope with changes.


A do-it-yourself guide to group problem solving. The use of QC (quality control) circles and other group problem-solving techniques has been hindered by a general lack of group-process skills among managers and prospective group leaders, according to author Ernesto Poza, president of E. J. Poza Associates, Inc. Thus many organization feel they must hire consultants to help implement group processes--an expensive prospect indeed. As he explains here, however, the author has developed a five-step do-it-yourself approach that will enable employee groups to solve organizational problems on their own. With the aid of his step-by-step explanation, human resources managers should gain enough "expertise" to use this approach themselves and to train others to use it. The steps include problem identification, brain-storming, cause-and-effect analysis, force-field analysis, and action planning and implementation.


Strategies for resolving conflict: their functional and dysfunctional sides. Conflict in the workplace can have a beneficial effect. That is if appropriately resolved, it plays an important part in effective problem solving, according to author Michele Stimac, associate dean, curriculum and instruction, and professor at Pepperdine University Graduate School of Education and Psychology. She advocates confrontation--by way of negotiation rather than brute force--as the best way to resolve conflict, heal wounds, reconcile the parties involved, and give the resolution long life. But she adds that if a person who has though through when, where, and how to confront someone foresees only disaster, avoidance is the best path to take. The emphasis here is on strategy. Avoiding confrontation, for example, is not a strategic move unless it is backed by considered judgment. Stimac lays out these basic tenets for engaging in sound negotiation: (1) The confrontation should take place in neutral territory. (2) The parties should actively listen to each other. (3) Each should assert his or her right to fair treatment. (4) Each must allow the other to retain his or her dignity. (5) The parties should seek a consensus on the issues inconflict, their resolution, and the means of reducing any tension that results from the resolution. (6) The parties should exhibit a spirit of give and take--that is, of compromise. (7) They should seek satisfaction for all involved.


Retrenchment: layoff procedures in a nonprofit organization. One of the most unsettling experiences that human resources and other managers must face is a large-scale employee layoff. Authors Robert Fuller, national director of personnel, Cassandra Jordan, assistant director of personnel, and Robert Anderson, employment and training manager--all at the Legal Services Corporation--show how careful management planning, extensive staff involvement, and well-planned counseling and outplacement services helped employees of Legal Services Corporation wheather such a layoff. As the first step, the planning committee (personnel director, equal employment opportunity director, and general counsel) recommended that the corporation conduct staff education about layoffs for all employees, that a representative employee task force be established to develop specific details of the layoff plan, and that the corporation hire an experienced person to help staff members implement the plan. Members of the task force, who were elected by staff members (except for one additional member who was selected to ensure proper representation of minority groups and women), made specific recommendations on the way to determine seniority and bumping rights. The task force also dealt with such issues as method of notification, an appeals procedure, reemployment rights, the counseling and outplacement services. The task force also considered the issue of "willingness to leave".


O.B. Mod.: Meeting the productivity challenge with human resources management. With its roots in modern behaviorist psychology, O.B. Mod. is a human resources management technique aimed at improving job-related behaviors that are observable and measurable, such as absenteeism or tardiness, or toward behavior products, such as quality or quantity of work. O.B. Mod calls for intervention to encourage desirable performance behavior and discourage undesirable behavior. The major intervention strategy involves (1) feedback on the critical performance-related behavior and (2) positive reinforcement for progress and attainment.


Preventing employee burnout.

Preventing employee burnout. Burnout, a condition that is affecting an increasing number of employees in industry today, can transform top-performing employees into indifferent, frequently absent, ineffective workers. What can human resources managers do to help prevent burnout among employees? Authors Susan E. Jackson, assistant professor of organizational psychology in the psychology department at the University of Maryland, and Randall S. Schuler, associate professor of personnel and human resources management in the department of management at New York University, suggest three specific approaches to preventing burnout. One of these, anticipatory socialization programs, is a way of preventing "reality shock" from sending idealistic new employees with unrealistic expectations about a job into burnout. The philosophy underlying anticipatory socialization programs holds that reality shock should be experienced before the individual begins his or her first full-time job- and, further, that it should be experienced in a context that permits and encourages the development of constructive strategies for coping with the unexpected reality.


Communicate your benefits program through an employee fair.


Rewarding employees for not using sick leave.


Design effective incentive plans.

Design effective incentive plans.


Recognition is still a top motivator.

Recognition is still a top motivator.


Shift work has complex effects on lifestyles and work habits.


Your two challenging roles encompass drug expert & patient helper.


Patient education project advises people what to ask pharmacists.


How our pharmacists act as poison control specialists.


Excessive refills.

Excessive refills.


How our pharmacists sift through and sort out drug therapy.


How we make pharmacists a key ingredient in a paramedic pack plan.


Here's why the pharmacist should know the role of the nurse practitioner.


In 90.5% of cases, Iowa consultant pharmacists also provide vendor pharmacy services.


What we advise patients is as important as the medication we provide.


Criminal OTC tampering: challenge and response.


Religious discrimination?

Religious discrimination?


10 more newsletters dramatize the hospital pharmacist's expanding role.


Has Alabama's tough law helped to curb pharmacy robberies?


What two services do hospital pharmacists evaluate as most important?


10 tips to help you evaluate patient education materials.


How our red Rolodex file helps to curb drug interactions.


Day treatment program.

Day treatment program.


Community service in a brown bag.

Community service in a brown bag.


Outreach in Jerusalem.

Outreach in Jerusalem.


Expansion. Getting the news to the community.


Using marketing research: studies in image.


Evaluating nurse recruitment literature.


Patient memos.

Patient memos.


The Kidney Kookbook.

The Kidney Kookbook.


The twenty tasks of a hospital marketer.


Exercising for two.

Exercising for two.


Prestige club.

Prestige club.


Computer communications.

Computer communications.


M*A*S*H. Bashing for a telethon.

M*A*S*H. Bashing for a telethon.


Mall health services.

Mall health services.


What steps should we take when developing an employee risk reduction program?


Little people's hospital.

Little people's hospital.


APA task force issues report on long-term care facilities.


Brief psychotherapy shown to reduce utilization of medical resources; evidence still ignored.


Physical therapy competencies: a market study. As an initial step toward curricula reevaluation and change, this study was designed to develop a list of competencies, applicable for entry-level physical therapists and appropriate to the present-day rehabilitation needs in the province of Québec. A comprehensive set of competence statements or items concerning physical therapy practice was compiled. These were subsequently edited, field tested and, through the mechanism of a questionnaire, sent to practising physical therapists in Québec for verification and rating. The level-of-importance ratings in professional practice of the 224 competence statements or items (which had been grouped into 11 categories encompassing ethics, evaluation, treatment skills, research, professional growth, administrative skills and theoretical knowledge) gave indications as to their applicability in the work market. The ratings of importance of each category were further analyzed in relation to the respondent's years of professional practice, place of training, type of position held, and work setting. Only for the variables years of experience and place of training were there any significant differences in importance ratings. The response ratings given to the competence statements and the categories can result in the determining of possible directions for educational curricula changes that would meet market demands, both at the undergraduate and graduate levels as well as in the area of continuing education programs.


After deinstitutionalization: planning for the future.


Alcoholism insurance benefits may reduce health care use.


The burgeoning of employee assistance programs: psychiatry moves into a new arena.


Court rules hospital should have controlled patient making homicidal threats.


Research shows short-term psychiatric hospitalization more effective than long-term in many cases.


Court finds NY's commitment laws constitutional.


Commitment guide expected to influence new state laws.


Ohio law restricts admitting privileges to medical staff.


Selling "psychiatric products': APA meeting examines issues.


Intercontinental communication.

Intercontinental communication.


Creative approaches to institutional internal medicine.


Hospital marketing: can it help?

Hospital marketing: can it help?


Hospital hotline.

Hospital hotline.


Why practitioners must be good writers.

Why practitioners must be good writers.


Welfare and the new dignity.

Welfare and the new dignity.


Media and agenda setting: effects on the public, interest group leaders, policy makers, and policy. Using an experimental design built around a single media event, the authors explored the impact of the media upon the general public, policy makers, interest group leaders, and public policy. The results suggested that the media influenced views about issue importance among the general public and government policy makers. The study suggests, however, that it was not this change in public opinion which led to subsequent policy changes. Instead, policy change resulted from collaboration between journalists and government staff members.


Man's best friend...and then some.

Man's best friend...and then some.


Implications of recent mortality trends for the size and composition of the population over 65. Recent mortality declines have been concentrated at the older ages and in the degenerative diseases. In order to examine the implications for the future of continuation of this mortality decline, cause-specific mortality rates by age are projected to the year 2000 assuming that the cause-specific rates of decline experienced during the past decade continue. The projection shows that if such rates of decline persist, by the year 2000 there will be a substantial increase in life expectancy at ages 65 and above and the number of people now over age 65 will be almost 4 million greater than that now officially projected by the U.S. government.


Toward an inventory of U.S. health care data bases. Because researchers have lacked convenient and comprehensive sources of information about data available to them from the health care data bases maintained by others in their field, many health care data collection activities are unnecessarily duplicative and many data bases have not been fully exploited. This paper presents the preliminary results of work by the Hospital Data Center of the American Hospital Association on an inventory of current (1976 to the present), nonbibliographic, computer-readable data bases containing national health care information that have been collected by organizations and agencies throughout the United States and that are, or can be, made available to outside researchers. The 30 public and private sector organizations identified as having such data bases are listed, together with the titles and main subject areas of their 112 data bases.


What makes a great lunch.

What makes a great lunch.


Health care. Hospital admissions are down, Medicare and Medicaid reimbursement are shrinking, and competition is fierce.


Health care reform and market discipline--federalism strikes back.


Health benefits for the jobless: the middle class cashes in.


Bethesda Memorial's tranquil setting is just what the doctor ordered.


Charity war in Washington.

Charity war in Washington.


Cook-chill system solves problems of space and time for Boston hospital.


Inside a buying decision. Part II.

Inside a buying decision. Part II.


Texas Dept. of Mental Health, Austin, Texas.


Health claims administration: is computerization the answer?


The 10 commandments for choosing and using consultants.


Ford finds containing health costs is no Sunday drive.


Experts' opinions vary on necessary tests for SDS.


QA adherence helps avoid medical-legal problems.


Project Orbis' DC-8 jet provides SDS to patients worldwide.


Preparedness is the key for managing catastrophies.


Legal issues and accreditation.

Legal issues and accreditation.


Cultural assumptions and productivity: the United States and China. Based on the premise that the study of another culture is a useful tool for learning about one's own environment, the author compares and contrasts major cultural characteristics of the U.S. and China. Although he guards against the idea of blindly adopting major Chinese cultural assumptions, the author feels that the U.S. may benefit economically by looking toward China to find new insights and fresh approaches to help the U.S. better cope with prevalent economic ills--low productivity and lack of innovation in the work force.


Plateauing and productivity.

Plateauing and productivity. Managers find it very frustrating to reach a point in their careers when promotions are no longer possible. As the number of people entering management increases, the phenomenon of "plateauing" becomes a significant concern for organizations. The author contends that plateauing is a complex problem, often involving factors both internal and external to the organization. To address this difficult issue, she describes several innovative interventions for coping with this dilemma.


Helping elderly couples in crisis.

Helping elderly couples in crisis.


Enabling in the eighties: the client advocacy group.


Fee and missed appointments as transference issues.


The missing system in social work's application of systems theory.


Roles of the professional in mutual aid groups.


Honesty tools.

Honesty tools.


Group work that supports adult victims of childhood incest.


Is the nursing shortage over?

Is the nursing shortage over?


The anomaly, the chronic patient and the play of medical power. In the middle of the twentieth century, the anomaly, the person whose body suffered the effects of an accident and who elicited a compassionate response designed to protect the anomaly from the effects of the accident, disappeared. The 'disabled', the 'handicapped', and the 'chronic patient' replaced the anomaly in medical discourse. This change is reflected in specific, technical aspects of medicine - medicine's understanding and treatment of two anomalous bodies - and in general medical ideology and the organization of medical care. The change extended the medical gaze to the most intimate aspects of life and to the fine seams of society where the anomaly used to wander. We must understand this change as part of the paradoxical play of medical power. Medical power became more totalizing, integrative and rapidly responsive just as it became more unobtrusive, humane and liberating.


The shaky foundations of quality circles.


Textile standards. Task force drafts voluntary standards.


How to interview for information.

How to interview for information.


Linen management.

Linen management.


Testing: return of the prodigal process.


Computer teleconferencing: the meeting that keeps on meeting.


The snake-oil syndrome (and how to fight it).


Putting the person-to-person touch into teleconferencing.


From whence the theory?

From whence the theory?


Autoclaves and the sterile supply manager.


Sterile medical disposable packaging.

Sterile medical disposable packaging.


Storage and sterility maintenance.

Storage and sterility maintenance.


Sterilising with steam and formaldehyde.


Fibrescope decontamination.

Fibrescope decontamination.


The central sterile supply department, the Princess Elizabeth Hospital, Guernsey.


The establishment of the Supply Council; its philosophies and what they mean to the NHS.


Processing heat-sensitive instruments and materials by low-temperature steam and formaldehyde.


The Foundation course for sterile services managers. Cardiff--September 1981.


Notes on low temperature steam and formaldehyde.


Methods of decontamination of anaesthetic equipment: daily sessional exchange of circuits. Sampling of untreated anaesthetic circuits showed heavy bacterial contamination. Daily or twice daily sessional exchange of circuits (i.e. use of one circuit for up to nine patients) considerably reduced the extent of contamination. Equipment was effectively treated by steam at high or low temperature or by immersion in glutaraldehyde. Steam at high temperature (134 degrees C) damaged reservoir bags on repeated treatment, whereas low temperature steam (68 degrees C) was satisfactory. Treatment with glutaraldehyde was also satisfactory, but slightly less reliable and its smell was difficult to remove from the equipment after repeated immersion.


Raw material controls used in the manufacture of sterile, single-use, medical devices.


Dutch public health and environmental hygiene draft law on the trade of sterilized medical products.


Sterile supply in U.S.A. and U.K.

Sterile supply in U.S.A. and U.K.


The needs for sterile supply in the community.


Computers in C.S.S.D.

Computers in C.S.S.D.


The needs of sterile supply within the community as seen by the engineer.


Sterile supplies for the primary care doctor.


The role of the hospital microbiologist in sterile supply and quality control.


Air-generation of aerosols.

Air-generation of aerosols.


Air in the operating room.

Air in the operating room.


Bacterial aerosols in the hospital.

Bacterial aerosols in the hospital.


Some problems in field evaluation of hand disinfection.


Definition and evaluation of sterility.

Definition and evaluation of sterility.


Factors influencing the design of LTSF machines.


Aspects of control of infection in the community.


The cost of infection.

The cost of infection. A recent cross-sectional survey of 43 hospitals in the U.K. indicated that at any one time over 19% of all patients are likely to have an infection. Nearly half of those (9.2%) having acquired that infection during their stay in hospital. Of these hospital-acquired infections, 2.8% were of the urinary-tract, 1.7% were wounds and 1.5% were of the lower respiratory-tract (Meers et al, 1981).


Foundation course in sterile supply services management.


CSSD and the law.

CSSD and the law.


Hospital sterilizing and disinfection units--our future.


The application of microprocessors to sterilizers.


CSSD and the law of negligence.

CSSD and the law of negligence.


Sterilising techniques used in the field.


Evaluation of both local exhaust and cycle purges to reduce operator exposure and environmental levels of ethylene oxide. A local exhaust manifold was attached to two different tabletop ethylene oxide sterilizers. One tabletop sterilizer had a built-in cycle purge feature, while the other had the standard single terminal vacuum cycle. Operator exposure and environmental levels of ethylene oxide were determined with and without local exhaust, and with and without purge cycle. Results from both charcoal tube collection samples and infra-red analysis clearly demonstrated the benefit of a local exhaust coupled with cycle purge in reducing operator exposure to and environmental contamination by ethylene oxide to nearly undetectable levels.


Evaluation of an ethylene oxide sterilizer. Ethylene oxide gas can be used under controlled conditions to sterilize heat and moisture sensitive articles, particularly those which cannot be steam sterilized or immersed in disinfectants. The ethylene oxide process is essentially one of sterilization and all micro-organisms, including bacterial spores, are destroyed.


T.S.T.--a new range of indicator devices for autoclaving processes. Simple process indicators, usually relying on a colour change, are widely used as an aid to user assessment of the success or otherwise of autoclaving processes. Ideally, a process indicator should be capable of indicating not only that heating in steam has occurred but that heating has been maintained at a correct level for a suitable period of time. Furthermore, it would be preferable if any colour changes were abrupt rather than gradual throughout the period of heating.


Survey results profile averager PR person.


Charity wrong choice of words.

Charity wrong choice of words.


Equivalencies for disaster drills.

Equivalencies for disaster drills.


If an apple a day keeps the doctor...what will make one stay?


'No one will know' attitude causes unnecessary risks.


Programming a stop to computer fraud.

Programming a stop to computer fraud.


68th Texas legislature in brief.

68th Texas legislature in brief.


Panic and payment.

Panic and payment.


Emergency rooms revisited.

Emergency rooms revisited.


Health planning subject to careful anti-trust scrutiny.


Disasters demand immediate PR action.

Disasters demand immediate PR action.


As the public sees it . . .

As the public sees it . . .


Regular meeting attendance.

Regular meeting attendance.


What's behind the changes in today's hospital services? Diversification and corporate restructuring have captured the imagination of more than a few hospital boards recently. In large measure, this movement can be explained as the attempt of health care facilities to cope with two seemingly contradictory sets of forces: one pulling patients out of the hospital and the other making patients who are placed in the hospital more dependent on its services.


Newest public health enemy: AIDS.

Newest public health enemy: AIDS.


Are hospitals and physicians allies or rivals in ambulatory care? Diversification into ambulatory care can pit the hospital against physicians, primarily because of competition for this growing segment of the health care market. The author provides an overview of the growth of ambulatory care services and suggests strategies for boards to ease tensions and promote cooperation, especially through joint ventures with the hospital's medical staff.


How to develop strategies to serve the aging health care consumer. This article provides a framework for trustees to evaluate the impacts of an aging population and analyze opportunities for their hospitals to serve the needs of the elderly market. It focuses on identifying and analyzing the many aging-related market opportunities available to hospitals, and it describes a process for developing diversification strategies in aging-related products/services.


A trustee with two hats: bridging the public-private gap. Interview by Emily Friedman. John H. Stroger Jr. is a trustee of both a large, county hospital (Cook County) and a private, community hospital (South Shore) in Chicago. Here, he discusses how governance concerns differ in the two settings, evaluates the contract management experience of Cook County Hospital, and speculates on what effect financing cutbacks will have on the partnership of public-private urban hospitals serving the poor.


Stable economy will ease transition to prospective pricing.


Swing-bed rule draws industry ire.

Swing-bed rule draws industry ire.


The dietetics service--preparing for a survey.


Seattle groups fight over rating system.


Dr. Robert Butler to head new geriatrics department.


And they call it puppy love.

And they call it puppy love.


Removing motivation blocks.

Removing motivation blocks.


Schedule substances.

Schedule substances.


Feeding the geriatric patient.

Feeding the geriatric patient.


As AIDS scare hits nation's blood supply.


Maximizing benefit plans for nursing home employees.


The exploding field of laser-beam surgery.


Restrictions tightened to cut CHAMPUS cost.


For VA medical care, bottom line is quality.


Group calls for patient role in decisions.


Center sought to plan for large-scale crises.


Defense Health Agency 'feasible'.

Defense Health Agency 'feasible'.


Health care of U.S. troops in Korea centered at Army's facility in Seoul.


Medical malpractice claims leveled at Air Force, Army.


Economics, politics curb bed expansion, encourage nursing home consolidation.


Genetic testing conducted by major U.S. companies.


El Salvador medical aid called 'humanitarian'.


Oregon considering public health insurance.


California patients win right to refuse institutional drugs.


Recession seen taking toll on health benefits.


Policymakers viewing AIDS as infection.

Policymakers viewing AIDS as infection.


U.S. Medicine interviews Dr. Kenneth Dickie.


Female veterans call care from VA elusive, substandard, insensitive.


ICU guidelines. Care levels defined.

ICU guidelines. Care levels defined.


Set of 'biases' seen determining who can receive renal dialysis.


CMCHS being expanded. 'Civilian disaster network' set.


Professional associations fearful of rule on 'handicapped' infants.


'Standard' combat supplies defined.

'Standard' combat supplies defined.


Ethics and professionalism the integrated way.


Bill connects 'Baby Doe,' child abuse.

Bill connects 'Baby Doe,' child abuse.


Improving your program through evaluation.


The value of a volunteer questionnaire.

The value of a volunteer questionnaire.


Perspectives. Health planning uncertainty continues.


Perspectives. Can capital costs be capped?


Perspectives. Doctor surplus breeds new practice forms.


'Baby Doe' controversy continuing.

'Baby Doe' controversy continuing.


Competition for hospital privileges seen rising.


Profile of Les Spero and United Service Company.


Illinois launderers to fight temperature law.


Informed consent: a contradictory doctrine for MDs, reports lecturer Jay Katz.


Pediatrics society opposes hotline, supports local review in "Baby Doe" cases.


FDA sends note to 36 million urging them to know more about medications.


Ethics for the doctors of the world.

Ethics for the doctors of the world.


The Declaration of Helsinki.

The Declaration of Helsinki.


Health care manpower: current status in Australia.


Industrial rationalization of a cottage industry: multi-institutional hospital systems. The environment facing hospitals, generally supportive until the 1970s, may now be characterized as complex, turbulent, and constrained. In response to such environmental conditions, hospitals have adopted new strategies and structures. The strategies, described as corporate rationalization, have led away from the traditional structure of freestanding, autonomous hospitals and toward the formation of multi-institutional systems. These systems are designed to provide sufficient strength to cope with the environment, to acquire scarce and valued resources, to allow organizational stability, to achieve organizational purpose, to enable growth and/or survival, and to enhance market position. The impact of multi-hospital systems is viewed in two major areas: acquisition, retention, and utilization of economic and human resources, and organizational, political, and social factors.


Quality, cost, and clinical decisions.

Quality, cost, and clinical decisions. Clinical decisions require determining the objectives of care as well as selecting and implementing a strategy of care. At the very least the optimal strategy balances the expected benefit and harm from technical interventions. Health care practitioners tend to specify optimal strategies based on what they consider to be best for patients, without regard to monetary cost. This is an absolutist definition of quality. Individuals may place different valuations on the outcomes, are concerned with the monetary costs to themselves, and are particularly sensitive to the attributes of the interpersonal relationship with the practitioners. Including all of these leads to an individualized definition of the quality of care. But this specification of quality may be in conflict with a social definition of quality, which takes into account social as well as individual monetary costs, externalities, and the social distribution of quality. The health care professions may respond to the conflict in several ways, which are described in this article as evasion, rejection and confrontation, anticipation, advocacy, active complicity, passive complicity, and ambiguous adaptations.


The aging of the population and health services. The demographic revolution--engendered in large part by modern medicine--which has led to the extraordinary and continuing increase in the number and proportion of elderly persons in the population has profound implications for health services. The elderly are disproportionately heavy utilizers of health care, primarily because of the prevalence of chronic disease. In the United States most health care for the elderly is financed through public funds, and costs have been increasing at an alarming rate. There is wide consensus that, for all the excellence of performance of the medical care system in treating acute episodes, care of chronic disease is frequently unsatisfactory in both quality and cost. Given the demographic imperatives, reform of mechanisms for chronic care is thus essential.


How many physicians are enough?

How many physicians are enough? Although it is difficult to ascertain whether or not the nation faces an oversupply of physicians in the coming decades, there is no doubt that a health care system can be operated more effectively with a taut supply of medical personnel than with a loose supply. The perception of severe specialty and geographic imbalance, which informed national health policy during the 1960s and 1970s, has been modified by evidence of a significant redistribution in the supply. Increasing numbers of practitioners are likely to effect further escalation in the costs of physician services and total expenditures for health care, even if--in conformity with classical laws of supply and demand--individual physicians' incomes and the relative economic advantage of the profession were to decline. Since the objective of improved access has to a considerable extent been realized, the principal benefit of the loosened supply in the future will be to facilitate the initiation of innovative practice modes and alternative health care delivery systems that offer the potential of improved efficiency and quality.


New federalism and health policy.

New federalism and health policy. The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.


Health care policy: lessons from the past and issues of the future. Liberal distributional values, the increasingly powerful capacity of medicine to provide more and better care, and concern about the health hazards of an industrial society fueled the vast expansion of the health care sector during the last 20 years. That growth was facilitated by a growing economy. The current health policy debate at one level reexamines the distributional bases of entitlement programs, and at another seeks alternative resource allocation mechanisms to reduce the cost of health care. This article has two themes. First, distributional and allocational policies are shown to be intrinsically related, so that the health policy debate is fundamentally a clash between liberal and libertarian values. Second, the inexorable social forces driving the health care system are shown to be the aging of the population and the rapid expansion of technology. The resulting dynamics imply the further growth of the health sector, now in the environment of a sluggish economy. Future policies will have to struggle with how to ration scarce health resources and how to reorient the health care sector to the problems of the aged.


The competition strategy for medical care. This article reviews the so-called competition strategy for medical care. It sets out the policy goals of the strategy and the problems in the present medical and insurance system that it seeks to address. It then describes several distinct formulations of the competition strategy, showing that it is not a single, rigid, monolithic approach, but rather a flexible combination of market-oriented approaches. Finally, it briefly discusses the technical and political problems and prospects of the strategy.


Competition and health care policy: experience and expectations. Since 1970 federal policymakers have tried to strengthen competition and incentive-based market forces as alternatives to regulation in containing health costs. The effort to stimulate the growth of health maintenance organizations (HMOs) throughout the country has had limited results, and federal plans to promote competition by enacting changes in the health insurance market have so far come to little. Coalitions in some localities have shown growing interest in flexible HMO variants, however, and the intellectual force of the HMO critique of mainstream practices remains strong. Moreover, the federal government has shown new interest in prospective reimbursement of hospitals--a proposal that draws from both HMOs--competition--and hospital rate-setting programs--regulation--the element of prospectivity.


Health care manpower in a rapidly changing world.


Creative Leaders: they generate the magic that best results. Interview by Jonathan Walters.


Your legal responsibilities as a member of the board.


Incomplete vertical integration in the health care industry: pseudomarkets and pseudopolicies. Most economic relationships are either arm's-length exchange transactions, each party seeking his or her own interest, or command structures, such as a firm or public agency, integrating joint efforts toward a common goal. The health care industry, however, displays a pattern of incomplete vertical integration--relationships which are neither truly arm's-length nor completely hierarchical. The doctor-patient relationship is archetypical. Physicians appear to sell services in private markets; yet they reach through the exchange process to direct the consumer-patient's utilization decisions, implicity undertaking to act in the patient's interest, and thus integrate forward. But they also integrate backward to control the public regulatory process--self-government--and some forms of insurance. The health care systems of different countries--Canada, the United Kingdom, and the United States--can be interpreted as different patterns of incomplete integration among five basic classes of transactors: consumer-patients, first-line providers, second-line providers, insurers, and governments. Each system of linkage has characteristic strengths and weaknesses. Nowhere, however, do we find a predominance of arm's-length market relationships. Where they exist, markets in health care are usually pseudomarkets dominated by one side of the transaction. The rhetoric of market relationships serves principally to obscure political struggles over shifting patterns of integration.


Enlightened persuasion or how to get people to see things your way.


Medical ethics and group practice.

Medical ethics and group practice.


Audio teleconferencing: a simple, frugal alternative.


Exploring the potential of computer-assisted medical illustration.


The group insurance myth revisited.

The group insurance myth revisited.


Over the short haul: some effects of automating health claims.


Essential equipment for ambulances. Committee on Trauma, American College of Surgeons, revised, May 1983.


Seven rules for disciplining problem employees.


Time: a manager's most important asset.

Time: a manager's most important asset.


Resolving differences.

Resolving differences.


Giving instructions that get followed.

Giving instructions that get followed.


A more systematic approach to employee development.


Making fringe benefits pay.

Making fringe benefits pay.


Self-appraisals: the next stage in performance evaluations.


Stalking the elusive computer.

Stalking the elusive computer.


Group problem solving: how to be an effective participant.


The principal players in your organization's information system.


Let's get a handle on QWL.

Let's get a handle on QWL.


Wife beating: the silent crime.

Wife beating: the silent crime.


Rape: the sexual weapon.

Rape: the sexual weapon.


How to beat hospital costs.

How to beat hospital costs.


Child abuse: the ultimate betrayal.

Child abuse: the ultimate betrayal.


Private violence.

Private violence.


Plague again.

Plague again.


Gay America in transition.

Gay America in transition.


Selecting an advertising agency: look before you leap.


The new era of transplants.

The new era of transplants.


Pharmaceutical Reimbursement Board; rinal maximum allowable cost (MAC) determinations for certain drug products--HCFA. Final notice for maximum allowable cost determinations.


New wave computer crime.

New wave computer crime.


Family obligations.

Family obligations.


Pharmaceutical Reimbursement Board; maximum allowable cost (MAC) limits and announcement of public hearing--HCFA. Proposed notice. The Pharmaceutical Reimbursement Board (PRB) proposes maximum allowable cost limits on the drugs specified below and announces a public hearing with regard to these proposed MAC limits.


Grants, loans and loan guarantees for construction and modernization of hospitals and medical facilities--PHS. Reinstatement of rule. This rule amends Title 42 of the Code of Federal Regulations by reinstating the provision at Section 53.134 concerning notification of the Department of the transfer of a medical facility assisted under Title VI of the Public Health Service Act (the Hill-Burton Act) or termination of services provided in the facility. The provision was incorrectly deleted in a rule published on August 6, 1979, 44 FR 45946.


Governing body requirements for health systems agencies--PHS. Final rule. This rule amends the portion of the Health Systems Agency Designation and Funding Regulation (March 26, 1976) prescribing the composition of health systems agency governing bodies and deletes the subsection of that regulation which limits the number of consecutive years a governing body member may serve. This rule is being issued pursuant to a court order.


Grants to state health planning and development agencies determination of population of the states.


What you need to know about your hospital's competitive position: a guide to planning, executing and evaluating marketing audits for hospital administrators. Part I.


The need for public involvement in medicine: the national economy and the public interest necessitate increased consumer activity in monitoring medical practices. Part I.


Voluntary protection programs to supplement enforcement and to provide safe and healthful working conditions--OSHA. Notice of implementation of revised voluntary protection programs. OSHA announces the implementation of three Voluntary Protection Programs. The programs, revised from the January 19, 1982, notice in the Federal Register (47 FR 2796), seek out and recognize exemplary safety and health programs as a means of expanding worker protection. Companies, general contractors, and small business organizations which meet specified programmatic safety and health criteria, which go beyond OSHA standards in providing safe and healthful workplaces for their employees, and which want to do more than is required to help the agency accomplish the goals of the Act are the applicants OSHA seeks for these voluntary programs. In return, OSHA will remove participants from general schedule inspection lists and give priority attention to any which request a variance. The programs are called "Star." "Try," and "Praise."


How major MD groups negotiate. Medical muscle.


Block grant programs--Office of the Secretary, HHS. Final rules. These rules implement seven block grant programs established by the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35). The block grants replace a large number of programs now administered by the Federal Government, transfer primary responsibility for their administration to the States, and confer substantial discretion on the States as to use of the block grant funds.


Federal Old-Age, Survivors, and Disability Insurance and Supplemental Security Income for the Aged, Blind and Disabled; representative payment--SSA. Final rule. These final regulations reorganize and restate in simpler language our regulations on representative payment under titles II, Old-Age, Survivors, and Disability Insurance (OASDI), and XVI, Supplemental Security Income for the Aged, Blind, and Disabled (SSI) of the Social Security Act. These regulations (1) explain representative payment; (2) state when title II and title XVI benefits will be paid to a representative payee rather than directly to the entitled person; (3) indicate the procedure we follow in selecting a representative payee; (4) specify the responsibilities of a representative payee; and (5) clarify our responsibilities to the beneficiary when we make payments to a representative payee on his or her behalf.


Guidelines for research involving recombinant DNA molecules.


Health maintenance organizations--PHS. Final regulations. This rule amends the Public Health Service regulations on qualification of health maintenance organizations (HMOs). Changes are made in the procedural requirements for entities to obtain qualification as federally qualified HMOs. These changes include requirements relating to Freedom of Information requests and deletion of the fair hearing provision. Adoption of these amendments will update the requirements for HMOs seeking Federal qualification.


Recombinant DNA research; actions under guidelines--NIH. Notice of actions under NIH guidelines for research. This notice sets forth actions taken by the Director, National Institute of Allergy and Infectious Diseases, by authority of the Director, NIH, under the April 1982 Guidelines for Research Involving Recombinant DNA Molecules (47 FR 17180).


Private Land Mobile Radio Services--Federal Communications Commission. Final rule. The Commission adopts a Second Report and Order releasing reserved radio spectrum in the 806-821/851-866 MHz bands for Private Land Mobile Radio Service use. The rules adopted provide enhanced flexibility in radio system design and user options. The action is necessary to satisfy land mobile spectrum needs across the country.


Health financing research and demonstration grants; availability of funds for grants--HCFA. General notice. This notice announces the availability of HCFA funds for certain priority research and demonstration grants for fiscal year 1983. It contains information about the subject areas for grants that will be given priority, project requirements, application procedures, amounts and duration of grants, and waiver of state plan requirements for demonstration projects. HCFA makes funds available for activities that will help to resolve major health financing policy and program issues or to develop innovative methods for the administration of Medicare and Medicaid.


Equipment acquired under public assistance programs--HHS. Final rule. This rule revises and consolidates current HHS regulations concerning Federal financial participation in the cost of equipment under HHS supported public assistance programs. The rule also revises and consolidates current regulations on the management and disposition of equipment under these programs. The rule would permit State public assistance agencies to claim the cost of most of their equipment acquired at the time of purchase rather than depreciating the equipment over its useful life as required by the current regulations. This change would allow these agencies to claim Federal financial participation in the cost of the equipment at an earlier date than under the current regulations and would simplify the accounting requirements associated with the equipment.


Exemption of certain research and demonstration projects from regulations for protection of human research subjects--DHHS. Notice of proposed rulemaking. The Department of Health and Human Services (the Department or HHS) is proposing to include among the types of research specifically exempt from the application of the regulatory requirements of 45 CFR Part 46 (protection of human research subjects), research and demonstration projects conducted under the Social Security Act and other Federal statutory authority and designed to study certain public benefit or service programs, the procedures for obtaining benefits or services under those programs, and possible changes or alternatives to those programs or procedures, including changes in methods or levels of payment. This proposed amendment to the revised final regulations for protection of human research subjects (published January 26, 1981) would, in effect, restore to the regulations an exemption included in the initial notice of proposed rulemaking (NPRM) (published August 14, 1979). These demonstration and service projects are already subject to procedures which provide for extensive review by high level officials in various program administration offices. Review by an IRB would be duplicative and burdensome to state and local agencies and to other entities participating in demonstration projects. Removal of an unnecessary layer of review will not only reduce the cost of the projects but help to avoid unnecessary delays in project implementation.


Medical device reporting--FDA. Reproposal. The Food and Drug Administration (FDA) is issuing a revised proposal to require manufacturers and importers of medical devices to report to FDA whenever the manufacturer or importer has information that reasonably suggests, or a person alleges and the manufacturer or importer is aware of the allegation, that a device has caused or contributed to a death or serious injury or that a device has malfunctioned, if a recurrence of the malfunction is likely to cause or contribute to a death or serious injury. After FDA analyzes the results of its manufacturer complaint file inspection program, the agency will consider whether any reports in addition to those proposed in this rule are necessary and, if so, will propose additional reporting requirements.


Prescriptions; dispensing controlled substances in institutional practitioner emergency rooms--Drug Enforcement Administration, Justice. Withdrawal of proposed rule. A Notice of Proposed Rulemaking published on September 17, 1982, would have amended Part 1306 of Title 21 of the Code of Federal Regulations to permit hospital emergency room personnel to dispense controlled substances to nonpatients when alternate pharmacy services were not available. This proposed action was initiated in response to requests from various state agencies and hospitals. After assessing the comments and objections to the proposal, the Drug Enforcement Administration (DEA) has determined that the need for the proposed rule change has not been established at this time and the proposal is therefore withdrawn for further study.


Privacy Act of 1974; proposed new routine uses--PHS. Notification of new routine uses permitting disclosure of information from four Privacy Act systems of records. In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish new routine uses permitting disclosure of information from four Privacy Act systems of records maintained by the National Institutes of Health (NIH): 09-25-0008, "Administration: Radiation Workers Monitoring, HHS/NIH/ORS"; 09-25-0010, "Research Resources: Registry of Individuals Potentially Exposed to Microbial Agents, HHS/NIH/NCI"; 09-25-0077, "Clinical Research: Biological Carcinogenesis Branch Human Specimen Program, HHS/NIH/NCI"; and 09-25-0099, "Clinical Research: Patient Medical Records, HHS/NIH/CC." The NIH Office of Research Services (ORS) is responsible for the first of these systems. The National Cancer Institute (NCI), a component of NIH, maintains the second and third systems of records. The NIH Clinical Center (CC) maintains the fourth system. The new routine uses will allow disclosure to contractors for routine records keeping and processing activities. These disclosures will be wholly compatible with the purposes of these systems, as discussed below.


Standards for the accreditation of educational programs for and the credentialing of radiologic personnel--PHS. Notice of proposed rulemaking. These proposed regulations would establish standards for the accreditation of educational programs for radiologic personnel, and for the credentialing of such persons. These standards are proposed as part of the implementation of the Consumer-Patient Radiation Health and Safety Act of 1981 (Title IX of Pub. L. 97-35), which requires their promulgation by regulation. The standards are voluntary for States and are intended to encourage the adoption of uniform accreditation and credentialing procedures.


New examination for alien foreign medical graduates Visa requirement.


Third party billing for cost and care provided by Indian Health Service--HRSA Options for Indian Health Service. The notice sets forth a discussion of major approaches under consideration by the Health Resources and Services Administration (HRSA) to implement the Administration's proposed Fiscal Year 1984 budget with respect to expanding the billing and collection for services provided by the IHS from insurance companies and other sources.


Miscellaneous amendments to the HHS procurement regulations--HHS. Final rule. The Office of the Secretary, Department of Health and Human Services is amending its procurement regulations by revising and updating the general provisions for use in fixed price and cost-reimbursement type contracts (HHS-314,-315,-315A, and-316) and related miscellaneous amendments. The revisions will result in the consolidation of all additions, removals and revisions to the general provisions. The effect of the amendment will be the updating of the Department's general provisions.


Protection of human subjects; reports of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research--Office of the Assistant Secretary for Health, HHS. Notice of availability of reports. This notice summarizes the reports of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, provides information on how these reports may be obtained, and requests public comment on the reports. The following summaries are intended to highlight conclusions and recommendations and do not provide in themselves complete information. It is strongly suggested that interested persons obtain complete copies of reports in order to fully understand the context in which various conclusions and recommendations were made. The reports summarized are Defining Death-A Report on the Medical, Legal and Ethical Issues in the Determination of Death (July 1981); Protecting Human Subjects-First Biennial Report on the Adequacy and Uniformity of Federal Rules and Policies, and their Implementation, for the Protection of Human Subjects in Biomedical and Behavioral Research (December 1981); Screening and Counseling for Genetic Conditions-A Report on the Ethical, Social and Legal Implications of Genetic Screening, Counseling, and Education Programs (February 1983); Compensating for Research Injuries-The Ethical and Legal Implications of Programs to Redress Injured Research Subjects (June 1982); Making Health Care Decisions-A Report on the Ethical, Social and Legal Implications of Informed Consent in the Patient-Practitioner Relationship (October 1982); Splicing Life-A Report on the Social and Ethical Issues of Genetic Engineering with Human Beings (November 1982); Deciding to Forego Life Sustaining Treatment-Ethical, Medical, and Legal Issues in Treatment Decisions (March 1983); Securing Access to Health Care-The Ethical Implications of Differences in the Availability of Health Services (March 1983); Implementing Human Research Regulations-The Adequacy and Uniformity of Federal Rules and of Their Implementation (March 1983); and Summing Up-Final Report on Studies of the Ethical and Legal Problems in Medicine and Biomedical and Behavioral Research (March 1983).


Radiological health; evaluation of radiation exposure in diagnostic radiology examinations; availability of draft recommendations--FDA. Notice. The Food and Drug Administration (FDA) announces the availability for public review and comment of draft recommendations on evaluation of radiation exposure in diagnostic radiology examinations, prepared by FDA's National Center for Devices and Radiological Health (NCDRH). In addition to the draft recommendations, FDA is making available background information, rationale, and NCDRH's response to comments that were received on a notice of inquiry regarding the need for and content of such recommendations. FDA is also encouraging private groups and individuals to join in the research efforts needed to develop further technique/exposure guidance and suggests a number of principles to be followed in these efforts so all interested parties may achieve consistent and useful results. Final recommendations, when developed, will be published as a technical report in NCDRH's radiation recommendation series.


Medicare and Medicaid programs; health care financing issues; solicitation of applications for a research center--HCFA. General notice. HCFA is soliciting applications for a research center to participate in the study of health care financing issues. This project will be funded under the Cooperative Research or Demonstration Projects provisions of section 1110 of the Social Security Act. This solicitation contains information about research center functions, project requirements, application procedures, criteria to be used in reviewing applications, and the amount and duration of awards.


Limitation on federal participation for capital expenditures--PHS. Notice of proposed rulemaking. Section 1122 of the Social Security Act, "Limitation on Federal Participation for Capital Expenditures," establishes under which the Secretary may deny Federal reimbursement under titles XVIII and XIX of the Act for expenses related to capital expenditures by or on behalf of health care facilities (1) which the health planning agency designated for a State has found to be inconsistent with standards, criteria, or plans developed under the Public Health Service Act, or (2) for which the designated planning agency was not provided notification as required. These proposed regulations include changes in the regulations now codified at 42 CFR Part 100 based on (1) the proposed amendments to the regulations published in the Federal Register on March 19, 1976, and comments submitted in response to that Notice, (2) the amendments to Title XV of the Public Health Service Act enacted by the Health Planning and Resources Development Amendments of 1979 (Pub. L. 96-79), the Health Programs Extension Act of 1980 (Pub. L. 96-538), and the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35), and (3) the amendments to section 1122 enacted by the Health Maintenance Organization Amendments of 1978 (Pub. L. 95-559), the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35), and the Social Security Amendments of 1983 (Pub. L. 98-21). Interested persons are invited to submit written comments and suggestions concerning this Notice of Proposed Rulemaking (NPRM).


Health systems agency and state health planning and development agency reviews; certificate of need programs--PHS. Notice of proposed rulemaking. The Assistant Secretary for Health, with the approval of the Secretary of Health and Human Services, proposes to amend the regulations governing certificates of need reviews by State health planning and development agencies (State Agencies) and health systems agencies (HSAs). The proposed amendments would accomplish two tasks: (1) Implement amendments to the Public Health Service Act made by the Health Programs Extension Act of 1980 (Pub. L. 96-538) and the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35) and (2) reduce Federal regulatory burdens. Under the provisions of Title XV of the Public Health Service Act, the planning agencies are required to administer certificate of need programs consistent with the Secretary's regulations, under which they review and determine the need for proposed capital expenditures, institutional health services and major medical equipment. These regulations set forth proposed changes to the requirements for satisfactory certificate of need programs. Interested persons are invited to submit written comments and recommendations concerning these proposed rules as well as suggestions for alternative methods of implementing any of the provisions of the amendments that affect the requirements for certificate of need programs.


Social Security benefits and supplemental security income; disability termination hearings at the reconsideration level--SSA. Notice of proposed rulemaking. We are proposing regulatory changes to carry out a requirement of Pub. L. 97-455 (enacted on January 12, 1983). That legislation requires several changes in the procedures used by the Social Security Administration (SSA) to conduct periodic reviews of disability cases for continuing eligibility. The proposed regulations would implement Sections 4 and 5 of the new law, which require SSA to make a face-to-face evidentiary hearing available in connection with the reconsideration of any initial determination that an individual receiving disability benefits under title II of the Social Security Act (the Act) is not now disabled. We also propose to make the new reconsideration procedure available in blindness and disability termination cases in the Supplemental Security Income (SSI) program under title XVI of the Act, pursuant to the Secretary's broad rulemaking authority in the SSI program. Although Congress has not specifically required that we do so, it is customary to extend legislative improvements in the title II disability program to comparable SSI cases, since the medical eligibility requirements in both programs are quite similar. Moreover, the proposed inclusion of SSI blindness and disability termination cases would promote effective program administration by providing a uniform appeal procedure in the two programs. We believe that this new procedure will make the reconsideration level more meaningful in blindness and disability termination cases, that beneficiaries affected by these termination decisions will be better served and that the overall quality of the decisionmaking process will also be improved.


Social Security benefits; disability insurance benefits; deductions, reductions, and nonpayments of benefits--SSA. Final rules with comment period. These regulations amend the existing regulations under which Social Security benefits payable to a disabled worker and his or her family may be reduced because of the worker's concurrent entitlement to workers' compensation benefits. They provide that entitlement to certain other public disability benefits may reduce the disability benefits paid by Social Security; that the reduction applies to the first month of concurrent entitlement regardless of the month in which we are notified of entitlement to the public disability benefit; and that the reduction applies to all months of concurrent entitlement until the disabled worker attains age 65. These regulations also provide that where a public disability law or plan provides for reduction of the public disability benefit on the basis of entitlement to Social Security disability insurance benefits that provision will preclude reduction of the Social Security benefits but only if it was in effect on February 18, 1981. These regulations implement section 2208 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35).


Privacy Act of 1974; report of routine use--Social Security Administration. New routine use disclosure. In accordance with the Privacy Act (5 U.S.C. 552a(e)(11)), we are issuing public notice of our intent to establish a new routine use of information we maintain in the majority of our systems of records. The proposed routine use will enable us to disclose information, as necessary, when utilizing a contractor or other Federal agency to assist in the efficient administration of our programs.


General and procurement by negotiation--DHHS. Proposed rule. The Office of the Secretary, Department of Health and Human Services, is proposing to amend 41 CFR 3-1.453, Establishment of cost rates, to identify officials delegated authority to approve indirect cost rates and special rates for commercial organizations. Part 3-3, Procurement by negotiation, is proposed to be amended by adding a new Subpart 3-3.7. Negotiated overhead rates, which sets forth policies and procedures concerning the approval of indirect cost rates and special rates for use in the pricing and administration of contracts.


Deregulation of mobile customer premises equipment--FCC. Proposed rule. In this Notice, the Commission proposes to deregulate all mobile telephone customer premises equipment (CPE). In the Second Computer Inquiry, the Commission directed common carriers to offer CPE on a nontariffed basis separate from their transmission offerings. However, the Commission expressly excluded mobile CPE from the scope of its decision. In this proceeding, the Commission will consider whether to conform the treatment of mobile CPE with its treatment of all other CPE.