A ten-year comparison of fathers' and mothers' reactions toward their hospitalized adolescents. Difficulties confronting parents of hospitalized adolescents are reviewed. Fathers' and mothers' reactions to their child's illness and hospitalization are compared to those of 10 years ago. Differences in attitudes and behavior over the decade are believed to be more attributable to the cultural climate than to the variability in the sample. The more pronounced changes were found among fathers, who currently showed less hostility toward the hospital and patient and a greater ability to express a range of feelings. Compared to 10 years ago, the fathers were more motivated to visit by concern than by duty and evidenced greater ease on the ward and more involvement with their children. Paternal and maternal roles appeared to overlap far more than previously, to the benefit to both.


The unique role of the child life worker in children's health care settings. The author expresses his concern that many child-life workers are not aware of the uniqueness of their role in child health care settings. He comments on four ways in which he perceives the child life worker's role to be unique. He concludes that the child life worker is irreplaceable in the child health care environment.


Nurses' perceptions of pediatric nursing functions. The purpose of this study was to describe nurses' perceptions of the importance of pediatric nursing functions and to determine if there were differences in perceptions of nurses in managerial, clinical, and teaching positions. Subjects were 125 pediatric nurses in managerial, clinical, and teaching positions. Respondents were asked to rate the importance of 43 nursing functions on a 9-point scale ranging from highly important to not at all important. Mean ratings of pediatric nursing functions were determined and one-way analyses of variance performed. The five nursing functions perceived to be most important were, in order of ranking: (a) providing emotional support of children, (b) recognizing significant physical deviations, (c) implementing nursing interventions, (d) preparing children psychologically for procedures and surgery, and (e) identifying nursing problems. Significant differences were found between groups in perceptions of the importance of 23 nursing functions, mainly in the areas of psychosocial care, teaching, and nursing process. Most differences were between the teaching and managerial groups or between teaching and the managerial and clinical groups combined. Differences in perceptions of the importance of a number of nursing functions, though not great, suggest a need for more dialogue between managers, teachers, and clinicians.


Child life workers: facilitating their growth and development. "Professionalization" of child life workers has potentially many benefits for workers and for the children and families they serve. An additional critical factor in enhancing job satisfaction, effectiveness, and retention is recognition of and facilitation of each worker's professional development. A development framework, based on the theory and research of Erikson (1963) and Katz (1972), is presented, as well as supportive strategies and training sources, to provide a structure for understanding and helping the "developing" child life worker.


Play and play areas for hospitalized children. Play is critical to children's development in social, cognitive, and affective domains. Children actively construct meaning through playful interaction with people and objects. Play materials and environments in turn, affect the level, structure and content of children's play. The following article discusses these issues and the application of contemporary architectural design and current research findings on play environments to the special problems of hospitalized children. Concerns related to separation from family and routine, unfamiliar hospital personnel and procedure, institutionalization, and temporary immobility can be constructively dealt with by thoughtful planning for children's play. Specific suggestions with respect to designing play spaces in hospitals are offered based on current theory and research.


The myth of formal operations: rethinking adolescent cognition in clinical contexts. There has been growing interest in the application of Piaget's theory to understanding children's thinking in clinical contexts. However, many such applications have been naive and accompanied by misconceptions. The present article deals specifically with the period of formal operations and its usefulness in understanding adolescent thinking. Literature is reviewed which leads to the conclusion that the formal operations concept has little clinical explanatory power. Formal operations represents an ideal description of intellectual competence, whereas clinicians must deal with factors influencing actual performance. Three performance factors are described which are especially relevant to understanding cognition in clinical situations.


Sibling visitation--what do we know about it?


Utilization of child health services by children in single-parent and two-parent families. With the increase in single-parent families, questions have been raised concerning the adequacy of the access to care for children residing in these families. A year of visits to primary health care sources are compared for a random sample of elementary school children residing with one of two-parent families. Contrary to expectations concerning the medical disenfranchisement of single-parent children when socioeconomic status, ethnicity, and children and youth project enrollment are controlled, no differences are found in use/nonuse of facilities or range of visits. Further studies should take into account parental employment as a separate and possibly more important factor than number of parents in the home when studying use of pediatric services.


Eight practices of good supervisors.

Eight practices of good supervisors. Eight practices of good supervisors are described and elaborated upon. Issues such as building relationships, fostering good communication, individualizing supervision, planning for supervision, and supervisory self-evaluation are discussed.


Student nurses' attitudes toward children's health rights: implications for advocacy. Student nurses were asked to consider a 10-year-old male clinic patient with urinary tract infections when responding to the Children's Rights Attitude Scale. Participants were also informed that the child's parents reported symptoms and complied with treatment. Attitudes were more favorable toward extending rights to receive health services than they were toward extending rights to make health-related decisions. The more concerned student nurses perceived the child's parents to be, the less willing they were to extend rights for special health services. Participants can be expected to be advocates for child health services but not for children's rights to act on their health decisions.


Renewed dignity in the care of suicidal adolescents: the Suicide Sitter program.


Cultural differences in groups of parents of children with cancer: English- and Spanish-speaking. Therapeutic groups of parents of children with cancer have been seen as potentially helpful to those parents who utilize the groups. The authors report on a study of the differing content raised in two parent groups, one English-speaking and one Spanish-speaking.


Child behavior management training for parents of chronically ill children: a professional activity in need of research. Parents of chronically ill children are often referred to professionals for help in managing problematic behaviors of the children. One very popular treatment approach is to train such parents in child behavior management skills. Surprisingly, hardly any research has been reported upon the development, implementation, or evaluation of child behavior management training in such cases. Some research strategies are suggested.


Parenting the chronically ill child in the hospital: issues and concerns. Chronic childhood illness and hospitalization are stressful events within the family unit. Parental response to the crisis of hospitalization profoundly affects the child's recovery process. This article discusses a team approach toward assessing and understanding parental reactions, methods of offering assistance and guidance, and basic issues and problems concerning staff-parent relationships. The focus is on the pediatric health care "team" as an agent for aiding families.


Preschool hospital tours.

Preschool hospital tours. Many hospitals have programs for planned admissions for children and adults. Very few offer preparation for unplanned ones, yet children have emergency admissions to hospital. A weekly hospital tour has been started recently for community preschool groups to meet this need. Feedback has been very positive. From those on the tours so far, three have had emergency admissions and parents report that the children evidence very good adjustment to the hospital. It is hoped that similar child education programs could be offered in other communities and the benefits extended to more children.


Sources of parental stress in pediatric intensive care units. This study utilized an inductive approach to identify sources of stress experienced by parents when a child is admitted to a pediatric intensive care unit. Based on a thorough review of the literature, clinical observations, and interviews with parents of children recently discharged from a pediatric intensive care unit, 79 items defining eight dimensions of pediatric intensive care stressors were identified. Suggestions are made for intervention strategies that can be utilized in an attempt to minimize parental stress.


Parenting stress and the utilization of pediatric services. Parents' level of stress as measured by the Parenting Stress Index is examined in relation to the utilization of pediatric medical services for children between the ages of 1 and 48 months. The six categories of medical services considered were: Well Visits, Sick Visits, Infections, Diarrhea and Vomiting, Traumatic Injuries, and Other Medical Services. For the first 18 months of age no significant mean difference between stress groups and medical utilization was found. Significant correlations and mean differences were found for the 19- to 24- and the 25- to 48-month age groups in relation to the traumatic injury criterion. Moderate parenting stress is interpreted as potentially adaptive in relation to reducing traumatic injuries.


School age children: are their needs recognized and met in the hospital setting? School age children are relatively self-sufficient and independent. With this in mind the question arose as to whether their concerns were recognized in the hospital setting or whether it was taken for granted they would verbalize their needs. A preliminary survey was done to see if there were specific concerns in this age group and if the concerns were realized and met. It was felt that hospitalization generates anxiety and needs that health team members do not always recognize or take into consideration. The survey demonstrated some definite concerns. After an inservice program the questionnaire was administered a second time. There was a decrease in the needs and concerns expressed. Care givers need to be aware of the threats and concerns of children in order to alleviate them.


Preadmission programs: development, implementation and evaluation. Preparation of children for hospitalization is utilized to mitigate the stresses which may accompany the experience. Preadmission programs provide preparation for the patient and family on a prehospital basis. The authors describe the development of family-centered, developmentally based programs which foster continuity and consistency in a large, pediatric tertiary care setting. Implementation and evaluation of the programs which contribute to quality patient care are discussed.


The effectiveness of a preoperation preparation program in reducing anxiety in children. A study to assess the effectiveness of a preoperative preparation program on the child and family was undertaken. Three groups of mothers and children who were to undergo tonsillo-adenoidectomy were tested, pre- and postoperatively, using a questionnaire and IPAT Anxiety Scale. Differences were noted in the socioeconomic and educational backgrounds of the mothers who came of their own accord, those who were telephoned and those who did not attend the preoperative program. These differences affected the parents' expectations of the program and their explanations to the children. Children's, but not mothers', anxiety appeared to reduced by attendance at the program. The IPAT Anxiety Scale revealed that the anxiety of mothers of children who did not attend the preoperative preparation program was the highest of all three groups.


Art experience and hospitalized children. This paper explores the utility of the art experience in helping children cope with the stressful situation of hospitalization. A brief historical overview of the developments in this field is presented. In the art experience, similar aspects of the activity of play are expanded. They are: (a) the use of metaphorical thinking, (b) the use of concrete, sensuous materials, and (c) the use of physical activity. These are described and the creative process is suggested as an alternative mode of thought. The possibilities of using the art experience with children under stress are presented, as well as the description of the benefits of the art object to both staff and child. The benefits of the art experience as a safe place for expression of unacceptable feelings and fantasies and for the facilitation of communication between child and staff are also suggested.


Meeting the psychological needs of hospitalized adolescents: a look at England. Great Britain has been in the forefront in the development of programs for meeting the psychological needs of the hospitalized young child. A visit to four medical hospitals in England, hospitals selected for their advanced adolescent programs, revealed that advances for older youth have not kept pace with those for younger. Social, economic, and psychodynamic reasons for their slower growth are discussed an implications for future development drawn.


A factor analysis of the informational concerns of adolescent cancer patients. To acquire insights into the number and nature of different underlying concerns that motivated individual adolescent cancer patients' responses to health information items previously studied by Levenson and associates, exploratory factor analysis methodology was employed. Ten major aspects of the content domain emerged as important information needs of individual cancer patients: physical appearance, current treatment concerns, nonspecific cancer information, future outlook, familial implications, communication, health behavior, near-term expectations, teenage identification, and use of medications. Most factors failed to consistently relate to patient age, sex, race or diagnosis. Discussion focuses on the implications and suggested application of outcomes.


Humanizing the physical environment of an inpatient pediatric division: two creative expressive components.


Closed circuit television: a unique tool. A closed circuit television station was instituted within the Children's Hospital of Winnipeg in April 1981. The station broadcasts commercial-free children's programming throughout the day with the highlight of the schedule being a 1-hour live broadcast each weekday. The personal, interactive format of the live program has made the show a unique and effective tool for reaching patients, helping individual patients accept different aspects of their care, teaching the children about the hospital, and simply boosting morale through making each child a part of the program.


Music therapy: meeting the psychosocial needs of hospitalized children. Music therapy offers a unique approach for reducing the stresses of hospitalization for children. By meeting important psychosocial needs, music therapy lessens anxiety, aids adaptation and contributes to making the hospital experience a more positive one. The use of music therapy is described and illustrated with three patients all of whom underwent painful and prolonged hospitalization with immobilization and severe movement restriction.


Special books for special children.

Special books for special children. Simple books written for an individual child can assist that child in coping with unusual and potentially stressful medical problems. The philosophy, techniques, and process of writing this type of book are shared, as well as examples of illustrations and text from two books written for preschool children: one with a glycogen storage problem and one requiring a hand amputation. The article serves as a guide and encouragement to others involved with the emotional care of children to consider this technique as a complement to preparation and hospital play.


Fun in the sun: an outdoor program in a health care setting. The Children's Hospital of Eastern Ontario in Ottawa, Ontario, has had a supervised playground program for the past 6 years, which is available to inpatients, outpatients, and their visitors. This paper describes playground staff and volunteer prerequisites, the role of interdisciplinary involvement, equipment and materials, factors to consider when planning outdoor activities, and the activities found to be most useful. The authors' purpose is not to give the recipe for an ideal playground program, but rather to stimulate interest in the desirability of playground programs in health care settings through the description of one such facility.


Dialogues with hospital pharmacists.

Dialogues with hospital pharmacists.


Development of pediatric secondary psychosocial care in a health maintenance organization. A pediatric secondary psychosocial service was developed to provide easy access to brief, focused, problem-oriented psychosocial care for children and their parents on referral from their primary care providers. The intent was to support parents' efforts at resolving their families' difficulties. Support was provided for patients with needs beyond the realm of primary care, so as to avoid deterioration in functioning and the need for tertiary care. During the first 6 months 243 children were seen for a wide range of behavioral, emotional, and social relationship difficulties. Evaluation revealed strong support by referring providers, parents, and psychosocial staff. Subsequent developments and plans are discussed.


Normalization: meeting growth and development needs of children in a pediatric intensive care unit.


Policy and procedure manual: medication quality assurance rounds.


Tips and techniques: nurses' evaluation of pharmacy services.


NAHC reports results of computer services survey.


Pharmacy-controlled drug administration: a proposed solution to the nursing shortage.


Computer contracts: let the buyer beware.


Making the right choice.

Making the right choice.


Alternative approaches to computerization.


Data processing companies speak to home health.


The maintenance of high ethical standards in the conduct of research.


Five Hospital Homebound Elderly Program--success in long term home care.


Randomized clinical trials, consent and the therapeutic relationship.


General clinical research centers: a program in jeopardy.


An academic medical career within the VA medical centers: pros and cons.


Health research funding for the NIH: a proposal for fiscal year 1984.


An ethical issue in biomedical research: the involvement of minors in informed and third party consent.


Surgical wound infections.

Surgical wound infections.


Alcohol in perspective.

Alcohol in perspective.


Adult day-care centers: a trend that bears watching--and perhaps action.


A hospital cost containment program.

A hospital cost containment program.


Implementing layoffs and reductions in staff.


A businessman's view of health care.

A businessman's view of health care.


Spreading the good word about hospitals.


Public relations for the pharmacy department.


Database lab systems come of age at Skokie Valley.


Screening criteria. Shortening the RFP process.


The Parkland On-Line Information System (POIS) associate concept.


A review of turnkey laboratory systems.

A review of turnkey laboratory systems.


Choosing the physician's computer.

Choosing the physician's computer.


Compliance with guidelines for monitoring aminoglycoside therapy. One hundred and twenty-one patients receiving 140 courses of aminoglycoside-therapy (76% gentamicin and 24% tobramycin) were retrospectively studied to assess the monitoring practices for these drugs. Compliance with specific items of the monitoring guidelines ranged from 16 to 93%. An education program regarding aminoglycoside monitoring, particularly the use of serum aminoglycoside concentrations, is necessary in the study institutions.


Handling antineoplastic drugs--whom do we protect?


Good patient relations crucial to hospital survival.


Recent developments in drug delivery.

Recent developments in drug delivery. Some recent innovative approaches to drug delivery have demonstrated that the administration of drugs can be more rigidly controlled with respect to the rate and amount of drug delivered to sites of action than from the conventional dosage forms. One category of controlled release referred to as programmed drug delivery primarily involves the application of polymers of defined specifications to release agents from either non-bioerodible membrane-controlled systems or bioerodible and non-bioerodible matrices. Also included here are the pro-drugs, inactive derivatives of drugs which are transformed into the active form in vivo but possess improved solubility, stability and disposition properties, yielding more efficient action and fewer side effects. Thus, exploitation of several routes of administration have resulted in products which are inserted ophtalmically, rectally or vaginally, implanted subcutaneously, taken orally or applied topically to achieve transdermal delivery of drugs to the systemic circulation. In several cases, release is designed to follow zero-order kinetics to achieve control of therapeutic plasma concentrations for prolonged time periods. Targeting of drugs by carrier is another form of controlled release technology. Normally administered intravenously, carriers such as liposomes, nanoparticles, microspheres, human cells and linear macromolecules are finding application in treating disease states with drugs which previously were unavailable to treatment.


Marketing your hospital: getting staff on board through in-service education.


Discharge planning models: the Long Island College Hospital, Brooklyn, NY.


Patient teaching in the emergency department.


Automatic food service: the meal of the future?


Authentic management: critical skills for hospital productivity improvement.


The implementation of comprehensive critical care pharmacy services through the development of a 24-hour satellite pharmacy. This report details the evolution of pharmacy services within the critical care areas of a large general hospital. The program began with the assignment of a clinical pharmacist to the intensive care unit and now includes a staff of six pharmacists operating from a 24-hour satellite pharmacy dedicated to critical care services. In the process a system has been developed which allows all staff to function in an integrated distributive-clinical role, eliminating the distinction between pharmacists performing these two separate functions. The system provides for total unit dose and IV admixture services as well as in-depth clinical monitoring, drug information and research responsibilities. Early impressions validate the success of this approach and objective evaluation, including the auditing of clinical input, is underway.


BP monitoring on the move.

BP monitoring on the move. For the past two decades, researchers have been experimenting with improvements and variations on the traditional mercury manometer. Many of these are now in common use, but the state of the art is still in flux as new automatic and manual, ambulatory and stationary BP monitoring systems are developed for research and diagnosis.


Discharge planning for the emergency department social worker.


State laws and court decisions define use of medical records to protect employee's privacy.


Hundreds of freestanding centers now operate.


Benefits for hospital workers generally below par.


Federal health plan studied as competitive model.


Examining hospice programs as cost-cutters.


Nation's hospitals ill-prepared for major disasters, study says.


Disaster drills essential to minimize 'turf' issues, organizational problems.


Alcohol abuse merits closer ED attention.


ED abuse and follow-up: one physician's opinion.


Billing: no one pays if not asked.

Billing: no one pays if not asked.


Prevention, trauma centers, research could cut down high cost of trauma.


Type of charging system can affect reimbursement.


AMA's approval of FEC guidelines called restraint of trade by NAFEC.


Poor still have access to Detroit EDs but not to hospitals, due to money woes.


Need, demand, supply.

Need, demand, supply. Ideally, health needs should arouse a proportionate and appropriate demand for health care, which can then be supplied in a systematic way. In real life, this desirable process is distorted by faulty perception of actual need; by failure of even perceived need to generate demand, while at the same time demands are made which bear little relation to need; and finally by the inappropriateness of some service provision to either need or demand. One approach to making a more objective assessment of what is needed in service provision is described, in the shape of a system of five indices of the burden cast by various types of illness on sufferers and on the health services.


Health care policy today: making way for the libertarians?


Effects of cost-sharing in health care.

Effects of cost-sharing in health care. This article gives an introduction to the literature dealing with cost-sharing in health care and focuses on the question: does a change in cost-sharing have any impact on the demand for medical care, keeping all other things equal? And if so, to what degree? The main empirical results in the health care economics literature are reviewed and some important studies are discussed. One conclusion on which all studies agree is that an increase of the out-of-pocket price results in a reduction of the demand for the medical care in question. There are many indications that this money price-effect is the larger the lower the time-price, the lower the income, the less urgent the medical care is and the more influence the patient has on the decision to receive medical care. Finally, there are indications that cost-sharing for out-patient services reduces the hospitalization rate.


A national approach to health service management information services.


Effectiveness and efficiency of health services.


The changing character of quality assurance: activities in acute care hospitals.


The problems related to confidentiality and effectiveness of health care. The problem of the impact of confidentiality on health effectiveness is discussed along five points: (1) Communication facilities between health departments are main features of health information systems. (2) Efforts, costs, limits of data protection. The privacy violation risks have to be related to the data protection costs. (3) Paradox of the fundamental rights to confidentiality regarding privacy of the individual and the preponderant interest of the State. (4) Facing the increasing health costs, the need for medical and hospital control systems is assessed. (5) New benefits in medicine and in the quality of care are partly the results of more or less extensive studies in epidemiology at national levels. The general conclusion is concerned with the risks that the computer could become an instrumental substitute for human reason with the progressive drop out of responsibility of health officers.


Acoustic design in videoconferencing facilities.


Inequalities in health in Britain. A critique of the report of a research working party.


The National Hospital Union in 1983. Ten years of struggle, ten years of progress.


Materials managers told to be bottom line conscious in new system.


How to boost the image of hospital foodservice.


Deaths from fire in sprinkler-protected buildings.


Cancer center doubles net income after appeal overhaul. Memorial Sloan-Kettering Cancer Center wanted a herd of higher quality donors. Following concentrated efforts with list segmentation, data processing, mailing packages with a human interest slant, and a change in renewal strategy, the center reached its goal. When it was over, the development department had turned a simple annual giving campaign into a refreshing multiple gift appeal.


Non-profits need development orientation to survive.


American Cancer Society's market planning process.


Non-business marketing becoming required strategy.


Marketing for fund raisers: developing a new sensibility.


Questions to include in the marketing audit.


Company executive keeps military ties as a chief nurse in Air Guard.


Wanted: more trustees with certain wallop.


"Fair" support by employees spurs hospital UW drive.


Grantees' overhead costs: should foundations pay?


Life cycle marketing of a medical building.


Giving more and liking it more.

Giving more and liking it more.


Unity in a competitive world.

Unity in a competitive world.


Quality assurance operations: good clinical practices. The pharmaceutical industry sponsor bears the ultimate responsibility for the verification of all clinical data submitted to the FDA in support of a New Drug Application (NDA). The author provides an overview of a systematic approach to providing quality assurance for all clinical data collected in the course of human trials with research compounds. This systemic approach includes such features as: Standard Operating Procedures Manuals, the development of a quality assurance function within the organization, detailed documentation for all monitoring activities, careful assessment of all clinical research data collected, and an emphasis on preventive measures that can be introduced to assure the quality of subsequent research data.


Surgery, lens implant restore sight to eye blinded 23 years.


Money isn't everything.

Money isn't everything.


Auditing clinical research data: objectives, applications and results. Formal auditing of clinical research data has become a standard contemporary practice within the pharmaceutical industry. Its basic purpose is to provide documentation relevant to an assessment of the quality and integrity of data collected in the course of a clinical trial. This paper outlines the audit procedures developed within one major pharmaceutical firm. These procedures require an intensive investigation of internal and external aspects of study management, records management, data entry, data analysis and statistical report preparation. A qualitative evaluation of the results achieved by this auditing procedure are presented.


For fee or charity?

For fee or charity?


HMO-employer contracts.

HMO-employer contracts.


HMO development in the U.S. and Brazil.

HMO development in the U.S. and Brazil.


The impact of insurance coverage on use of out-of-plan emergency services. One HMO's experience.


Council challenges IRS on trustee liability.


Six trends shaping philanthropy's future.


The propriety of judicial deference to corporate boards of directors.


Tax policy and equipment leasing after TEFRA. The Tax Equity and Fiscal Responsibility Act of 1982 substantially modified the "safe harbor" leasing provisions enacted by the Economic Recovery Tax Act of 1981. In this Comment, Professors Warren and Auerbach argue that the modifications did not remedy the defects they identified in an earlier Article and that a new category of "finance leases" may prove to be nearly as valuable for some taxpayers as were safe harbor leases before the 1982 changes.


Evaluating the impact of prevention programs aimed at children.


SmithKline's ulcer medicine "holy war".

SmithKline's ulcer medicine "holy war".


VAV and heat recovery in a medical center.


Hospital stays vary from coast to coast.


Price tag for home-based services for elderly could be billions, CBO says.


Korner Report. Bridging the information gap.


Syringe pumps.

Syringe pumps.


Secure units: caring behind locked doors.


Recovery rooms: dangerous slumbers.

Recovery rooms: dangerous slumbers.


Finance: day of judgement.

Finance: day of judgement.


The allocation of units of medical time in relation to medical staff establishments.


The developing IHSA education programme.


A new marketing concept: bring consumers into partnership with the health care system.


The future isn't what it used to be.

The future isn't what it used to be.


The challenge of medical manpower planning.


Interview with Trevor Clay. General Secretary, Royal College of Nursing.


Observations on the implications of Korner Working Group on Manpower.


Hospital supply prices continue to outpace general rate of inflation.


Buying for the clinical laboratory.

Buying for the clinical laboratory.


Costs of home health care causes concern. Reagan administration opposes expansion.


Case of the disputed dismissal.

Case of the disputed dismissal. Managers in the United States, acting in anger, indignation, frustration, or even error, fire many capable employees every year. In some of these cases, the managers act unfairly. Perplexing questions arise when the story of an unjustified discharge catches the public's eye. Does an organization have an obligation to manage equitably as well as efficiently? It is conceivable that every man and woman has a right to a job, and, if so, is this right a factor that managers must weigh in deciding to lay off an employee who doesn't "fit in"? The employee in this case "Adrian Reese," is an outspoken health official who irritates the city manager and members of the "Marshall City" board of health. Like most HBR cases, this is based on a real situation. As the problem unfolds, readers may find the circumstances and the characters familiar. And yet they may be surprised at the outcome, as truth is stranger than fiction.


Taping bed reservations: careful planning paid off.


Reimbursement: knowing where you stand.

Reimbursement: knowing where you stand.


Are reimbursement appeals worth effort?

Are reimbursement appeals worth effort?


Are admitters liable in suits against impaired physicians?


Screen applicants' backs to reduce injuries.


Compensation, jobs, and gender.

Compensation, jobs, and gender.


Managing for efficiency, managing for equity. It is a truism that not all managers do the same things in the same ways. Less often recognized, however, is the fact that the essential tasks and goals of management are not everywhere the same. Indeed, so unlike each other are the two primary systems of management--the "technocratic" and the "political"--that they consistently vary in the implicit contract offered to participants, the career path of members, the use of organizational structure, the choice of purpose, and the allocation of resources, but also provides a conceptual framework for understanding why they happen and what can be done to prevent their happening in the future.


Hospitals find not everyone wants HB vaccine.


Foodborne GI infections still a problem.


NIOSH establishes task force on hospital occupational hazards.


Educating pregnant staff called 'best' policy.


Fight AIDS fears with IC measures, information.


Preplacement screenings help gauge general employee health.


Handwashing, food handling care limit diarrheal diseases.


Baltimore hospital employee succumbs to AIDS.


Money, time may be barriers to meeting new EtO rule.


Hospitals put priority on TB, hepatitis screening for OR staff.


Trouble: some observations on drainage and sanitation.


Alternative contract methods in use in the NHS. Management contracting.


Center provides day care, health services to elderly.


Child abuse program focuses on parents' problems.


Tragedy shows need for cautious discharge planning.


Building a healthy society: a Catholic challenge for the future.


Archdiocese, hospital cooperate in corporate reorganization.


CHA study reveals Catholic hospitals' deep involvement with HMOs.


Ethics committees and ethicists in Catholic hospitals.


Retreat for chronically ill patients emphasizes "spiritual rehabilitation".


Social justice issues: considerations on rights and responsibilities.


A conservative health care plan for the unemployed.


Hospital has absolute control over staff privileges.


Hospital's liability for OR accidents emphasizes need for adequate insurance.


Prehospital coronary care: does it save lives?


A case involving a nurse acquiring an infection from a patient and the M.D.'s responsibility.


How to evaluate the effectiveness and efficiency of your hospital's operations.


Management tools for the modern day health administrator. Part 4. Communicating tools.


Responsibility of management.

Responsibility of management.


State legal initiatives. Health planning status reported by AHA's Office of Public Policy Analysis.


West Virginia passes law requiring 40% consumer representation on nonprofit hospital boards.


How to increase employee productivity. Quality control circles can help hospitals improve care, reduce costs, boost morale.


Changes in Wisconsin's Certificate-Of-Need Law; challenged moratorium extended.


Central service questions and answers. The necessity for cleaning surgical instruments prior to sterilization.


Coalitions perspective: Zenith program emphasizes employee as part of health care team.


Theory of organization.

Theory of organization.


What are Pareto diagrams?

What are Pareto diagrams?


Three steps to identifying or justifying C.S. personnel needs.


Sterilization assurance system cuts central supply costs.


An effective case cart system for a large university.


Expectations and considerations when you introduce a case cart system.


Amsterdam medical complex.

Amsterdam medical complex.


A director of nurses assesses the progress of CS.


Marketing a new program begins inside your own hospital.


The importance of visual environment.

The importance of visual environment.


AHA files "Baby Doe" comments; criticizes proposed rule.


The medical day care program in New Jersey. This article discusses the growth of Medical Day Care as a Title XIX funded service in New Jersey. It also examines the licensure requirements of the program under the Department of Health and the standards for certification under Medicaid. Two studies of participants attending medical day care centers are reported. One study examines 406 persons in six centers, providing a profile of the population served. The second study reviews the cost of care of 52 participants over a one and one-half year period, comparing total cost of care with institutional care, concluding that medical day care is much less expensive.


Nurses and social workers in home health care: identifying and resolving turf conflict. A survey of role perceptions of nurses and social workers employed in home health care in Washington State indicated potential turf conflict in a number of roles involved in home care of elderly patients. Nurses tended to perceive themselves capable of all patient-directed tasks and perceived few professional tasks in home health care as the unique domain of social work. This attitude was in sharp contrast to social workers' perceptions, particularly regarding tasks in the psychosocial area. Strategies for identifying and overcoming professional turf conflict in home health care agencies are discussed.


Hospitals and community-oriented programs for the elderly. Five case studies are presented of hospitals which have become involved in developing community-oriented programs for elderly persons. The reasons behind the new hospital interest in the elderly are complex, ranging from idealistic to self-interested reasons. Major actors involved in initiating interest in hospitals varies greatly from hospital to hospital. Advantages and disadvantages of hospital involvement are presented.


Evaluating the home care service needs of the elderly: a research note.


Off-hour telephone calls to a geriatric home care team. This is a study of off-hour telephone calls to a physician/nurse practitioner/social worker team available on a round-the-clock basis to a population, averaging 54 in number, of chronically or terminally ill home-bound elderly patients. Most calls could reasonably be considered urgent and appropriate, and only about three per month necessitated immediate home visits: the off-hours time demand is not excessive and can be managed with appropriate practice organization and provider-patient understanding.


Design issues for evaluations of community care demonstrations. The evaluation of community care demonstrations poses a number of interdependent program and methodological design choices. Whether or not the program to be tested has a system-wide mission, for example, determines whether the program should be implemented on a small or large scale. This in turn has important implications for whether a randomized or a comparison site design is the appropriate evaluation methodology. This paper examines the relation between system-wide mission and scale considerations, on the one hand, and appropriate choice of methodology, on the other. It concludes that a small scale program with a randomized evaluation design is easiest to implement, costs less, and is more likely to provide defensible answers to a limited set of policy questions than a large scale program with a system-wide mission evaluated using a comparison site methodology. Despite the greater difficulty and cost of a large scale demonstration, however, such a demonstration should be seriously considered whenever increased funding makes it a feasible option, because it is able to address a number of significant policy questions that cannot be answered within the constraints of a small scale demonstration.


Home care for the dying: homemakers' perspectives. Homemakers are important members of the health care team providing hospice care at home, yet there is little information about their views and experiences. This paper summarizes findings of a survey of homemakers working with a newly-developed program for providing home care for dying patients and their families. Results indicate that homemakers perform multiple roles, which they report tend to be more demanding physically and psychosocially than other kinds of homemaking. Being able to provide comfort in a time of extreme need is satisfying to homemakers, although frustrations exist as well. Implications for program planning and future research are discussed.


A program of evaluation and research for hospital based home care. A program of evaluation and research has been developed and initiated in a large Hospital Based Home Care Program which principally serves chronically-ill, elderly veterans. Program evaluation is based on data from an automated home care information system developed for this purpose. The information system is based on the Long-Term Health Care Minimum Data Set, a nationally-recommended data set which describes patient demographics and physical and mental health status, and health services provided. Home care and related costs per visit and per patient day have been identified. A proposed, experimental research protocol identifies health status outcomes and health care costs of home care and alternative modes of long-term health care.


A time-motion study of patient care activities of a geriatric home care team. A self-administered time-motion study of the activities of a home care team, consisting of physician, nurse practitioner and social worker is reported. The patients were home-bound, chronically or terminally ill and largely elderly, and the physician and nurse practitioner were available by telephone and for emergency visits on a 24-hour, 7 day per week basis. A systematic sample of 24 hour calendar days was studied; the average team patient census was 54 (the team had other clinical responsibilities in addition). Time spent on travel, home visits and on team conferencing and consultation was higher than in other practices, as might be expected. Full-time equivalent requirements for this type of care program were extrapolated to come to approximately one physician and social worker and one and one-half nurse practitioner per 100 patients. A truer estimate of actual costs of provision of team services to home-bound patients can be provided by this method than by the usual calculation of charges based only on actual home visits.


Home health care: will the past predict the future?


Voluntary rubella vaccination program described.


Malpractice claims for infections analyzed.


It Works. Developing a personnel manual.


VHA wins first round in antitrust battle.


Budgeting cost increases: a self-fulfilling prophecy.


Policy responses to schizophrenia: support for the vulnerable family.


Hospital group purchasing--a rebuttal.

Hospital group purchasing--a rebuttal.


Vendor certification--the benefits are worth the effort.


Hospital or hotel? There may be a choice.


Integrated medical equipment management.


New linen policy saves dollars and makes sense.


Bar coding system makes exchange carts obsolete.


Group buying: where are we going?

Group buying: where are we going?


Developing the work group.

Developing the work group.


Theft in the hospital.

Theft in the hospital.


Not all physicians are embracing a new 'corporate sector' in health care.


Fire preparedness program pays off for WA hospital.


Cooperation will conquer competition.

Cooperation will conquer competition.


AHA convention consensus: physicians crucial to hospitals' viability.


A new formulary statement and formulary service.


Use of nonsteroidal anti-inflammatory drugs in a rheumatologic outpatient clinic.


P & T committees and the hospital formulary.


Evaluating the quality of patient education in a self-medication teaching program.


Healthcare marketing and the regional model.


Chicago Tylenol poisonings: Mississippi hospitals' thoughts and actions.


Analysis of drug information questions on a decentralized pharmacy service unit. The pharmaceutical services at Rhode Island Hospital integrate the decentralized distribution role of the pharmacist with the provision of patient-specific drug information. This service is backed up by a Drug Information Center (DIC). A study to analyze the inquiries addressed to pharmacists assigned to a decentralized unit (PSU) was conducted over a 30-day period. The survey tabulated what kind of requests were made, if they could be answered with the information available on the patient care unit, and what action was taken as a result of the information provided. When the requests were categorized according to the type of information, the PSUs and the DICs top three categories were the same. Only 3.8% of the requests for information on the PSU could not be answered using the references available on the unit. Fifty one per cent of the requests received by the PSU were acted upon by the inquirer exactly according to the information provided by the pharmacist.


Twenty-four hour a day pharmacy service in hospitals with less than 300 beds--Part 3.


A perspective from the Knowledge Base Research Program (KBRP).


Physician-centered marketing: a practical step to hospital survival.


Social dimensions of changing office technology.


Impressions of marketplace competition in the Twin Cities.


Macro-marketing in health care.

Macro-marketing in health care.


Washington State Medical Association. Guidelines for patient access to medical records.


Manager and evaluator views of program evaluation. This article presents the results of a 1979 national survey of federally funded community mental health centers (CMHCs). The directors and chief program evaluators of 323 CMHCs returned questionnaires which allow comparisons of the opinions of the center managers and their evaluators regarding accountability and evaluation and the level and knowledge of center evaluation staff. The CMHC directors and evaluators are also compared to a random sample of community psychologists and four other criterion groups of professionals regarding their responses to three items of the service provider accountability subscale of the Human Service Ideology scale.


Factors related to job stability of direct-care staff of residential facilities for mentally retarded people. Direct-care staff turnover has frequently been cited as a major problem in the management of both public and nonpublic residential facilities. This article reports on a follow-up study of over 100 direct-care staff one year after an initial interview. Staff members were employees of facilities in a national, stratified random sample of public and nonpublic facilities. Demographic, experiential, job satisfaction, geographical, and institutional factors related to occupational status at the time of the follow-up are reported.


Delivery of rape-related services in CMHCs: an initial study. A questionnaire designed to assess how rape-related services are delivered was mailed to directors of 34 federally funded comprehensive Community Mental Health Centers (CMHCs) in Missouri and Illinois. Responses were received from 18 CMHCs. Results indicated that rape-related services were offered by approximately three-quarters of the respondents, who reported delivering primarily clinical services.


Training community-based, Asian-American mental health personnel in behavior modification. Sixteen Asian-American and Pacific Island mental health professionals received 10 weekly, 2-hour training sessions on behavior modification and its application, in particular, to Asian-American clients. A three-fold assessment of the training results revealed: a) a significant increase in knowledge of behavior modification principles, b) a significant increase in ability to accomplish a behavioral analysis and behavioral treatment plan, and c) a significant increase in one of three attitudes toward behavior modification: oriented activity. In general, the training was rated highly and, perhaps more importantly, was viewed as having relevance for this particular minority population which often under utilizes mental health services. The training model and needs for further consultation and supervision were discussed.


Analyzing triage tag samples.

Analyzing triage tag samples.


The ambulance report as legal document.

The ambulance report as legal document.


Market strategies for hospitals in a competitive environment.


Championship mania. Testing an interagency command operation.


Financial strategies for surviving the 80's. Part 4. Cost Control.


Collapse of Coalinga.

Collapse of Coalinga.


A better mousetrap. What makes up the "perfect" triage tag?


The public/private interface.

The public/private interface.


Trauma care. Evaluating effectiveness with the injury severity score.


An ounce of intervention. Developing a standard training program for behaviorial emergencies.


Employ the best. A guide to paramedic selection.


"Do not resuscitate" administrative and ethical considerations in prehospital arrests.


Development and implementation of a music/activity therapy intake assessment for psychiatric patients. Part I: initial standardization procedures on data from university students. The stimulus for the Music/Activity Therapy Intake Assessment was a recent publication by the Joint Commission on Accreditation of Hospitals requiring for activity services, "assessment of the patient's needs, interests, life experiences, capacities, and deficiencies" (1981, p. 126). The Assessment was written in the spring of 1982 and contains four sections: Activity Preference, Organizational involvement, Attitude Survey, and Post-Interview Observations. The purpose of the present study was to investigate the psychometric properties of the Attitude Survey. The Attitude Survey was administered to 214 university students enrolled in three areas of study: human science, performance, and liberal arts. Results show that each of the three scales in the Survey is internally consistent (.63 to .74), that each scale measures a single large dimension, and that two of the three scales significantly discriminate between groups of students (p less than .05). The authors conclude that the Attitude Survey possesses adequate psychometric properties to justify its continued use as part of the Music/Activity Intake Assessment.


Clinical pastoral counseling: an Australian model.


Hospitalization, arrest, or discharge: important legal and clinical issues in the emergency evaluation of persons believed dangerous to others.


The beginning of clinical pastoral care in the Philippines.


Loss, mishandling of personal laundry major complaint in PA nursing homes.


Why are in-house laundries closing?

Why are in-house laundries closing?


Hospital co-op to buy water soluble bags as part of settlement with striking workers.


Private agencies for public purposes: some new perspectives on policy making in health insurance between the wars. The approved societies, who were charged with the administration of health insurance in Britain, have long been blamed for the failure of the scheme to expand its coverage or scope in the interwar period. This paper takes a closer look at the administrative process and argues that societies were more vulnerable to central regulation than is commonly thought and were unable to resist cuts in public subsidies and extensions in liability introduced at their expense. They provided a convenient scapegoat for policies emanating primarily from the economic orthodoxy subscribed to by both government and the Treasury, modified to protect the unemployed during the slump. Health insurance policy was dominated to a large extent by the Government Actuary, who aimed to guarantee the cost effectiveness of the scheme. This paper also shows how administrative definitions and practices affected the classification of claimants to state social insurance at this time. It re-establishes the major weaknesses of the system, arguing that--in the light of recent discussions about reviving a system of national health insurance--we have much to learn from looking again at the experience of the interwar period.


Organizing a corporate philanthropy program.


Inappropriate patient confinement and appropriate state advocacy.


Vitek and beyond: the empirical context of prison-to-hospital transfers.


Major current issues concerning civil commitment criteria.


Following the leader: how to link management style to subordinate personalities.


If an A-plant blows, what can a doctor do?


Non-profit hospital co-op laundry now profit-making linen exchange.


Thermal-oil system helps slash hospital laundry's energy costs.


Illinois to revamp legislation will simplify nursing home law.


Hospitals that still want doctors.

Hospitals that still want doctors.


Ethical dilemma: should I break patient confidentiality?


Would you really want to join the PPO movement?


. . . And other competition you'll face in 1983.


Would this service help your patients?

Would this service help your patients?


Cable Health programming lures prescription advertisers.


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


Third annual guide. Copiers.

Third annual guide. Copiers.


Merger. A response to increasing competition. Two group practices in Wisconsin, the East Madison Clinic and the Dean Clinic, chose the path of merger to meet the demands of the competitive healthcare environment. The key-issues which had to be addressed before the merger could take place are presented, including: redesign of the earnings distribution formula for the groups, determination of quality assurance mechanisms for the new and larger organization, the effect on administration, considerations in announcing the merger to the public, and many more. Given the unique set of circumstances surrounding the two groups, merger has proven to be a very successful venture and has led to the realization of multiple benefits for the new organization.


The goal-oriented job evaluation.

The goal-oriented job evaluation.


A workable buy-in/out strategy.

A workable buy-in/out strategy. Many medical groups experience dilemma in negotiating buy-in agreements between owners and non-owner group members of clinic property. Anything less than broad-based ownership can promote a divisive undercurrent within the organization and the group's very perpetuity may be held in jeopardy. The author offers a complicated financing strategy which redistributes building equity, thereby reducing buy-in value.


A medical group on Embassy Row.

A medical group on Embassy Row.


Detailing and quantifying job performance.


Guide to a good management library.

Guide to a good management library.


Specialized ratio analysis.

Specialized ratio analysis. Many common management techniques have little use in managing a medical group practice. Ratio analysis, however, can easily be adapted to the group practice setting. Acting as broad-gauge indicators, financial ratios provide an early warning of potential problems and can be very useful in planning for future operations. The author has gathered a collection of financial ratios which were developed by participants at an education seminar presented for the Virginia Medical Group Management Association. Classified according to the human element, system component, and financial factor, the ratios provide a good sampling of measurements relevant to medical group practices and can serve as an example for custom-tailoring a ratio analysis system for your medical group.


Are you managing a future national medical practice? Are you a futuristic medical group manager? Do you dream of being president of a national medical practice? This entrepreneurial look at the group practice marketplace encourages managers to rise to the challenge of competition. A national medical practice represents the supreme challenge for a futuristic medical group manager. The author gives his insights to marketplace forces and clues about how the challenged manager can expand his group on a regional or national basis.


Don't overlook phlebotomy QC.

Don't overlook phlebotomy QC.


Giving and handling criticism.

Giving and handling criticism.


Moving. Ain't it great?

Moving. Ain't it great? Group practice administrators often say that they do not want to "reinvent the wheel," but simply want to use it after it has been tested and perfected. In this humorously written and very informative article, an administrator relates his group's building and moving experience and, looking in retrospect, imparts many constructive comments as well. The reader no doubt will identify mistakes made and may even take exception to the methodology used. If, however, this experience in moving can provoke either positive or negative observations, then perhaps other administrators will be able to avoid reinventing the wheel when it comes time for a move to a new facility.


How a color code kept our reports from vanishing.


Rx for the elderly: a little time and tenderness.


Improving our professional credibility.

Improving our professional credibility.


Emerging developments in laboratory technology.


Pay raises: merit or seniority?

Pay raises: merit or seniority?


Genetic screening: a medicolegal time bomb?


Office of the future. Clinic style.

Office of the future. Clinic style. With technology as the driving force, there are many changes occurring in medical group offices. The medical office of the future is a concept which encompasses the total office -- the interrelationship of all pieces of equipment. This focus on the total office will mean improved productivity and effectiveness not only in clerical areas, but in managerial and physician areas as well. The author examines some of the technology that is being developed today in voice and text processing and communication. Each medical group must analyze its present and future needs and then implement advanced concepts to meet those needs.


Maintaining medical records.

Maintaining medical records. In addition to being a required legal document, the medical record is a necessary tool for continuity of care and accurate billing. Its proper appearance, organization, and completeness are essential to good management. A series of steps have been set down in this nuts-and bolts article, providing the administrator with a systematic guide for efficient medical record maintenance.


Plugging the lab into a computer network.


An overall laboratory communication plan.


A guide to progressive disciplinary measures.


Interview: a physician/administrator talks about physicians in today's hospitals.


Career ladder encourages better nursing care.


ALRMM: an approach to productivity monitoring.


Staffing a new hospital.

Staffing a new hospital.


Credentialing system enhances quality, cuts costs.


Quality circles work for hospitals.

Quality circles work for hospitals.


Human development as a catalyst for change.


Physical therapists: too few now, fewer tomorrow.


Manpower: a view of changing needs.

Manpower: a view of changing needs.


OSHA pushes EtO limit too fast: AHA.

OSHA pushes EtO limit too fast: AHA.


Market predictions give CHI an edge in rug-of-war for healthcare dollars.


Hospital information systems: more computer firms entering already crowded hospital market.


Hospital information systems: hospitals' reliance on in-house systems expected to increase.


Hospital information systems: terminal becoming bedside tool.


Food service: subtle change in menu, delivery can beef up kitchen productivity.


Food service: comparing 'apples and oranges' isn't a problem with formal RFPs.


Food service: evaluation can be keen weapon for defending capital purchase.


Trends may intensify M.D.-CEO tensions.

Trends may intensify M.D.-CEO tensions.


Court ruling on tax-free status casts shadow on common financing strategy.


Hospitals balk as interest creeps up.

Hospitals balk as interest creeps up.


AMI is guilty in antitrust case: FTC.

AMI is guilty in antitrust case: FTC.


OMB's support of House planning bill opens new road to compromise.


Hospitals must lead development of morally difficult rationing policy.


Competitive buying groups pluck hospitals from each others' regions.


Competition closing gap between I.V. prices groups pay.


Some hospitals 'shoot from the hip,' but others use research to target marketing.


Prescription for health costs.

Prescription for health costs.


The due process of effective management.


Blues seek sane balance in medical economics.


Economic aspects of primary health care.


The health care plight of illegal immigrants.


Government intervention: "the Baby Doe rule".


Pharmacist certification program.

Pharmacist certification program.


Recession ills. Physicians respond with free health care.


Group discussion methods.

Group discussion methods.


Readiness to learn in patient education.


Hospital-based health information center.


Social support and health.

Social support and health.


A synthesis of methods.

A synthesis of methods.


The physician oversupply: implications for patient education.


Informed consent in perspective.

Informed consent in perspective.


Marketing and health education.

Marketing and health education.


Primary prevention for children: a framework for the assessment of need. This paper discusses the role of needs assessment procedures in the development of effective primary prevention strategies for children and youth. A number of techniques which may be employed in the assessment of need for such services are presented and their strengths and limitations for such application are discussed. Particular problems for needs assessment planning and implementation stemming from differences in the goals and objectives of preventive, as opposed to more traditional mental health services for children, are elaborated and possible strategies for their resolution suggested.


A needs assessment of human service agencies in an urban community.


Needs assessment and community development: an ideological perspective. Many practitioners of the social sciences have fostered the value-free, apolitical and ahistorical character of their disciplines. This position distorts the real perception that should permeate the theory, methodology, techniques and practices of the social sciences. This paper, by examining the method of needs assessment, focuses on the undesirability of preserving this point of view. Needs assessment is discussed as a political process for the organization, mobilization and consciousness-raising of groups and communities.


Mental health needs assessment approaches: a case for applied epidemiology. This paper briefly describes the political and social factors which have prompted the rapid development of needs assessment as a research activity. It also suggests reasons for the likelihood of continuing assessment mandates through the 1980s. The five most commonly employed needs assessment methodologies are outlined and a critique is offered for each. The major focus of the paper is on the development and uses of an applied epidemiologic survey assessment model which has been designed and tested extensively by the authors in a variety of geographic areas and agency settings. Illustrations of how field survey data can be presented for enumerating mental health needs are also presented.


The central risk organization.

The central risk organization.


Dealing with elderly patients' special needs.


House calls: how big a comeback?

House calls: how big a comeback?


The politics of hospital privileges.

The politics of hospital privileges.


Incompetent physicians: a legal mine field.


Malpractice liability and your staff.

Malpractice liability and your staff.


How recent court rulings are affecting staff privileges.


10-point checklist to prevent malpractice claims.


The freestanding ER: a growing competitor.


Court ruling threatens reimbursement increases.


Malpractice liabilities in referrals.

Malpractice liabilities in referrals.


Supporting the homemaker-home health aide as a valuable player on the home care team.


The Urban Community Family Medicine Home Visit Program at Thomas Jefferson University Hospital.


Homemaker-home health aides as members of the home care team.


The National Homecaring Council's standards for paraprofessional services: a critical guide.


Children of psychotic mothers may benefit from home care.


Program builds self-reliance, self-care skills in unique approach to promoting health.


Persons mentally ill and retarded need better care.


Plugging health promotion into the cable TV boom.


Challenging responsibility: patient education.


Evolution of the work ethnic.

Evolution of the work ethnic.


Establishing a management system: the interaction of power shifts and personality under federal MBO.


Electrolytic fixer.

Electrolytic fixer. Interest in the recovery of silver from radiographic film generates a need to understand the operating procedures of recovery units utilizing the electrolytic fixer principle. Tailing or terminal units and recirculation units using electrolysis are evaluated. Difficulties encountered in the number of Coulombs applied to a specific amount of fixer are discussed. Reduction of sulfiding as a result of electrolysis and variations in film volumes are noted. The quantity and quality of silver collected can be improved by being aware of alterations in chemical activity used in a silver recovery program.


Technology update: automated microfilm retrieval.


Position control: a system of labor containment.


The Es of radiology management: planning for the future.


A clinical study of an automatic exposure control for portable radiography.


Tapping a valuable resource--the employee.


Policy for pregnant radiology employees.


Establishing clinical privilege standards for future hospital practitioners.


Radiology as an information system.

Radiology as an information system.


Mammography for the small community hospital.


AIDS a plague of fear.

AIDS a plague of fear.


The child abuse program in a child guidance center. This paper is a case example of how one private child guidance clinic responded to problems of child abuse seen in the clinic and how the center moved from the "micro-level" of treating individual victims and their families to the "macro-level" of education and community involvement. The authors show how case-by-case treatment of abused families can be used as a guide for program development and community education.


Program evaluation using a patient opinion survey: one hospital's experience. This article describes the development of a Patient Opinion Survey (POS) for hospitalized adolescents and adults at a private psychiatric hospital. In addition to patient satisfaction with treatment, patient perception of the importance of various treatment modalities (individual therapy, group therapy, medication, etc.) was also assessed. Results are discussed in regard to adolescent and adult differences in satisfaction, degree of satisfaction expressed by patients at our facility compared with degree of satisfaction expressed by patients in other institutions, and implications of patients' perceptions of the relative importance of different treatment modalities for future research.


Pitfalls in geriatric drug therapy.

Pitfalls in geriatric drug therapy.


Vascular prostheses today.

Vascular prostheses today.


Litigation over loss of staff privileges.


Genetic counseling and congenital heart disease.


CPR: the pioneers.

CPR: the pioneers.


Impact of manual and computer-assisted PACS for automated PACS. Considerations of totally electronic picture archiving system (PACS) often neglect the fact that every radiology practice currently has some system for storing and retrieving images and related alphanumeric data. Although these systems are usually manual, many departments now use on-line computers to help manage film flow. In either event, the creation of electronic PACS can be viewed as a classic data processing problem of automating an existing system, and the conversion should proceed through the usual steps of documenting the existing system in detail, and conducting feasibility studies and cost-benefit analyses. Documenting current systems should be facilitated by computer-assisted PACS--particularly documenting transaction volumes which can be provided as a by-product of radiology information management systems. Similarly cost-benefit analysis should be facilitated, although the cost/benefit ratio may be less favorable when comparing automated to computer-assisted PACS. Finally, information management features such as those provided by current on-line radiology systems provide a framework necessary to realize the full benefits of automated PACS.


EIL financial responsibility comes of age.


Legal forum: the role of product liability in medical malpractice.


The new era of microcomputers: developing the expertise.


Health care cost containment needs more than lip-service cooperation.


New block approach smoothes OR scheduling.


Flying eye doctors.

Flying eye doctors.


Survival skills for working with potentially violent clients.


The older generation: what is due, what is owed.


Hospital peer review committees: privileges of confidentiality and immunity.


Indicators for planning of health services: assessing impacts of social and health care factors on population health. Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.


Potential savings from the adoption of nurse practitioner technology in the Canadian health care system. An investigation is reported of the potential for reducing aggregate medical costs by the introduction of nurse practitioners into the Canadian health care system to an extent consistent with demonstrated safety and effectiveness. A cost model is developed for this purpose and estimates of its parameters are provided. The cost model is coupled with a demographic projection model and potential cost reductions are simulated over the period 1980-2050, under alternative assumptions. Results suggest that savings could have been in the range 10-15% in 1980 for medical services as a whole, and 16-24% for ambulatory services. The estimated savings percentages are quite insensitive to projected changes in the age structure of the Canadian population.


Security systems.

Security systems.


Plumbing fixtures in special environments.


Talkback telephone network. Techniques of providing library continuing education. Four lectures on solving medical reference requests were given over a talkback telephone teleconference network which links 110 hospitals throughout the state. Participants in the course were librarians in nonurban public libraries, systems libraries, and small hospital libraries. Professional librarians as well as library personnel with little training took the course. Techniques were developed for providing continuing education over this telephone network to individuals located in remote areas. These techniques are described including analysis of their advantages and disadvantages.


Cost reimbursement: reusables versus disposables.


The therapeutic process in clinical social work.


How to conduct a needs assessment for computer-literacy training.


New evidence on low temperature laundering.


Training technology's next frontier: on-the-job performance objectives.


The quality practitioner.

The quality practitioner.


Doing more with less.

Doing more with less.


The development of forensic social work.


Hepatitis B: an environmental hazard.

Hepatitis B: an environmental hazard.


Licensure vs. certification.

Licensure vs. certification.


An introduction to word processing.

An introduction to word processing.


Word processing: productivity measurement.


Enhancing word processing productivity with an optical character reader.


Ergonomics: the people factor.

Ergonomics: the people factor.


Competency issues for the 1980s.

Competency issues for the 1980s.


Coping with word processing equipment vendor selection.


Outside transcription services: a cost-effective alternative to in-house word processing.


Adoption and the right to inspect medical records.


Continuing medical education. How to make the most of your program.


Management training after hours. The hospital's hidden resource.


An era in retrospect.

An era in retrospect.


Feedback, follow-up part of QA.

Feedback, follow-up part of QA.


The logistics of a hospital name change.


Organizational communication. The role of the administrator in human relations training.


Hidden benefits of continuing education.


Teleconferencing.

Teleconferencing.


Competence-based study: it's not what you know but how you use it.


Terminating a physician: his right to be heard.


Advertising is effective means of telling the hospital story.


QA and the credentialing mechanism.

QA and the credentialing mechanism.


Choosing the right media for the job.

Choosing the right media for the job.


Continuing education in infection control.


Television. Promoting hospital services: the Institute for Rehabilitation and Research, Houston.


Orientation: making the strange less strange.


Print. Promoting a physician referral service: Twelve Oaks Hospital, Houston.


Healthy employees: the first line of defense.


Specialty advertising: a friendly medium.


Community fitness goal focused on Gamefield.


Selecting and working with an advertising agency.


Radio. Promoting a hospital wellness program: Brackenridge Hospital, Austin.


Health care advertising.

Health care advertising.


AIDS: facts may prevent panic.

AIDS: facts may prevent panic.


Hospital advertising--is it ethical?

Hospital advertising--is it ethical?


Whatever happened to the PSA?

Whatever happened to the PSA?


Interchange/A problem-solving forum.

Interchange/A problem-solving forum.


Rhode Island's experience with budgets negotiated in advance.


"Medicine has overdrawn its credit" in American Society by Alvin P. Sanoff.


Cooperative effort helps a small hospital recruit physicians. To attract physicians to its community, a Wisconsin hospital began a recruitment program in cooperation with three area clinics, led by the hospital's board committee on physician recruitment. Key to the success of the process is a site visit to the community. The authors detail the process that led seven new physicians to relocate to the area within a single year.


Recruitment assumes you know what you want, so learn from the past. Henry Ford Hospital in Detroit has a full-time, salaried medical staff. Yet its program to monitor physician recruitment and retention may interest the boards of other hospitals without a large number of salaried physicians that are engaged in recruitment activities. Key to the program is the establishment of a profile of the background characteristics of physician recruits.


When employees turn into thieves.

When employees turn into thieves.


If you have to care for your aging parents.


Soaring hospital costs.

Soaring hospital costs.


A new understanding about death.

A new understanding about death.


Matching skills keeps pros in tune, turned on.


Suicide 'epidemic' spurs support and prevention programs.


Position control means better management and more recognition.


Perspectives. Technology: who shall judge?


Perspectives. Preferred providers proliferate.


Perspectives. Debate widens over scope of practice.


Perspectives. FTC facing an uncertain future.


Perspectives. Baby Doe: HHS, Congress & the courts.


Equal access to urban hospital care: threats and responses.


The Declaration of Sydney: towards a revision?


Advertising--a test case.

Advertising--a test case.


Public health programming for Hansen's disease.


Health care manpower in India: current status and deployment.


Shared hospital services--growing practice for "cost avoidance".


Good Samaritan laws: can a hospital be the scene of an emergency?


CDC update: acquired immunodeficiency syndrome (AIDS) update--United States.


Philadelphia area hospitals conduct campaign against underfunding.


Update: Henry Ford Hospital's chronic disease care program.


Patient noncompliance: a model with implications for treatment.


Getting along with the boss.

Getting along with the boss.


Computers can't walk or talk. That's the problem with management information systems.


The role of goal acceptance in goal setting and task performance. Goal setting has been widely used to enhance work motivation. This paper discusses the importance of goal acceptance in moderating goal setting effects and shows how workers' acceptance of goals can be influenced at various stages of the progression from goal setting to goal attainment. A heuristic organization of goal acceptance strategies is proposed as a basis for extending the theoretical framework underlying goal setting research.


Cusp catastrophe model of employee turnover. A cusp catastrophe model is developed to explain job turnover of nursing employees. The temporal dynamics of the catastrophe model suggest that leavers experience lower organization commitment than do stayers prior to termination. Leavers' perceptions of job tension and commitment appear to cross the threshold levels prior to the termination dates.


When you offer people a free lunch, they don't eat at McDonald's. They go to the Ritz.


Thinking the unthinkable about genetic screening.


The Veterans Administration voluntary service program.


AA volunteers provide support to inpatients.


Note on tension discharge rate as an employee health status predictor.


Rehabbing of a laundry increases its productivity.


When to say "No" to an interested volunteer: the screening process.


Volunteers support legislation for health insurance coverage.


Art therapy: what it is and what it is not.


MDs conduct ICU rounds using home computers.


Computer intruders endanger care.

Computer intruders endanger care.


'Test-tube' baby clinics on rise.

'Test-tube' baby clinics on rise.


For terminating treatment MDs face unprecedented murder charge.


10 ways to generate meeting publicity.

10 ways to generate meeting publicity.


Computer network to aid multihospital group's internal communication.


New use of method cuts hospital losses.

New use of method cuts hospital losses.


Closures deal jobs blow to executives.

Closures deal jobs blow to executives.


The very many ways to throw some light on patient rooms.


TB controversy unresolved, claims expert.


NHS planning.

NHS planning.


Who needs good medical records?

Who needs good medical records?


Training needs.

Training needs.


A review of outcome studies.

A review of outcome studies.


Expanding media production capabilities with volunteers.


Keeping them well is good business too.

Keeping them well is good business too. Many hospitals today regard motivating people to take better care of themselves, and teaching them how, to be as much a part of their mission as repairing the damage when they don't.


Using video to monitor patients during EEGs.


Can your department produce TV commercials?


Getting motivated employees to perform.

Getting motivated employees to perform.


What supervisors should know about discipline.


Coping with sexual harassment.

Coping with sexual harassment.


Discontinuation of approval of modifications in notes, guaranteed under Title VI or VII of the Public Health Service Act, proposed to permit use of the notes as collateral for tax-exempt financings--PHS. Final rule. The Department of Health and Human Services (HHS) adds a new section to regulations for making and guaranteeing loans for construction and modernization of hospitals and medical facilities and to regulations for guaranteeing loans for the construction of teaching facilities for health professions personnel. Under these regulations HHS will not approve the modification of the terms of an existing loan guaranteed under Title VI or Title VII of the Public Health Service (PHS) Act if the modification would permit use of the guarantee (or guaranteed loan) as collateral for tax-exempt financing.


Health maintenance organizations--PHS. Final rule; confirmation of interim rule. This document finalizes, without change, the interim rule published on January 12, 1983, that amends the Public Health Service regulations on Federal qualification of health maintence organizations (HMOs) to provide for greater flexibility for already existing prepaid health care delivery systems to become transitionally qualified HMOs.


Availability of information and records to the public; fees for providing information and records; procedures and appeals--SSA. Notice of proposed rulemaking. The Social Security Administration (SSA) announces proposed changes in the fees it charges for providing records from its files and record related services. These proposed changes will conform SSA's fee schedule to that recently published by the Department of Health and Human Services (HHS). The proposed rules also implement the discretion given the Secretary of Health and Human Services by section 2207 of the Omnibus Budget Reconciliation Act of 1981 to charge the full cost of providing certain information and records. The proposed rules do not change SSA's longstanding policy of generally not charging an individual for information needed to assure that our records concerning her or him are correct. In preparing these amendments, we deleted from SSA's rules several provisions concerning Medicare information. The Health Care Financing Administration (HCFA) has published separate regulations governing the availability of Medicare information and records. We have also clarified the rules for handling requests for information about individuals under the Privacy Act and the Freedom of Information Act (FOIA) and incorporated HHS' recent rules on who has authority to release or deny records in this revised material.


The big business of medicine.

The big business of medicine.


Pharmaceutical Reimbursement Board; suspension of maximum allowable cost limits on specific drug products--HCFA. The Pharmaceutical Reimbursement Board announces the suspension of the Maximum allowable cost (MAC) limit on penicillin G potassium, oral tablets, 800 mu, effective August 18, 1963. The limit for this drug product was published on December 11, 1978 (43 FR 57972) and became effective on October 15, 1979. The suspension of the MAC limit on penicillin G potassium, oral tablets, 800 mu, results from the unavailability of this product in the marketplace at or below the MAC limit. The Pharmaceutical Reimbursement Board may establish a new MAC limit on this drug product in the future.


Implementation of the Equal Access to Justice Act in agency proceedings--HHS. Final rule. These regulations implement the Equal Access to Justice Act, 5 U.S.C. 504 and 504 note, for the Department of Health and Human Services. They describe the circumstances under which the Department may award attorney fees and certain other expenses to eligible individuals and entities who prevail over the Department in specified administrative proceedings where the Department's position in the proceeding was not substantially justified.


Employers ambivalent about big PPO push.


The inflating factors in health care.

The inflating factors in health care.


Is it your duty or privilege to take an active role in suicide assistance?


Options for the future--will you survive?


Not many PPOs actually providing care.

Not many PPOs actually providing care.


Make your partnership work by adhering to a well-defined agreement.


Are you prepared to invest in a medical office building?


Mental health services: stalemate in development.


Provincial breakdown of pharmacists and pharmacies in Canada: 1983.


Department of Health and Human Services--unified agenda of regulations. Publication of unified agenda of regulations. The President's February 17, 1981, Executive Order (12291) and the Regulatory Flexibility Act of 1980 require the Department to publish an agenda of significant regulations being developed and an indication of those regulatory actions that are being analyzed for their effect on small businesses. The Department published its last agenda on April 25, 1983.


Whither prevention?

Whither prevention?


Supportive group action for women: a self-help strategy. A major goal of the demonstration project described was to test a model of self-help and voluntary support in developing groups for female single parents. Community meetings, study programs, and related experiential strategies were used to promote coping skills and strategies; access to resources; decision-making learning and responsibility; social contacts and networking; work skills and employment opportunities. The effectiveness of the model, which emphasized self-help, consumer power, and accessibility, was reflected in increased membership, self-awareness and confidence, leadership, employment and development of community resources. Initial individual contact, informal contracting, and community support were seen as important factors in the project's success.


Requiem for an era.

Requiem for an era.


An indigenous mental health program in remote Northwestern Ontario: development and training. This paper describes a shift in the focus of mental health services to remote Indian villages in Northwestern Ontario. Traditional indigenous counsellors are assuming control of this service, previously offered by non-Indian outsiders. The resources of the Federal Sioux Lookout Zone Hospital and psychiatrists from the University of Toronto are used in the ongoing training of the counsellors. Challenges encountered by outside non-Indian professionals providing relevant training and consultation to the area's natural helpers are described. This unique program has enjoyed enthusiastic acceptance by local people in helping positions.


Who administered mental health? Fifty years of community mental health services in Alberta.


The team approach: for or against the patient?


Cautiousness, risk, and informed consent in clinical geriatrics.


The future of mental health services in Canada: trends and challenges.


The dollars in wellness.

The dollars in wellness.


Information systems: the importance of 'fit'.


Microcomputers and food service management.


An information system for HMOs: designed from the ground up.


Extemporaneous dosage preparations for pediatrics. Extemporaneous dosage preparations for pediatrics are described including method of compounding, storage, stability and classification with respect to reliability of expiry date information. Information from the literature as well as our experience at The Hospital for Sick Children are discussed and presented in tabular format.


A paperless system for administrative effectiveness in medical billing.


Focus: France...a second look. Interview by Karen M. Richards.


Inevitability of a new practice associate.


Adequate health research funding: a justifiable imperative. The position paper that follows was developed by an ad hoc committee comprised of representatives of national organizations interested in biomedical and behavioral research including the Association of American Medical Colleges, the Association of American Universities, the Delegation for Basic Biomedical Research, and the National Committee for Medical Research and Education. The development of this document represented a unique attempt to reach a consensus among the diverse segments of the research community on the level of funding necessary to preserve the integrity of the health research enterprise. This paper was subsequently endorsed by 58 major organizations with a commitment to maintaining a strong national research program. The AFCR Public Policy Committee endorsed this position paper on July 10, 1982. It is worthy of note that although recent trends in health research funding are cause for concern, this situation will worsen in the future because of the recent passage of the Small Business Innovation Development Act. This bill will require all federal agencies, including the NIH, to "set-aside" 1.25% of their R&D budgets for allocation to small businesses. The FY 1983 projections in this position paper do not include estimates of the impact of this recent legislation.


Health Care Financing Administration--Statement of organization, functions, and delegations of authority.


Home care: a long overdue alternative.

Home care: a long overdue alternative.


Abortion: following the legal guidelines.


Will new rules help lower health care costs?


The emerging healthcare information systems environment.


Micronetworking: an administrative approach to managing.


Focus: Canada. Interview by Karen M Richards.


Healthcare computer trends. Interview by Bill W. Childs.


SCAMC: the growth in information transfer.


A chief financial officer's views on financial modeling.


Futuristic clinic management--computers keeping the bottom line up. This article emphasizes the need for medical groups to stop reacting and start initiating. Every problem--be it competition, adverse legislation or declining patient visits--offers offsetting opportunities. Find these opportunities and one has a competitive edge. Futuristic or prospective management sows the profit of tomorrow through sound business decisions today.


Facing economic realities--what role do trustees play?


Public receivership: an administrative tool for the '80s.


Caveat emptor.

Caveat emptor.


Mental health training and the hospice community: a national survey. This article summarizes a national survey of the hospice community. Respondents provided detailed information in the following areas: (a) What formal mental health training is provided for staff members? (b) Who conducts this training? (c) What areas are covered and where would more training be useful? (d) How is the training conducted--what formats and teaching materials are used? and (e) How much training do staff members receive? The results of the survey indicate that the hospice community is making a concerted effort to meet the mental health training needs of its paid staff members and volunteers. However, more than half of the hospices surveyed expressed a need for further training in 26 of the 33 issues and skills covered in the questionnaire, and many reported a need for a more systematic and comprehensive mental health curriculum. The findings point to several areas of particularly great need and provide a basis for the development of future mental health training in the hospice community.


The viability of pediatric hospices: a case study. This paper identifies the special characteristics needed by hospices caring for terminally ill children. It is based on a feasibility study conducted in 1979 for a pediatric hospital in New York City. From the analysis of statistical data and confidential interviews with health care professionals in the hospital and in the community, the study concludes that the needs of terminally ill children and their families are not being met currently and that the hospice is as appropriate for children as for adults. Three major differences in emphasis are noted, however. First, support of the family suffering the death of a child is of prime importance, because the grief is devastating and long lasting and because the number of family members affected is usually large. Second, the hospice emphasis on home care is even more imperative for children than for adults as it more significantly benefits both child and family; home care can be facilitated through supplementary care components such as day care. Third, there is a major need for both professional and public education in caring for terminally ill children and their families and in coping with childhood death. The author concludes that further research is needed in all aspects of pediatric terminal care.


Hospice--an education center for professionals. The need for further improved professional training in the care of the dying is now being recognized by doctors themselves, and increasingly they are turning to hospices for such education. The ways in which such training might be provided are outlined and some of the problems discussed in the light of British experience. It is suggested that no major hospice program should ever be initiated unless it incorporates an education program aimed to meet the deficiencies revealed in recent studies.


Accreditation is not frightening!

Accreditation is not frightening!


Comprehensive statutory health care system covers vast majority of German employees.


The supply of physician services: a comment.


Videotape and computers in cardiology.

Videotape and computers in cardiology.


Hospital pensions well funded and in good health.


Limitations on an employer's right to discipline and discharge employees. An employer's prerogative to discipline and discharge its employees has been substantially infringed by the courts, state legislatures, Congress, and governmental agencies. In its recent Materials Research decision, the National Labor Relations Board has expanded the Weingarten principle by limiting the employer's ability to conduct investigatory and disciplinary interviews of nonunion employees. In addition, state courts and legislatures have begun to scrutinize the grounds for an employer's discharge of an employee, and Congress has statutorily prohibited the discipline or discharge of employees who "blow the whistle" on their employers under certain circumstances. This article will evaluate recent developments in this area of law and explore their impact on an employer's right to discipline and discharge its employees.


Narrowing an employer's right to present views, arguments, or opinions against union representation.


The legal right to die.

The legal right to die.


Gestalt therapy with the dying patient: integrative work using clay, poetry therapy, and creative media. This is a report on death therapy with a 36-year-old cancer patient. Gestalt therapy and creative media (clay, poetry, and colors) were used to facilitate an integration of life and to give the person a sense of balance with life. The author tries to communicate his thoughts and feelings as they were during the course of the therapy, to show that counseling the dying means walking along a stretch of the path together. The companion-therapist cannot avoid his own perplexity and confusion by simply falling back on his professional role. Once he has become involved in an interpersonal relationship, he does not treat the patient as some kind of object. With the aid of transcripts taken from tape recordings, the integrating effect of using gestalt dialogue, and fantasy work becomes evident.


Protected activities of nonunion employees. The vast majority of American workers are nonunion and therefore unprotected by many of the mechanisms established through collective bargaining. They are protected to some degree, however, by a number of statutes and evolving legal doctrines that limit the employer's right to hire, fire, or otherwise discipline its nonunion people. The most elemental of these limitations is embodies in the National Labor Relations Act: section 7 protects the concerted activities of nonunion employees, section 8(a)(1) makes it an unfair labor practice for an employer to interfere with the section 7 rights of its employees; and section 10(c) grants the National Labor Relations Board broad remedial powers to correct violations, including the power to reinstate workers with or without back pay. The following article will examine this basic protection of nonunion employees and will point out those areas in which the Board has attempted to expand the scope of section 7's protection.


Confidentiality of medical information in employer and plan records.