Planning for progress, productivity, and performance. A project is described for the interim renovation of a labor intensive existing foodservice facility. The renovated area will provide effective food management during the hospital's redevelopment period, including a new foodservice. Objectives of the interim project were to conserve labor while emphasizing control and centralization, provide economic foodservices with improved quality, and incorporate one tray distribution system throughout the hospital complex. Immediate measures were necessary in order to generate funds to proceed. Renovations had to occur without disrupting food-service to patients. The project was planned over a three year period and included an ingredient control area, two patient tray service centres, a renewed production kitchen and test kitchen facility. Each phase has been financed on the understanding that the costs of construction and equipment will be repaid within one fiscal year of operating the renovated facility. Positive results are being achieved, attributable to the support and encouragement received from staff during the change process.


Dietetic performance indicators: a new management tool. The need for dietetic performance indicators that more accurately reflect the performance of the department of dietetics has led to the development of an effective tool for directors of dietetics to use in monitoring departmental performance, planning departmental activities, services and programs, and budgeting. To follow-up on the work initiated by a group of directors of dietetics in Metropolitan Toronto, the joint Ontario Dietetic Association-Ontario Hospital Association (ODA-OHA) Steering Committee on Alternative Dietetic Performance Indicators (SCADPI) was established. The work of this Committee has involved identifying relevant dietetic performance indicators based on three areas of departmental activity: patient meal service, non-patient meal service, and clinical nutrition service; developing the methodology of allocating food, sundry, and labor costs to these three areas of departmental activity; and testing the validity and feasibility of the methodology among hospitals of varying sizes and levels of dietary department management personnel.


A computerized food management system for an extended care unit. Burnaby Hospital recently implemented a computerized Food Management System. The system is fully operational in the Extended Care Unit (ECU) and now is being introduced in the Acute Care Unit (ACU). The main goals for the new program were: cost savings, more effective use of foodservice employee time and skills, and better patient care. To date, the total time saved by use of the computerized system has been equivalent to one full time employee. The ECU dietitian's and the dietary technician's duties have been upgraded. The technician has been relieved of clerical tasks and has taken over some responsibilities formerly performed by the dietitian; the dietitian is able to perform more administrative and planning tasks; and the former ECU coordinator is manager of patient services and responsible for coordinating changes in the computer system. Research indicates that this system, designed and developed for Burnaby Hospital by Rick Hepting & Associates and running on an MAI Basic Four min computer, model 210, is unique among North American hospitals. Current applications include manipulation of patient diet information for automatic menu processing, food tallying, and production of nourishment labels. Future enhancements will take care of production reporting, standard recipe printouts, food cost analysis, and nutrient analysis. The system has valuable potential for use in other hospitals.


Dietetics in Australia and New Zealand, May 1983: expanding professional horizons. This is a report on the author's activities and impressions of the dietetic profession in Australia and New Zealand, during a professional visit in May 1983. Activities included presenting the Abbott Lecture to the Third Annual Conference of the Australian Association of Dietitians, speaking at several state dietetic association meetings, and presenting some seminars. Foodservice systems in several hospitals were observed. Impressions related to the diverse educational backgrounds of dietitians, the focus on clinical practice, and the extreme youthfulness of the profession in some states. The author also modified a post-graduate program at the University of New South Wales to assist dietitians to gain more knowledge in foodservice administration.


Medical society president-elect calls for physician self-regulation.


A taste of nutrition--a nutrition resource for leaders working with mentally handicapped adults. The trend towards deinstitutionalization for mentally handicapped adults has precipitated a need to provide these individuals with nutrition education and food preparation skills. Food, nutrition, and eating are important components of training programs for life skills, which lead to greater independence for the mentally handicapped. The types of nutrition information and learning activities needed for the mentally handicapped were determined through a literature review and a series of interviews with those working with this target group. The nutritional concerns of mentally handicapped adults include food selection to meet their nutritional needs, menu planning, food preparation, weight control, and nutrient-drug interactions. A Nutrition Resource Kit for Leaders Working with Mentally Handicapped Adults has been developed in The Regional Municipality of York in response to local demand for nutrition education programs and resources for mentally handicapped adults. The kit provides those working with mentally handicapped adults with background nutrition information, learning activities, resource materials, and references to additional resources. The topic areas covered include basic nutrition, nutritional concerns of mentally handicapped adults, nutrient-drug interactions, menu planning, shopping strategies, and food preparation. Dietitian-nutritionists can assist leaders who work with mentally handicapped adults by providing them with up-to-date nutrition information and motivating the to use available nutrition education resources.


Red Deer Regional Dietetic Services Program. The Regional Dietetic Services Program coordinated by the Red Deer Regional Hospital Centre is described. The Program became a reality in June 1978, in response to requests for professional dietetic assistance from the rural hospitals located in Central Alberta. The program objectives were defined, standards were determined, duties and responsibilities of Red Deer Regional Hospital Centre (the 'Agency') and the 'User' hospital were clarified, and a yearly contract was established. The dietetic consulting program was then presented to interested rural administrators and board members. When the first commitment was received, the Red Deer Regional Hospital Centre hired a part-time dietitian to implement the program. As a spin-off benefit, this program provided an avenue through which a dietitian could participate part-time in the professional and contribute to the community in a rewarding way.


Hospital pharmacy finds ways to increase revenues, lower costs.


Competition in health care: strategies from other industries. Health care managers can learn to adjust to competition by observing companies in other deregulated industries. Six basic strategies will separate the winners from the losers: Increase market share. This strategy requires not only increasing the share of current markets but also introducing new products and services into new markets. Scrutinize operations. Managers must be knowledgeable about strategic planning, adept at product line analysis, and skillful in using management information systems. Prune where necessary. Operations must be periodically reviewed to assess whether programs, products, and services continue to be profitable. Increase productivity. Productivity in this labor-intensive industry is essential. Wages may have to be reduced and staffing levels changed in the future to permit better control of labor costs. Increasing the volume of service, investing in nonclinical technology, and encouraging employee ideas also should be considered in seeking higher productivity. Strengthen the balance sheet. Hospitals should avoid incurring both long- and short-term debt, and they should attempt to accelerate repayment of long-term debt. Not-for-profit hospitals should investigate joint ventures, which spread the financial risk among investors, as means to raise capital to expand their operations. Increase cash. Prudent organizations will establish reserve funds, adopt fund-raising programs, and initiate improved cash collection systems. Health care executives also should reflect on how deregulation may affect their employees, the poor, and access to sophisticated medical procedures. The successful health care organization eventually will position itself in line not only with its markets but also with its mission and values.


Competition presents opportunity for not-for-profit systems. Though they face similar challenges in adapting to a competitive environment, investor-owned and not-for-profit (NFP) health care systems react differently. The investor-owned strategy reflects a philosophy that regards patient care and economics with equal concern, while NFPs' management decisions are rooted in a tradition of community service. For-profit chains are perceived as more efficient than NFP chains because they respond to marketplace demand. Studies, however, show that while operating expenses are about the same, for-profits charge more per admission. On the other hand, NFP systems, by allowing affiliates to participate in service expansion decisions, are able to maintain lean corporate staffs and thereby minimize administrative and fiscal costs. The NFP organizational structure enforces economic discipline in a way that for-profit chains--where corporate staff alone make service decisions--cannot achieve. The major difference, of course, between for-profits and NFPs is in philosophy, not in management techniques. NFPs should communicate to the public their commitment to serve all patients and remind consumers that their charges are comparable with for-profits'. Developing a capitation plan would provide NFP systems another opportunity to emphasize their service orientation. An effective capitation plan is a means to influence the marketplace toward chain affiliates, since subscribers under the terms of the plan use contract hospitals and physicians. In addition to sufficient capital, such a venture requires expert management. NFP systems will have to offer incentives such as executive stock ownership plans to attract and keep top talent. In the future, management and governing boards must base strategic plans on the public's needs, attitudes, and economic status, not on myths about the competition.


Personalized care helps facilities compete. Catholic health facilities may believe that they provide personalized care, since this value is a part of their mission statement. In the face of shrinking inpatient services and competition for patients, however, formal efforts to provide such care are essential. Personalized care can be a primary factor in differentiating Catholic health care facilities in the marketplace. St. Edward Mercy Medical Center implemented marketing surveys to determine patients' perceptions of personalized care. Using the results, the medical center instituted employee education programs and physical improvements in order to meet patients' needs and thus maintain and improve the facility's patient market share.


Catholic hospitals' PPOs can set ethical standards.


Trusteeship: salvaging the myth of the governance role. A myth of trusteeship--that governance is the central role of board members--has been difficult for trustees to put into practice. The process of initiating new trustees implicitly communicates a set of largely unspoken practices that do not fulfill the myth. In actual practice, trustees find themselves involved in management, rather than governance. Although regulatory bodies, the courts, or a constituent can clarify the job of governance, trustees must call one another to action to reshape their practice and refurbish the myth with credibility. Trustees generally are expected to ensure quality of service and performance standards through governance, although many question their competence to do so. Since a direct link exists between a board's ability to evaluate itself and its ability to evaluate others, members first must learn to evaluate themselves in an open, verifiable manner. Trustees also must take account of the cyclical emphasis society places on private interests versus public issues, noting shifts in the cycle to identify and define board responsibilities. Members should act not as representatives of a single group but keep in touch with as many constituencies as possible. Though models are being developed to evaluate board performance and to chart management/governance functions, the most effective change in practice will come from within boards--through members' study and reflection. A board retreat that allows trustees to share information and examine principles of practice may facilitate this role definition.


Canadian bishops' letter presents theology of healing, suffering. With board input from theologians, health personnel, patients, and others interested in health care, the Canadian Conference of Catholic Bishops released its pastoral letter on sickness and healing in September 1983. Acknowledging that suffering and healing are mysteries beyond complete understanding, the letter illuminates the connection between caring for one's own health, helping the sick, and following Christ. The letter's first major section reviews suffering and healing as presented in the Bible, and asserts that the act of healing should help to restore not only the body but also the sufferer's relationship with God and with the community. The letter's second section surveys the history of the healing tradition within the Church and notes that, because the great healers often suffered themselves, their example can help people to integrate suffering into their own quest for wholeness and spiritual growth. In the pastoral's third section the bishops suggest attitudes and practices for those who wish to be healers today. They apply theological teaching to five practical levels of pastoral concern: individual actions, parish communities, Catholic and other health care institutions, and the social, economic, and political community. Each level, the bishops stress, must play an important role in healing and salvation.


May Catholic facilities baptize dying infants without consent?


Maryland hospitals get plan for creating ethics committees. The Maryland Hospital Association's Advisory Committee on Medical Ethics, charged to assist member hospitals in forming ethics committees, focused on four concerns: study and development, physician support, patient/family participation, and potential issues. The committee recommended as a first step in establishing an ethics committee the creation of a study group. It warned hospitals not to expect a fully operational ethics committee immediately. A start-up period, according to the committee, should be used to develop a process for handling ethical questions and for educating the hospital community about the committee's role. To promote the best possible decision making, the hospital ethics committee should function as a support unit, for physicians as well as for patients, families, and hospital personnel. Clearly stated policies will provide a basis for appropriate intervention and help gain physician cooperation, the committee said. Such policies should encourage ethics committees to anticipate problems and to review decisions already made. While recognizing the need to involve patients' families in decision making, the advisory group agreed that the question of their presence at committee meetings should be addressed by each institution. In cases of controversial treatment or disagreement about the course of treatment, patient/family access to the committee should be clearly defined. The advisory committee suggested that each institution prepare its own list of topics that an ethics committee might consider. It also prepared a "model statement" of an ethics committee's purposes, membership, and procedures.


Mission effectiveness study identifies, reinforces values. When the Congregation of Alexian Brothers recommended that its sponsored institutions evaluate their mission effectiveness, the Alexian Brothers Medical Center, Elk Grove Village, IL, developed a study of patient and constituent perceptions. The purpose was to assess the degree to which the Alexian mission guided the institution's performance. Survey instruments included a survey of patient care perceptions and a questionnaire administered to Alexians, Alexian comembers, professional and support staffs, volunteers, governing board members, and administrators. Selected constituents also participated in interviews and in a survey that identified various groups' capacity to influence the medical center's mission. Administrators found that patients and constituents perceive that the congregation's ideals exist in the medical center and that constituents view those ideals as important. They concluded that institutions benefit from establishing administrative responsibility for mission effectiveness and that the study process itself can reinforce mission values.


The use of the microcomputer in fitness assessment and exercise prescription for the older adult. The process outlined in this paper points to the fact that fitness assessment and exercise prescription is largely an information management task. The gap between existing knowledge and its practical application to the care of patients can be successfully closed by using modern information services. For health professionals, moving into the computer age will be an evolutionary, continuing education process. For clinical practice to reach its full potential, there must be an improvement in methods of handling information. The microcomputer offers an innovative way of providing the clinician with a practical, inexpensive manner of information management that will lead to improved efficiency, safety, and lower health care cost and at the same time provide patient satisfaction. Microcomputer applications in fitness assessment, dietary analysis and exercise prescription for the elderly are presented.


Guideline report. Trends in nuclear medicine.


Infection control and the ambulance.

Infection control and the ambulance.


An information bill of rights.

An information bill of rights.


Evaluating practical skills.

Evaluating practical skills.


Hepatitis B. An occupational hazard.

Hepatitis B. An occupational hazard.


A new image of long-term care: a challenge to management.


Assessing automated information requirements in long-term care: some general considerations.


The use of automated systems in long-term care facilities.


Attendance awareness--a formula for success.


Program evaluation as an impression management tool: the role of the program director.


The community health care administrator project: characteristics and problems of rural administrators.


An incentive system for outpatient therapists. (A private practice model that works.)


Future C.E.O.'s in year 2002.

Future C.E.O.'s in year 2002. Chief Executive Officers of mental health facilities have been interested civil leaders. Many doctors have accepted C.E.O. positions in our history. Today the competitions out to see who will be the future's C.E.O.'s. The rumors run from lawyers to clinicians from many of the hospital's disciplines and from purely administrative side of the hospitals management system. It will not be unusual to see more Ph.D., M.B.A.'s, or M.D., M.P.A. or M.S., M.H.A. degree combinations in year 2002.


Burnout and dependency: awakening in the arm of the wire frame surrogate.


Multichannel real-time analysis of the clinical EEG on a dual microprocessor system. A dual microprocessor system has been developed as an aid to conventional visual analysis of the EEG. Up to eight channels of EEG gathered from any standard EEG strip-chart machine can be processed in real time. The analysis is performed on a dual microprocessor "pipe-line" configuration that is built using Motorola 68000 (16-bit) and 6809 (8-bit) microprocessors. The system is basically software oriented in order to offer processing flexibility. The 16-bit processor is dedicated to the critical task of signal analysis based on a newly developed period-peak algorithm. The 8-bit processor is dedicated to the pre- and post-processing tasks, including statistical generations and display control. Analysis results for each channel are displayed on a video terminal in several convenient graphical formats.


Mental health attitudes in the eighties: what are they?


Providing mental health services in a health maintenance organization.


"Circle the wagons".

"Circle the wagons".


Demystification of deinstitutionalization.


Planning within multi-agency context.

Planning within multi-agency context. Current environmental conditions such as limited financial resources, cost containment, rising consumer expectation, and perhaps more stringent regulation of available public monies to support social services signal declining opportunities for survival of autonomous, freestanding community agencies and the development of newer collaborative forms of organization. In order to preserve maximum input of need information among their professional and community environments, community agencies will require improved procedures for processing multisource assessments. A methodology is presented for weighting and pooling of multisource need information geared for use by planners and decisionmakers of performance oriented multi-agency health care systems.


First party payments: is pursuing client payments worthwhile?


Cutback management in mental health.

Cutback management in mental health.


Toward better communication between social service agencies and the community: improving the utilization of advisory committees.


Formulating program goals and objectives in a psychiatric hospital.


Psychiatric emergency room: a resource for the eighties.


"Mental health administration (factors which indicate success on the job)".


Strategic caseload configuring.

Strategic caseload configuring.


Management and time utilization.

Management and time utilization.


The Central State Hospital linkage task force. The current economic climate demands timely communications and closer working relationships among Agencies. The Author describes the efforts of a State Hospital and eight Community Mental Health Centers in their attempt to enhance linkages and planning efforts.


A "special" savings account.

A "special" savings account.


Economic recession and increases in mental health emergencies.


Reducing state hospitalizations through a community screening program. The role of State hospitals has been limited to admitting persons, and then performing elaborate assessments, treatment interventions, and aftercare planning on an inpatient basis. Because of the division of roles and often physical distance from local communities, State hospitals have had limited ability to reinforce community treatment as a means to prevent re-admissions. This paper describes "Pre-Admission Screening" and "Admission Coordination", two programs initiated by a community mental health center, designed to maintain persons in the community through intensive evaluation, crisis intervention, and treatment planning on an outpatient basis.


Managing medical care for special children. The organized management of medical services provided to special children can influence: The development of a coordinated follow-up plan for each child; reduced costs for parents by avoiding the duplication of tests and unnecessary trips to the doctor; and, increased referrals once it becomes known that services are being provided with the consumer in mind.


The social service model of management by objectives: wedding MBO and the task-centered system.


Managing transition: guidelines for mental health administrators facing services retrenchment due to funding cuts. This piece of writing is one part of a four part series on managing transition in turbulent times. The series is written for mental health administrators and is a product of the author's direct experience as chief administrator of addiction treatment facilities and programs for The Salvation Army in Hawaii. Despite the loss of several hundred thousands of dollars, the agency was able to manage its own transition to emerge stronger and with two full years of accreditation as a psychiatric facility by the prestigious Joint Commission on the Accreditation of Hospitals.


The newest ideas in management.

The newest ideas in management.


The marketing approach as a model for mental health needs assessment. This article compares the marketing approach of private business to the mental health planning process as it relates to needs assessment. It is the authors' assumption that the future of mental health programs will depend on careful planning designed to exhibit fiscal responsibility and program accountability. It is concluded that private business is an appropriate resource for planning strategies in mental health, and one that mental health administrators can readily turn to, especially in time of shrinking revenues for human service programs.


Nuances for differences between future C.E.O.'s and middle managers' styles and training. The success of the administrators in the future depends on their ability to motivate people to do better with less. They will be required to promote a good work environment in the midst of cutbacks, layoffs, and continued threats of layoffs. To reach their goals, they will work with staff members that face day to day uncertainties regardless of how hard they work. C.E.O.'s must convince them to continue to do their best in these stressful environments.


A comparison of methods for orienting new personnel to the human service setting.


Evaluative research in community mental health. This paper compares evaluative research to program evaluation by defining and describing each. A case example using the scientific design and methodology of evaluative research to evaluate a specific community mental health program is also presented. Project design is discussed in light of the awareness that the mental health needs of communities do not always bend to fit the requisite of precise scientific procedure. Some ideas on methodological considerations reflect that normal research tools can be useful to achieve a valid study. Implications for the application of evaluative research to community mental health needs are also identified.


Beating burnout: findings from a three-year study.


Who are our mental health center dropouts?


"Reaching for excellence: the human service administrator".


Taking the agency's pulse: organizational feedback from employees.


Allegheny County Mental Health/Mental Retardation/Drug and Alcohol Program prescription drug study.


Certification and pursuit of professional excellence.


A psychiatrist looks at committees.

A psychiatrist looks at committees.


Monitoring staff productivity: the unit of service concept and the SSB rating system.


Ions purify patient's air.

Ions purify patient's air. A New York psychiatric center sought means to both rid a geriatrics' lounge of unpleasant orders and clear an out-patient program's hall of tobacco smoke. Many devices were tried, including scented mop water and ceiling vents. Small "air cleaners" were found to be ineffective; electrostatic air cleaners would be both expensive and troublesome. Ceiling mounted ion generators have done the job, are cost effective, simple, and unobtrusive. No behavioral side effects have been noticed. The Center is now experimenting with a device which negatively charges a whole room.


What a public mental health administrator really does.


How to make an affiliate model work--a case history. The North Shore Community Mental Health Center has an unusual mental health delivery system. "Out-stationed" staff work in affiliated agencies, yet are employees of the NSCMHC. This service configuration is the result of an arduous planning process which weighed the advantages of several organizational models. On one extreme was a "Centralized" model, wherein one organization was solely responsible for delivering mental health services. On the other extreme was an "Umbrella" model, wherein the organization acted as a fiscal conduit to several service providers. Somewhere in the middle a compromise was found with a "Lead Agency" model. Here, an organization provides the administrative structure, provides some services, and subcontracts the remaining services. The North Shore Community Mental Health Center adapted this system one step further. Rather than subcontracting services, it outstationed CMHC staff to affiliate agencies. United Cerebral Palsy Association of the North Shore is one of the CMHC's affiliates. The service need for family and play therapists resulted in two CMHC therapists being outstationed at UCP. The affiliation agreement between the two organizations specify the responsibilities and roles each have. The hiring process between the two organizations is an example of the duality of the system. Both agencies had interviewing roles, yet the final hiring decision was the affiliate's, since the employee would spend the majority of his/her time outstationed at the affiliate side. Outstationed staff integration to the North Shore Community Mental Health Center presented problems, however. Since these were new staff hired with federal funds, and since their visibility at the Center was minimal, they had some difficulty being identified as Center staff by existing employees.(ABSTRACT TRUNCATED AT 250 WORDS)


Development of an administrative externship in an institution for developmentally disabled. The development of an administrative externship at an institution for the developmentally disabled is presented. The program utilizes extern rotations through the various departments and units of the institution to provide the students with valuable "hands on" experience in mental health administration. It is suggested that the externship program will serve to increase the number of clinical psychologists with administrative experience and training.


C.M.H.C. management, governing board and program evaluation: a tripartite coalition.


Collection fees: a commentary on changing trends.


A state-wide assessment of training needs of community mental health administrators. In order to construct a trainee-designed continuing education (CE) program for administrators, a training needs assessment of all community mental health agencies in Illinois was conducted using a framework of pertinent organization, task, and individual variables. Mental health administrators were, indeed, interested in CE. Areas of interest included leadership, clinical services, planning and evaluation, supplemental services, accountability and accreditation. Funding source was the key variable in relation to training priorities. However, other variables such as comprehensiveness, caseload, serving all ages, and years of experience were also related to training interests. There were contrasts in organization, task, and administrator variables but not in training preferences in relation to geographic location. Implications of administrator/agency descriptive data for the planning of CE are discussed.


Towards a policy of board governance.

Towards a policy of board governance.


Consultation and education in rural mental health: core elements for the (lean) 1980's. The consultation and educational components of local mental health centers, which flourished in the 1970's, now find themselves being cut back, either along with or instead of direct services. This article examines some core ingredients of rural mental health consultation and education which can continue even with low levels of funding.


Deinstitutionalization--we are aiming at the wrong target.


"It's so simple, why didn't I think of it myself?": active marketing strategy in perspective.


A behavioral health systems model for Hawaii: planned change in response to block grants & funding cuts.


Understanding choice: gateway to sound mental health.


Things they didn't teach in clinical training.


Patient perception of care as a management tool.


Getting the most from program consultation: guidelines for mental health administrators.


Matrix structure in social delivery systems.


Coordinated funding: how to stretch the local mental health dollar.


Employee leave benefits vs. the need for more "on the job productivity".


"The view from Snowmass Village.".

"The view from Snowmass Village.".


Mental health systems and services abroad. A cross-national survey of forty-two countries and provinces was undertaken to compare mental health policies, mental health services, awareness of these services, the evaluation of such services and how mental health care is financed. Notable differences were found between respondents and these differences could not always be accounted for in terms of the level of the countries economic development. Discussions of trends are detailed and suggestions for future inquiry are proffered.


Deinstitutionalization: a microcosmic perspective. Changes have taken place in caring for chronic patients due to deinstitutionalization, and these changes have affected the services rendered by the community mental health centers. Statistical data on dehospitalized patients treated in a community mental health center located in the South Central Bronx are examined to determine trends in service utilization by these patients. Demographic characteristics of this population are also examined. Issues surrounding treatment and rehabilitation of chronic mentally ill patients are critically explored and recommendations for changes in the care of the chronically mentally ill patient are offered.


Guidelines for the development of a uniform mental health client data reporting system.


Patient resource volunteer program.

Patient resource volunteer program.


On deadline...managing special news media events.


Toronto central laundry adds 3-million pounds. New tunnel handles extra load efficiently.


Hospital builds laundry to save money. Commercial lost linens cost too much: LM.


More important than 'what' or 'how' is the 'why' behind individual work performance.


Shared services laundry out of red. Facility turns profit and cuts costs.


Three Philadelphia area hospitals consolidate laundries for economization.


The right way to get your patient out of the hospital.


Hospital laundry starts rental service. Serves area institutions, restaurants.


Biomedical photography '84.

Biomedical photography '84.


Changes in workload recording for 1984.

Changes in workload recording for 1984.


Realistic staffing via workload recording.


Crisis control workshop. Interview by Bruce Kielty.


Leisure time takes a toll.

Leisure time takes a toll.


Home safety.

Home safety.


Three questions that can improve your performance reviews.


EtO exposure: OSHA's new rule.

EtO exposure: OSHA's new rule.


Medical records role in risk management.


MHASC creates innovative savings program with Michigan hospitals.


Right-to-know legislation and its impact on hospitals.


Many hospitals report census drops; workforces haven't felt impact yet.


Cole compensation survey. Executive pay raises slim again, but they stay ahead of inflation.


Hospitals' use of tax-exempt Bonds expected to rise in second half of '84.


Hospital-based PPOs could find discounts lead to disappointment.


Missouri Baptist marks centennial with its eyes firmly on the future.


Price disclosure attracts interest, but hospitals may face pressure too.


Arizona's healthcare cost war holds lessons for entire nation.


Baby Doe compromise shifts burden to state protection agencies.


Florida high court takes proposed limited liability amendment off ballot.


Court ruling clarifies judicial review of physician's ouster by hospital.


HCA agrees to $194 million price tag for Forum Group's acute care division.


St. Louis Blues start Alliance health program.


Why become an accreditation surveyor?

Why become an accreditation surveyor?


Researching your market.

Researching your market.


Managing impaired physicians.

Managing impaired physicians.


The effects of cost sharing on the demand for prescription drugs in Belgium.


A creative combination: why commercial and hospital laboratories should unite. The trend for existing hospital laboratories to combine with their commercial counterparts is a prudent one, the author says. He recommends that hospitals continue to perform routine testing, but send the sophisticated, high-technology tests to a commercial laboratory. His advice: Several hospitals should join to own and operate the central facility in combination with a reference laboratory. He concludes with practical suggestions, guided by experience, to make this model work.


Will voluntary Rx leaflets to the public be a standard of practice?


Working with groups in patient education. Group processes are an effective means of helping individuals change their behavior. Of six types of group events, three have particular relevance in the health-care setting: individually oriented change groups, group-process oriented change groups, and focused-criterion groups. The role health professionals can play in designing and implementing group discussion methods is presented.


A medical laboratory in Saudi Arabia.

A medical laboratory in Saudi Arabia. The chairman of this department of pathology and laboratory medicine describes a laboratory that "rose from the desert" eight years ago and today impresses visiting officials from all parts of the world.


Cost cutting and competition to change delivery of services in future.


Employees make the rules.

Employees make the rules.


A survey of primary-care physician preventive services: implications for smoking-cessation counseling. We surveyed office-based preventive procedures among a random sample of primary-care physicians. The completed response rate was 60%, with no discernible bias between respondents and nonrespondents. Of the ten preventive procedures inquired about, seven were offered by more than 70% of the respondents. Further detail was obtained for a "tracer" procedure, smoking-cessation counseling. While 73.5% of respondents reported offering this, the majority desired additional support in their counseling efforts in the form of patient materials, physician guides, or continuing medical education workshops. Additionally, 79% felt that feedback provided to them concerning their patients' cessation efforts would improve their ability to help patients stop smoking.


Regulated cutbacks force hospitals to increase income with cash operations and satelliting.


A structured approach to evaluating and selecting clinical laboratory information systems. A number of informal and formal approaches are used for evaluating and selecting clinical laboratory computer systems. The authors review the more common methods and then explain in detail the multiattribute utility model, which they believe is the approach most likely to result in a successful decision.


How we broadened the RPh's role in medicine identification.


Videotaped parent education in pediatric waiting rooms. Parents in pediatric appointment clinic and pediatric emergency clinic waiting rooms were exposed to a five-minute videotaped program offering parenting tips. For half of the parents, the program was presented incidentally on a television monitor in the waiting room. The remaining half were asked to view the program individually in an adjacent room. Half of the first group actually watched the program, and those who watched learned less than half as much as did parents who viewed the program in a structured setting. In both conditions, parents rated the programs as highly appealing. Type of clinic did not affect parents' awareness, learning, or appeal ratings.


Seeking an effective strategy for promoting breast self-examination among women. Breast self-examination (BSE) may be effective in the early detection of breast cancer, but women must be aware of both the benefit of the procedure and the need for regular practice. The purpose of this study was to ascertain the effects of modeling plus rehearsal with respect to knowledge, attitudes, and subsequent frequency of BSE among women. The sample for this study consisted of 292 college students randomly assigned to one of two groups and exposed to: a facilitator-conducted program using modeling plus rehearsal (treatment group); or pamphlets addressing breast cancer and BSE (comparison group). A posttest-only comparison-group design was used. At completion of the programs, subjects responded to knowledge and attitude inventories. Three months later, a questionnaire requesting information on BSE practice was mailed to all subjects. Performance on the knowledge inventory indicated no group differences (P = 0.05). However, there were significant differences between groups in practice frequency and in selected attitudes (P less than 0.05). At three-month follow-up, significantly more members of the treatment group indicated practicing BSE at least once since exposure to the educational program. Conclusions support those of earlier investigations and indicate that modeling with rehearsal can be a useful method for promoting the practice of BSE.


From a lawyer-social worker--some thoughts on confidentiality and other matters.


Health care programs put emphasis on prevention.


Automation is the first step to health care cost recovery.


Social class and psychological ill-health during unemployment. This study explores psychological health and the experience of being unemployed for between 6 and 11 months in two social class groups: unskilled and semi-skilled workers v. white-collar, managerial and professional workers. The respondents were British married men aged between 25 and 39. Information was obtained through interviews about financial and other problems, perceived threats associated with unemployment, anxiety, depression, general psychological distress and ratings of general health. It was expected that the working-class sample would exhibit poorer psychological health than the middle-class, but this was not confirmed. Medium-term unemployment appeared to have a homogenizing effect, with similarly poor health in both social class samples, although working-class respondents reported significantly greater financial problems and difficulties in filling the time.


Student nurses' construction of occupational socialisation. This paper examines the occupational socialisation of British nurses. It uses Bucher and Strauss's notion of segmentation and considers two major segments within nursing: the education segment which, through the colleges of nursing, promotes a 'professional' version of nursing, and the service segment which is concerned with getting nursing work done. Students' accounts of their training were obtained by means of 40 informal interviews. On the basis of these accounts it is argued that the students learn neither the education nor the service segment's version of nursing, rather they learn to recognise when one version is appropriate and the other not and 'fit in' accordingly. The organisation of nurse training is based on a compromise between the two segments whereby the students move between clinical placements and the college of nursing; in this way both versions of nursing are enforceable on the students. The paper argues that nursing as an occupation, by its organisation and compromise solution to the training of its recruits, supports a transient approach to nursing work itself and so implicitly supports a lack of commitment to nursing as an occupation.


Intensive care in small hospitals.

Intensive care in small hospitals. The scene: a small ICU in a 120-bed community hospital with no resident house staff. Emergency coverage is assigned to the emergency room physician. A patient in the ICU has cardiac arrest. His physician is called but cannot come to the hospital immediately, and the emergency room physician is attending a seriously injured patient. In the critical interim, paramedical professionals must shoulder the heavy responsibilities for decisions and interventions.


The genesis of chronic illness: narrative re-construction. In this paper I demonstrate the way in which people's beliefs about the aetiology of their particular affliction (arthritis) need to be understood as part of a more comprehensive imaginative enterprise which I refer to as narrative reconstruction. The intrinsically teleological form of this enterprise means that identified 'causes' represent only putative efficient connexions between the disease and antecedent factors but also narrative reference points between the individual and society in an unfolding process which has become profoundly disrupted. Through the presentation of case material taken from lengthy interviews I illustrate the way in which my question to the subjects about the cause of their disease: 'Why do you think you got arthritis?' was translated by them into a narrative reconstruction of their changing relationship to the world in which they live and the genesis of illness within it.


The primacy of standard antitrust analysis in health care.


Health-related economic costs of the Three-Mile Island accident. On March 1979, a nuclear power station at Three-Mile Island (TMI) near Harrisburg, Pennsylvania, had a major breakdown. During the two-week period of the accident, about 150,000 residents were evacuated for reasons associated with safety and health. Many residents during and after the accident, regardless of whether they left or stayed, made mental and physical adjustments due to this accident. This paper is to estimate the economic costs incurred by individuals or communities as a result of a change in physical or mental health status and/or a change in health care services due to the TMI accident. The findings indicate that stress symptoms caused by the accident did affect the health-related behaviors of area residents. Of the costs examined, the economic costs of work days lost and physician visits are the largest cost items. There were some increases in consumption of alcohol, cigarettes, and tranquilizers immediately following the accident.


Recovery of childrearing expenses in wrongful birth cases: a motivational analysis.


A guide for laboratory safety inspections.


Information: public or private?

Information: public or private?


Transport of a ventilator-dependent patient from Los Angeles to Athens by commercial airline. When a young man with terminal cancer requested return to his native country to spend the remainder of his life with family and friends, the medical team assigned to take him home learned firsthand the challenges of caring for a ventilator-dependent patient during a long international flight on a commercial aircraft.


Primary Life Systems Department. St. Luke's Hospital, Maumee, Ohio. This suburban hospital has succeeded in improving the quality of patient care while cutting costs for both personnel and equipment. The traditionally separate pulmonary, cardiac, vascular, and neurologic services have been combined into a single department. A key element in its success is the training of personnel in multiple job functions.


The misguided quest for the artificial heart.


New perspectives for medical staff and hospital evaluation committees.


Irresistible medical technologies: weighing the costs and benefits.


Quality control in the pulmonary function laboratory. Quality control and proficiency testing are well recognized as means for evaluating equipment accuracy and technical proficiency use of spirometry in physicians' offices, clinics, and industry has brought attention to the need for standardization of calibration and testing techniques in pulmonary function testing. Minimum specifications for equipment accuracy provide the basis for consistency of interlaboratory measurements, and familiarity with operation, calibration, and maintenance procedures enhances personnel proficiency.


The integration of quality assurance and productivity monitoring: a case study.


Medical staff motivation and peer review.


Quality assurance as a market approach.

Quality assurance as a market approach.


HUD grants available for projects that create jobs in depressed areas.


Emergency department quality assurance: perspectives from the teaching hospital.


A quality assurance study of medication errors in a psychiatric hospital.


Child abuse reporting versus patient confidentiality.


Quality of care: bridging the gap between promise and performance. A well-organized quality assurance program is the primary mechanism by which hospitals maintain the quality of patient care. However, there are other elements of quality improvement that can be achieved only through the leadership of the board and administration. The author outlines some actions that hospital leadership needs to take to ensure continuing improvement in patient care.


An overview of medical staff functions within the hospital.


What to expect from the new tax act.

What to expect from the new tax act.


An informal approach to board evaluation. This article provides a brief description of the informal board evaluation process that Rochester (MN) Methodist Hospital recently initiated. The evaluation process consisted of informal interviews between individual board members and an ad hoc committee that included the hospital administrator and the chairman of the board.


How ethics committees can safely navigate untested legal waters. If hospital ethics committees are to meet their goal of ensuring that society's ethical maturation follows technology's growth and impact, they need to carefully formulate their functions before putting them in operation. The author provides some important guidelines on how to match the function and form of ethics committees so that potential legal problems, such as guardianship, informed consent, malpractice, and statutory civil rights issues, can be avoided.


Tracing foundations' pattern of giving for health care construction. The philanthropic contributions of foundations have long been recognized as an important source of low-cost capital for hospitals. But to what extent do foundations contribute to hospitals' capital needs for construction and equipment? The authors discuss the findings of an HHS study that queried foundations to discover the extent to which they are providing such funds, what purposes the grants serve, and the criteria that institutions must meet.


The effects of patient characteristics and beliefs on responses to behavioral interventions for control of chronic diseases. Tests of behavioral interventions seldom examine changes in health beliefs and behaviors thought to be prerequisites of improved outcome health states and they do not attempt to specify how patient characteristics or pretest measures influence responses to the intervention. In this study an experimental nursing intervention, its impact on hypertensive patients' beliefs about their disease, efficacy of medications and diet, as well as blood pressure and weight are described. Among patients from the experimental group, the ability of selected pretest variables to predict clinical outcomes and changes in clinical health states was evaluated. The intervention was successful in lowering diastolic blood pressure and altering certain beliefs held by the patients. The pretest characteristics were not successful in explaining hypertensive patients' responses to the intervention. Explanations for this are pursued through remarks from the content analysis of the intervention protocol. From these observations, the original health belief model was revised. The discussion concludes with a set of research questions that may prove promising for future research.


Multis' delicate balancing act: corporate goals and local board autonomy. Do the responsibilities of local boards in multihospital systems differ from one system to another? Can local board autonomy be maintained within the corporate goals and mission of the system? This article, which is based on informal interviews with system executives, examines how a number of multihospital systems select local board members, what duties are typically delegated to local boards, and the powers reserved by corporate boards.


Tips for effective merger planning.

Tips for effective merger planning. There are many emotionally-charged issues that must be confronted when two hospitals decide to merge, from board membership to what clinical services to offer and where. The author discusses the major concerns that usually arise when a merger is being planned and how the adoption of a guiding set of principles at the outset of the process can resolve many of the immediate issues while protecting the interests of each institution.


Nominations please! Or how a multi singled out potential trustees. As multihospital systems become more geographically diversified, it can be increasingly difficult to maintain an effective, systemwide governance structure. This article describes the governance structure that Baptist Hospitals and Health Systems, Phoenix, has in place, and how it successfully duplicated that structure in a large county hospital it recently acquired in Florida.


Two tiers of care: the unthinkable meets the inevitable? The controversy over whether or not it is acceptable to have multiple tiers of health care continues. In this article, industry leaders discuss the issues involved in the ongoing controversy, including the ability of the nation to provide a single level of care for all, the role of public hospitals in a multi-tiered system, and whether high-quality care can be preserved in such a system.


Pooled financing technique enhances market access, preserves autonomy.


Health care 'class system' forecast.

Health care 'class system' forecast.


Transplants--progress along with agony.

Transplants--progress along with agony.


Perspectives. PPOs face antitrust problems.


Alcoholism: the response of a public hospital. This report presents an analysis of the Alcohol Intervention Program (AIP) at Parkland Memorial Hospital in Dallas, Texas. This pilot project was initiated in January of 1983. A total of 1,822 patients were screened by two trained counselors. Operated in the emergency room, the project significantly reduced the rate of both hospital admissions and readmissions for patients with alcohol-related illnesses. This project demonstrated its effectiveness by making appropriate referrals to local alcoholism service providers. A total of 387 patients were referred directly to Alcoholics Anonymous and 440 were referred to residential alcoholism programs. Of the latter group, follow-up documentation demonstrated that nearly half of those referred remained in treatment for the duration of the program.


Nuclear magnetic resonance as a diagnostic tool in medicine.


HAS figures. Laundry costs still low.

HAS figures. Laundry costs still low.


Five tips to help your linen control program.


Reusables more feasible. MHL tests wrappers.


Congress reaches accord on "Baby Doe' issue after unprecedented consensus effort.


Law and reality of involuntary hospitalization.


Issues in emergency medical services.

Issues in emergency medical services.


Rights of discharged employees.

Rights of discharged employees.


Reducing hospital admissions from a skilled nursing home. With good nursing care and the resources of a dedicated skilled nursing facility, many nursing home patients usually admitted to a hospital for various medical illnesses can be handled within the framework of the skilled nursing facility without necessarily incurring an increased nursing home death rate. The medical advantage to the patient and to the usually overburdened hospitals, as well as the economic advantage to the public in general, calls for a full evaluation and consideration of this alternative to the regular and ongoing practice of hospital admissions of the elderly nursing home patient. The experiences of Carmel Richmond Nursing Home, a skilled nursing facility, have shown that this alternate level of approach and care can be quite successful and beneficial to all involved, especially the nursing home patient.


Types of organizational decision processes. Seventy-eight case studies of decision making were profiled to identify the nature of the process. Analysis revealed evaluative, historical model, off-the-shelf, search, and nova process types. These processes differ in their approach to idea generation, the guarantors applied, and process-management rationale. Variations in each type are described to lay out the distinctions between the processes. The study found that managers do not use the normative methods prescribed by scholars for good decision making. Most decision processes were found to be solution centered, which seemed to restrict innovation, limit the number of alternatives considered, and perpetuate the use of questionable tactics.


Health care reform American style.

Health care reform American style.


Activities of physicians in urban hospitals.


A safer method of drug distribution.

A safer method of drug distribution.


Report of the Chairman of the Board of Regents: the current and serious issue of the oversupply of physicians in our nation today.


Lessons to be learned from Japanese.

Lessons to be learned from Japanese.


Gatekeeper programs.

Gatekeeper programs.


Determining technologist staffing requirements and productivity in an academic setting. The department of radiology at New England Deaconess Hospital, in response to the recently imposed legislative constraints on reimbursement for the care of hospitalized patients, has extended a method developed in 1977 to define staffing requirements and productivity and to track departmental operating efficiency.


Fellowship: the benchmark for American surgery.


Digital computers in nuclear medicine. An overview. Just a few years ago the role of digital processing and display in nuclear medicine was in question. With the emergence of applications that make the value of digital processing more evident plus the favorable trends in digital equipment price and performance, the controversy has died away. The use of computers to acquire, process, and display radionuclide measurements is now routine in many hospitals and research laboratories.


Wanted: smoking policies for the work place.


The campaign for clean air indoors.

The campaign for clean air indoors.


In defense of smokers.

In defense of smokers.


Life insurer plans for a smoke-free office.


The dynamics of coordinating benefits.

The dynamics of coordinating benefits.


One miracle, many doubts. A feat of heart surgery sharpens the debate over benefits and costs.


Where is MRI heading?

Where is MRI heading?


Uncovering cover-ups in COB.

Uncovering cover-ups in COB.


Eliminating duplicate benefits with tighter claims review.


AT & T's medical director promotes healthy life system. Interview by Jane Stein.


Worcester a demonstration of health care competition.


HHS survey illustrates difference in large, small employers' health plans.


Clearinghouse educates Congress on long-term health policy issues.


Expanded view for worksite counseling.

Expanded view for worksite counseling.


The effects of publicity and policy on smoking and health.


Broad brush EAP approach.

Broad brush EAP approach.


EAP evaluation: a problematic exercise.

EAP evaluation: a problematic exercise.


Mammography. Part 2. Evaluation of equipment and guidelines for quality assurance. Whether existing equipment is modified for use in mammography or a dedicated system is purchased, the services of a qualified medical physicist are necessary. Factors to consider in modifying existing equipment and in purchasing new equipment are detailed, as well as features concerning patient safety. Guidelines for quality assurance tests and their respective time intervals are given.


CEOs balance corporate, community needs.


States seek solutions to problem of caring for medical indigent.


AMA president promotes freedom of choice.


Career development can be an important element in employees' health.


New breed of PPOs hold promise, but raise numerous legal questions.


Insurance agents can help small employers avoid health insurance pitfalls.


'I have him back again'. The controversial operation behind him, the world's second artificial-heart recipient faces a new life.


Home care: an industry on the horizon.

Home care: an industry on the horizon.


Discontinuation of the acceptance of applications for the repayment of educational loans for failure to complete studies--HRA. Notice. This Notice announces that, until further notice the Department of Health and Human Services will no longer accept applications for repayment of all or part of educational loans from former nursing students who failed to complete a course of study leading to a diploma in nursing, an associate degree in nursing, a bachelor's degree in nursing or equivalent degree, or a graduate degree in nursing, as authorized under section 836[j] of the PHS Act. This decision is based on the fact that Federal funds are not available for the repayment of these loans.


Grants to State Health Planning and Development Agencies--HRSA. Notice regarding grants to State Health Planning and Development Agencies--determination of population of the States. This notice provides the population figures the Department will use when it determines the amount of grants to State Health Planning and Development Agencies (States Agencies).


Right programs can help control health care costs.


How patients complain...you can count the ways.


More insurers formalize coverage for transplants.


Bucknam v. Kostuik: disclosing alternative procedures.


Don't overlook self-funding group health plans.


How much space do you really need?

How much space do you really need?


From the drawing board.

From the drawing board.


Bergen vs Sturgeon General Hospital et al: a case of diagnostic malpractice.


Between physician and patient: the technological link.


Why consent forms should be phased out.

Why consent forms should be phased out.


Medicare. Is the noble experiment a failure?


Muriel Driver Memorial Lecture 1984. Quality assurance--reflections on the wave. This paper provides an overview of the evolution of quality assurance within the health care industry, with emphasis on the development of occupational therapy expertise. The current concept of quality assurance, focussed on ongoing monitoring and resolution of patient care problems, is discussed. The results of a national survey are presented, relating to the development of occupational therapy, quality assurance programs in the areas of: expertise in component activities, integration of facility and department programs, use of available resources, and extent of academic teaching. Predicted health care trends and their implications to occupational therapy are presented.


Interior design: making the most of the space you have.


Joint statement on terminal illness. Canadian Nurses Association, Canadian Medical Association, Canadian Hospital Association.


An occupational therapist as a sexual health clinician in the management of spinal cord injuries. The Sexual Health Clinician is a health care specialist who is able to assess the sexual potential of physically disabled persons and assist them in the development of acceptable alternatives in sexual practices. This specialty role was first developed at the Spinal Cord Injury Unit, Shaughnessy Hospital in Vancouver, B.C., Canada, to answer a need of spinal cord injured patients, their partners and family. The opportunity to join the Service arose in May, 1981 following one year as the Senior Occupational Therapist on the Spinal Cord Injury Unit. This paper, which describes the experience of an occupational therapist as a member of the Sexual Health Service, is presented in five brief parts: 1. a background history; 2. a description of the sexual problems of the spinal cord injured and the goals of rehabilitation in this area; 3. the role of the Sexual Health Clinician; 4. the strengths and limitations of Occupational Therapy in this new role; 5. a brief discussion of the the need for a sex-related role and curriculum for students of Occupational Therapy.


33rd Annual Welch Memorial Lecture. "2020".


Multidisciplinary teams: common goals and communication.


Studies in design.

Studies in design.


Community care for the chronic mentally ill. The movement of chronic mentally ill patients from large mental hospitals into the community, seeks to liberate institutionalized clients and substitute a more humane environment. This article reviews the types of chronic mental patients now living in the community. The differences between a maintenance and a rehabilitation model for treating the chronic mental patient living in the community are discussed. Special treatment programs for the young adult chronic client are also considered. Three questions specific to occupational therapists working with chronic mentally ill patients in the community are then explored. These are: A. How can we increase the visibility of occupational therapy in community mental health?; B. Should occupational therapists be involved in programs which have a maintenance, rather than a rehabilitation focus?: and C. What has the occupational therapist to offer the young adult chronic client?


Do not resuscitate orders and the ethical issues involved.


Quality assurance/departmental audits--new buzzwords in health care.


Repeated participation in a bereaved parents group: two case studies and implications for clinicians. Over 30,000 children die each year from catastrophic illness. Groups for the bereaved have arisen to address the needs of family members following the profound loss of a child. The authors review the commonly held notions of "normal" and "pathological" mourning and their special application to bereaved parents. The case of two women who participated in their fifth group for bereaved parents are presented with the meanings of their repeated attendance examined in the context of incomplete mourning. Implications for professionals working with bereaved parents are discussed.


Have a health fair!

Have a health fair! Have a Health Fair! It is an excellent mechanism for teaching health, disease prevention, and safety to young children. It also provides many benefits to parents, nurses, hospital staff and members of the community.


Documentation: key to survival in child life services. With the increased demands placed on hospital resources, the need for a comprehensive documentation and program accountability system becomes paramount. In addition to the provision of services, the child life specialist must generate written program description and policy and procedure manuals, participate actively in patient charting, maintain quantitative records of clientele served, and perform program evaluation. It is only through such comprehensive documentation efforts that child life and activity therapy programs can demonstrate to administrative personnel: (a) program philosophy and direction, (b) quality, cost-effective patient care, and (c) program effectiveness. The neglect of these important managerial practices could prove detrimental to the continued survival of child life programs.


Serendipitous findings from a pilot project on preparation of health preschoolers. Thirty-four healthy preschoolers were pretested and posttested as part of a pilot project on preparation programming. Variables associated with their knowledge about medical equipment were identified. The results of this small pilot project are used to present suggestions for future research evaluating the effects of preparation programs for health young children.


A study of hospital computer system management.


Tapping for information systems.

Tapping for information systems.


A multidisciplinary approach to the role of senior therapist on a child psychiatry unit. The function of "Senior Therapist" was developed by the social worker and the head nurse at the Inpatient Child Psychiatry Unit of the British Columbia Children's Hospital. The role of the Senior Therapist lead to a modification of the usual medical model by involving other professionals in primary patient care, discharge planning, and follow-up services for the young patients and their families. The program serves as a model of innovative clinical services.


An example of a nutrition support team.

An example of a nutrition support team.


Visiting Nurse Corporation of Milwaukee.


The human side of the RFP process.

The human side of the RFP process.


CONTU revisited: the case against copyright protection for computer programs in machine-readable form. Professor Samuelson casts a critical eye on the Final Report of the National Commission on New Technological Uses of Copyrighted Works (CONTU) which recommended that copyright protection be extended to machine-readable versions of computer programs. CONTU appears to have misunderstood computer technology and misinterpreted copyright tradition in two significant respects. The Commission failed to take into account the historical importance of disclosure of the contents of protected works as a fundamental goal of both the copyright and patent laws. It also erroneously opined that the utilitarian character of a work was no bar to its copyrightability when both the statute and the case law make clear that utilitarian works are not copyrightable. Since computer programs in machine-readable forms do not disclose their contents and are inherently utilitarian, copyright protection for them is inappropriate. Congress acted on CONTU's recommendation without understanding the significance of these conceptual flaws. Professor Samuelson recommends the creation of a new form of intellectual property law specifically designed for machine-readable programs.


Changes in health care use affect premium rates.


The practice of emergency medicine and the HMO.


Hinsdale Hospital: learning about the elements of a good lighting system.


Hospital contact lens services in the United Kingdom.


Social characteristics of newly admitted mental hospital patients--a replication study. Data were examined on all patients entering the admission wards of a large provincial mental hospital in 1979. Out of a total of 534 admissions, 470 came from permanent addresses, most of the rest from supportive accommodation or transitory addresses, while less than 2% were of no fixed abode. Only 73 of the sample, mostly aged over 60 years remained in hospital after a year: 17 died and 444 were discharged. Of the discharged patients, 45(10.3%) could not return to their original addresses. Comparison is made with the results previously reported from a London mental hospital.


Administration of clinical units: experiences in a department of anaesthetics.


Stroke rehabilitation units in the United Kingdom.


Community antenatal care--a local study. Views of 16 general practitioners and 14 midwives on "shared antenatal care" revealed local differences in organization, in policy, in the roles of the professionals involved, and in the level of communication and co-operation between them.


Pre-operative medical complications in patients admitted to hospital for elective orthopaedic surgery. At the Royal National Orthopaedic Hospital (RNOH) between 1 November 1981 and 31 October 1982 3,628 operations were performed and 96 patients were referred preoperatively to a physician for clinical assessment of their fitness to withstand the operation. In 36 of these patients the operation was postponed because of medical complications and in 6 it was cancelled. The commonest reason for postponement was uncontrolled hypertension (16 patients). It is likely that 24 (67%) of the 36 postponements could have been avoided if arrangements had existed to record the blood pressure, pulse rate, haemoglobin level and urinalysis of each patient at the time of initial hospital attendance.


Medical arrangements in 108 open-entry Britain marathons, 1983. In 108 open-entry full marathons held in Great Britain in 1983 (35 incorporating shorter races) the number of static first-aid posts varied from 0 to 28 (median 9). In 54 (50%) the first of these was within 3 miles of the start but in 11 (10%) there were none in the first 10 miles. Mobile first-aid arrangements did not compensate for the absence of static posts. The numbers of qualified first-aid staff ranged from 1-250 in events with fewer than 1,000 entrants (67%), and 18-930 in larger events. Intravenous infusion facilitates were available in 59 (55); defibrillators in 34 (31%). Drink stations were provided in all events but in at least 40 they were spaced more than 2 1/2 miles apart on average. Oral and intravenous fluid replacement facilities were available to no greater extent in summer events than at other times of the year; 25 of the 57 summer events started at or after 11.00 hrs. Races with fewer than 10 first-aid posts had mean contact rates of 75 per 1,000 entrants (S.E. 15.4); those with 10 or more, 107 per 1,000 (S.E. 14.4). Only 160 runners were taken to hospital from all events combined (2 deaths). The mean hospital contact rate was 1.6 per 1,000 entrants, and was not related to the size of entry, density of first-aid posts nor sophistication of the first-aid offered. The inadequacy of arrangements in some marathons for preventing dehydration and treating collapsed runners on the course suggests that marathon organizers should be required to apply consistent, high standards to their arrangements for preventing and treating medical problems.


An analysis of hospital fire reports.

An analysis of hospital fire reports. All fires notified from one English Regional Health Authority for a six-year period were analyzed using a method developed by the Department of Fire Safety Engineering at Edinburgh University. Three of the important factors in fire safety--control of the fire, evacuation from threatened areas and the prevention of ignition--are evaluated and recommendations are made with regard to them.


The feedback research approach to evaluation: a method to increase evaluation utility. The utilization of evaluation results continues to be a great concern among professionals in the field. To increase the potential usefulness of evaluation, the feedback research approach is proposed as a method that is especially helpful in studies that fail to find program effectiveness. Going beyond the bounds of the evaluation framework and studying the problem for which the program was designed to ameliorate, evaluations that incorporate a feedback research component can provide clients with valuable information to guide further program development. This paper provides a description of the approach and an illustration of its use in an evaluation of a major international corporation's health improvement/stress management program.


Correlates of honor ratings in a clinical clerkship employing a faculty forum evaluation system. 5he purpose of this study was to determine whether or not suspected variables affected a surgery clerk's chances of being awarded an honor rating. Findings indicated a significant relationship between a student receiving an honor rating and his or her preceptor's predetermined level of student advocacy, the number of completed patient interview and physical examination write-ups, and final examination scores. There was no significant relationship found between honor ratings and the preceptor's status, the sequence in which the student was discussed or the length of time spent discussing the student at the final evaluation meeting, or the number of clinical faculty present at the meeting. These results lend support to the faculty forum evaluation approach, but suggest a need for further scrutiny of some influencing variables to ensure all students are fairly considered and honor ratings judiciously awarded.


Dietitians' wages & salaries.

Dietitians' wages & salaries.


More medical-legal educational material. Part 2. Physician-patient relationship.


Two patients die in Arkansas nursing home fire.


Allegheny General Hospital: staff cafeteria.


The future spells opportunity: the time is right for foodservice administrators.


Is there strength in numbers? Institutional purchasing strategies for the 80s.


Do female EMTs/paramedics face tougher challenges?


The relationship between the federal government and state licensing boards.


Would Quincy make it as a health educator? Commercial television's potential as a source of health-related information is nearly unknown. One hundred seventy-six undergraduate students watched a fictional, dramatic television program and recorded health information as if they were taking course notes. These notes were compared to a "key" developed by a panel of health professionals. Slightly less than half (42%) of the total possible health information was recorded. Ninety-two percent included some specific information about the program's main health theme. Females recorded significantly more information than males. Persons who enjoyed the program had higher point scores than those who did not enjoy the program. Further research as to the usefulness of all varieties of commercial television as disseminators of accurate, recognizable health-related information is warranted. Additionally, improved skills for students as well as the general public as critical viewers are needed.


Treating the spiritual dimension through educational imagery. Recently, health educators have shown an interest in the spiritual dimension of health. Despite this interest, most health educators have taken the "safe" approach and avoided the discussion of spiritual issues in the classroom. The problem with this avoidance position is that sensitive issues such as sexuality, drug use, and death and dying are laden with spiritual implications, particularly when students are asked to make personal decisions regarding these issues. The present article suggests the use of Educational Imagery as a method for incorporating the spiritual dimension into the health lesson. When certain simple precautions are taken, the educational imagery technique applied to the spiritual dimension can be both useful in meeting educational objectives and in making the classroom exciting and interesting for the students. The reader is provided with a definition of the spiritual dimension, along with a complete description of Educational Imagery. In addition, specific strategies for incorporating spiritual health in the classroom are given. The final section of the article includes implications and precautions for the teacher.


Effects of exercise training and dietary behavior modification on weight reduction and lipoprotein lipids in female hospital employees. A study was carried out to evaluate the relative contribution of exercise training and dietary modification on weight loss and selected coronary heart disease (CHD) risk factors in overweight female subjects. Forty-eight subjects were randomized into three intervention groups. An exercise only group (I), a diet only group (II) and exercise and diet group (III). All subjects were enrolled for a period of 12 weeks. Groups I and III exercised five days per week for a minimum of 40 minutes per session. Groups II and III met two hours per week for behavioral modification sessions. After 12 weeks, subjects in all groups had lost a significant amount of weight. Groups I and III had positive changes in the level of their lipoprotein lipids while group II remained unchanged except for their level of triglycerides, which were reduced significantly. Groups I and III had a significant increase in work capacity, as well as a significant drop in resting heart rate and blood pressure. Results showed that the combined effects of exercise and dietary modification can have a more profound effect on weight loss when compared with either intervention used alone. The significance of exercise induced lipid changes and blood pressure reduction are discussed in light of risk status for CHD.


Reflections. You still can't judge a book by its cover.


"Let's be cooperative" at Group Health: a case study in becoming a smoke-free workplace.


Case in point. St. Peter's Hospital.

Case in point. St. Peter's Hospital.


The progressive management of cardiac disease.


Case in point--the answer. Good Shepherd Hospital.


Cardiac rehabilitation: developing a successful program. The Downriver Treadmill Team, a Phase II and Phase III outpatient cardiac rehabilitation program, is presented as a prototypical successful program. The qualities and attributes of this program are discussed as a means to actively promote cardiac rehabilitation directly to the consumer.


Hospital design to support greater operating efficiency. With the new imperative on cost containment and particular emphasis on prospective payment, hospital design must support greater productivity. It is incumbent on architects and engineers to reduce construction costs; but more importantly, to design facilities that improve personnel productivity. Several approaches to designing for efficiency are discussed including improving the development process; systems building, ease of maintenance, and conserving energy; developing the model hospital; minimizing travel throughout the hospital; centralization vs. decentralization; automating support systems; designing for growth and change; analyzing workflow; utilizing swing space; and emphasizing consumer centered care.


No vacancy: hospital bed needs in the year 2000 and beyond. Federal programs in health facility planning once encouraged increases in the nation's inventory of hospital beds. More recent programs, however, discourage the provision of additional beds. The current controls combined with the population, especially in the 65 and over age groups, will lead to a hospital bed shortage in the twenty first century.


Cash planning in the NHS.

Cash planning in the NHS.


Hospital utilization in the twenty first century. The combined influence of a number of trends will determine the utilization rate of hospitals in the twenty first century. Aging of the population would suggest that hospital utilization will increase significantly over the next 40 years; however, major changes are taking place in the delivery of health services. This article examines the possible combined impact of the aging population, the increased use of alternative health insurance policies, and the growth in HMOs.


Health management. Ups and downs of a service on trial.


Health management. Method right--climate wrong.


Money in the bank.

Money in the bank.


US health care. Positive lessons...and pitfalls.


Countering the dustbin image.

Countering the dustbin image.


The caring foundation.

The caring foundation.


Ironing out some dirty linen tangles.

Ironing out some dirty linen tangles.


Estate management. Raking over old ground for future use. The professional approach.


Estate management. Breaking down the barriers.


Laundry services. The competition hots up.


Minimizing resistance to death education. Death education is now an accepted phenomenon within institutions of higher education. Death education is also being taught at the elementary and secondary school levels though less is known about its acceptance as a worthwhile pedagogical endeavor by parents of school-age children. This article addresses the potential sensitivity and hesitation parents may demonstrate relative to death education's delicate, multifaceted subject matter and offers some suggestions for minimizing possible resistance to death and dying pedagogy. Any resistance that parents demonstrate is generally due to their own fear of death and dying and their inability to deal realistically with it. Certain antecedents of fear and strategies for coping with fear are offered.


When a grievance has no appeal.

When a grievance has no appeal.


Developing neighbourhood networks.

Developing neighbourhood networks.


Emerging POMIS culture: away from sheer strength toward adaptability.


Curing a hospital's growing pains.

Curing a hospital's growing pains.


The RFP--a management issue.

The RFP--a management issue.


Managing home care businesses. Coping with union organizing attempts.


LANS for the physician's office.

LANS for the physician's office.


Making use of a fire brigade as a loss prevention tool.


An interview with: William Robert Clouse.


The surgical case cart.

The surgical case cart.


Case-per-cart management: a new approach.


Working within architectural restrictions to achieve an effective surgical case cart system.


Implementing a case cart system in an existing hospital: a team approach.


The case-per-cart system: educating the operating room and central processing and distribution staff.


The organizational concept for case-per-cart delivery support.


Cycle counting as a method for improving perpetual inventory accuracy.


Applications of the SPD concept to prime vendor relationships.


Symbiosis: material management and the operating room.


Central service: yesterday, today and forever?


Patient transport and material: they will manage.


Robotic technology in health care settings. The goal--increased productivity. Part II. Applications already in use.


Central service Q & A: running a biological indicator with every flash load.


How to write nursing care plans--an easy five step method.


How do you handle an employee who steals?


How to finance employee education: hospital and employees should both gain.


"The Humpty Dumpty syndrome"--patient falls--standing your ground.


How department heads can use cost studies to reduce hospital costs.


Teaching clerical support staff effective techniques for dealing with behavioral problem patients.


HMO drug sales exempt from antitrust statute.


Financial support of health care coalitions increasing.


State courts rule on removal of life-support systems.


Status report: health planning and capital expenditure regulation.


Treasury's modified flat tax proposal could adversely affect tax-exempt hospitals.


Make incident reports more than an exercise on paper.


HHS publishes proposed regulations to implement "Baby Doe" sections of Child Abuse Act.


An age old problem...who will care for our elderly?


Get employees in shape with a fitness program.


How to save time, money and personnel in central service and infection control.


Administrators need not fear residents' councils.


Native liaison lessens the trauma of hospitalization.


Health education versus health promotion--a practitioner's view.


Towards a definition of health education and health promotion.


An evaluation of two antenatal information booklets. The readability of two antenatal education books which are widely distributed to expectant mothers was assessed. There were some significant differences, and it was anticipated that this would be reflected in the levels of information imparted to the mothers, particularly when they were analysed by social class. In practice the differences were small, and the only one of significance was that the book which was believed to be more readable and more attractive in format resulted in higher knowledge scores in social classes I and II, but not in social classes III to V. Possible explanations for this are discussed. Clear benefit in terms of knowledge was demonstrated when mothers received a book in advance of their attendance at the antenatal booking clinic. They arrived better prepared and better informed, with knowledge to help the healthy development of the foetus at an early stage in pregnancy. The additional postage costs in sending out booklets is considered justifiable.


Regional continuing education for HEOs--East Anglia.


Hospital topical law. A hospital board vs a staff physician.


Central service/materials management: meeting the challenge of DRG's.


A systematic decision.

A systematic decision.


When Diana spoke, hospitals listened.

When Diana spoke, hospitals listened.


The older employee: harvesting the experience. Interview by Barbara Feiner.


Health industry bar coding--a management perspective.


Robotic technology in health care settings. The goal--increased productivity. Part I. Overview.


Shops on wheels. The gift cart option.

Shops on wheels. The gift cart option.


Pharmacist's role when dispensing pressurized aerosols for asthma. Pharmacists should ensure that patients with asthma know how to use their pressurized aerosol medication, including bronchodilators and steroids. Inappropriate inhalation technique with these agents is common and may result in suboptimal response or therapeutic failure. Instruction by the pharmacist should include demonstration of the inhalation technique as well as the use of verbal and printed information. After demonstrating the use of the inhaler, the pharmacist should observe the patient to verify proper use. Instructions should be reinforced when prescriptions are refilled or if the patient is readmitted to the hospital. For patients who cannot learn proper inhalation technique, extension devices are now available.


Staffing levels: how do you compare?

Staffing levels: how do you compare?


Types of selected security devices for hospital pharmacies. Every pharmacist, whether in the hospital or in a community environment, faces the daily possibility of a holdup, burglary, or forged prescription. Statistics on drug-related crime are on the upswing as an increasing number of perpetrators recognize that wholesalers and hospitals are large depots of injectable narcotics and controlled substances. In response to this, many Federal drug crime laws and increased security have been proposed. This report identifies many types of security devices available to provide early warning or deter robberies. They include perimeter security systems, motion detectors, surveillance cameras, bullet-resistant windows, and key-lock systems. This report also suggests several considerations to be used in developing a security system in a hospital pharmacy. A basic understanding of security devices will enhance the manager's ability to choose the appropriate devices(s) for a particular service.


Utilization review report.

Utilization review report.


Cost effective method of implementing decentralized unit dose pharmacy services in a Friesen setting. A limited decentralized drug distribution system was implemented at the Graduate Hospital, a 310-bed Friesen Concept teaching hospital. This mobile system services 252 medical/surgical beds on three floors of the hospital. Operation was limited to hours of peak demand for pharmacy services and to initial doses. The system was able to reduce turnaround time from 217 minutes to 90 minutes for 80-85% of newly written orders. Further, the systems was found to increase the availability of the pharmacist as a reference source and to clarify unclear or inappropriate orders. This approach required no increase in full-time equivalents and minimal capital expenditure.


Financial management issues. Position control procedure: Part 2.


The CCRC as a business opportunity: consider the issues.


Tax-exempt leasing offers savings.

Tax-exempt leasing offers savings.


Yes, we can humanize bottom-line management.


Shared savings finance energy investments.


Survey results show diversity in sources, uses of working capital.


Audit of digoxin prescribing in ambulatory patients. Digoxin prescribing for ambulatory patients with uncomplicated congestive heart failure in normal sinus rhythm (UCHF) was evaluated. The audit was conducted at a hospital primary care clinic and was performed retrospectively over a recent 2-year period. The audit focused on the discontinuance of digoxin prescribing and the attendant monitoring necessary. There was 34 patients prescribed digoxin during the study period who were classified as UCHF. Of these, 23 (68%) met our a priori criteria for digoxin discontinuance. However, only three of the 23 were discontinued and none met the criteria for proper follow-up. With regard to monitoring, the average patient was seen once every 2 months, but in fewer than half of the visits the patient was assessed on basic subjective and objective parameters of CHF status and digoxin toxicity. These results are being used in an educational program for the clinic physicians who before the audit had perceived their care of digoxin patients to be optimal.


A practical approach to capital investment decisions.


The Health Maintenance Plan (HMP) of Wisconsin Physicians Service. The origin and development of the Health Maintenance Plan of Wisconsin are discussed in relation to participants in the plan, the Wisconsin Medical Society and its similarity to alternative health care delivery systems. The roles of primary, referral, and non-participating physicians are also described. The author suggests that relationships among physicians in the community remain collegial and that hospitals are not affected adversely. The elements which have contributed to the success of this plan, one of the largest in the United States, are discussed in general terms.


Consumer-sponsored prepaid group practice: restructuring the health care system. The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.


Building a Trojan horse. Science under the Reagan Administration.


Blue Cross/Blue Shield-sponsored prepaid individual practice. The HMO is no longer a fledgling idea in the Blue Cross/Blue Shield System. There are 45 Blue Cross/Blue Shield Plans throughout the country which sponsor a total of 54 HMO programs with about 1,040,000 members. Among those 54 programs are staff models, group models, Individual Practice Associations (IPAs), and other structures. This analysis is confined to the Minnesota affiliate corporation, "HMO Minnesota."


Changes in corporate organization of the health care system. Health care financing has undergone numerous structural changes over the years. Change continues while extreme growth seriously affects the health care focus. The author examines the multiclass system and health financing trends. Restructuring techniques are also discussed.


Geisinger Medical Center and the Geisinger Health Plan: the rural HMO. The Geisinger Health Plan (GHP) in Danville, Pennsylvania represents one of the nation's first rural health maintenance organizations. Opened in the Geisinger Medical Center in 1972, this hospital-based, multi-specialty group practice today provides comprehensive care to an enrolled population of 6,000 members in Montour County. Cost and utilization statistics for GHP compare favorably with other HMO settings.


Maintenance drug option plans.

Maintenance drug option plans.


Prepaid group practice in a metropolitan area: Health Insurance Plan of Greater New York. This article presents an overview of the benefits of prepaid group practice to the efficient delivery of medical care in a large metropolitan area. The management techniques of the Health Insurance Plan (HIP) of Greater New York are examined. Included is a short history of HIP, the problems it has faced, and how it overcame them.


Hospital-sponsored group practice.

Hospital-sponsored group practice. Henry Ford Hospital, a 1,000-bed institution in central Detroit, is being developed into a "center of excellence" with expansion of ambulatory care to suburban satellite clinics. A hospital-based HMO has been started in an effort to cut costs, decentralize care, and provide an alternative to Blue Cross. It has been successful and is now being considered as a solution to Michigan's Medicaid problems. Background and analysis follow.


Creating competitive weapons from information systems. As the pace of competition intensifies in the 1980s, information systems will emerge as critical new weapons in the battle to gain an advantage over competitors. The authors show how a business can use modern information technologies to create a competitive edge by adding value to present products and services.


The hospital corporate negligence doctrine.


CHA, federal and state officials analyze health needs of poor.


Hospital's television programs educate diverse audience.