How healthy are your control systems?

How healthy are your control systems?


Comments on the working paper: evaluative criteria for Catholic health care facilities.


Buildings and budgets: the overinvestment crisis. Over the last ten years, American colleges and universities have spent over $400 billion on their physical plants despite the fact that student enrollments have continued to decline. The increase in maintenance and energy costs has caused a financial strain, forcing cutbacks in vital ingredients of education: research, course offerings, student financial aid, faculty and staff support. The author draws a comparison between higher education and the health care industry and suggests that costs can be reduced by avoiding duplication of facilities and developing modes of interinstitutional cooperation. An increase in institutional efficiency will reduce the reliance of the higher education community on public subsidies for operations. This approach is seen to be particularly important during an era when every qualified student is expected to have the opportunity to obtain a university education without undue financial strain.


Bringing Christian values to society through health care.


Social health care in the next decade and beyond: a personal statement.


Pastoral care at St. Boniface General Hospital: a policy statement.


Catholic Health Conference of Ontario.

Catholic Health Conference of Ontario.


Tort liability in genetic counseling.

Tort liability in genetic counseling.


The hospital pharmacist and nursing pharmacology. This article attempts to provide some general guidelines to pharmacists who teach pharmacology to student nurses. With proper preparation, the pharmacist-instructor can offer a course that will be rewarding both for him and for his students. To aid the beginning instructor in organizing a course, suggestions are made regarding the organization of a course, methods of instruction, the selection of a textbook, the use of audiovisual aids, the selection of guest speakers, the preparation of tests, and course evaluation. After having read the article, the novice instructor should be able to set clear goals and objectives for his course and to avoid some of the potential pitfalls associated with a course on a complex subject.


Research in clinical pharmacy: needs and priorities. The importance of research to a service profession such as pharmacy is established. The current state of research in clinical pharmacy, and some proposed priorities for the future, are outlined. General requirements for research staff, facilities, and funding are listed. To produce accurate and meaningful results, three guidelines must be borne in the minds of researchers: (1) select research topics that will have recognized impact on the quality of patient care and education; (2) design and conduct studies which can withstand the scrutiny of the established scientific community; and (3) communicate meaningful information to all who can facilitate its utilization.


[Unit dose system can prevent medication errors--only if monitored properly].


Public relations in emergency care.

Public relations in emergency care.


Treating the Jehovah's Witness.

Treating the Jehovah's Witness.


Public information and education Texas style.


North Dakota's approach to moving the message.


Emergency medical services and the media: partners for better health care.


Crisis management: the EMT and the sexual assault victim.


Ten pointers for organizing hospitalwide education. Although there is no one particular "recipe" for putting together a hospitalwide education function, there are some basic guidelines and general caveats that have been culled during the concept's 10 years of existence. Some helpful hints that can be applied to most situations are detailed herein.


Rural volunteer emergency medical coordinators.


One answer to the problem of education.

One answer to the problem of education.


Bylaws of the National Association of Emergency Medical Technicians, Inc.--adopted Nov. 15, 1975; revised Jan. 21, 1978, and April 27, 1979.


Keep an eye on human resources 'yardsticks'. By monitoring certain human resources "yardsticks", personnel administrators can demonstrate the results of institutional and departmental goals and objectives. Thus, taking an economic approach to personnel management can help the hospital in the struggle to contain costs.


Materials to continue to Immunization Initiative.


Comprehensive evaluation model for nursing education. The proposed model provides structure for determining decisions to be made, questions to be answered, and sources of information about evaluation. A sample of the kinds of decisions that can be made for the various matrix elements of the evaluation model is reflected. Examples of questions that could be asked (why) in order to evaluate various aspects of a program (what) and of whom these questions could be asked (who) are provided. The model as described is useful in comprehensively delineating all aspects of the system. The flexibility of the system allows for the unique needs and aspects of the individual school to emerge. The model also provides a framework for organizing and implementing a plan for total program evaluation.


Utilization of behavioral knowledge from short-term workshops. Workshops on new methods in the health professions have often been evaluated for participant reaction and understanding of the material. But behavior change on the job following workshops has seldom been assessed. Rehabilitation professionals in seven states were surveyed to determine use of behavior management procedures after three-day training workshops. Those trained within the previous 15 months reported more frequent use of specific procedures than those trained 16 to 30 months before the survey. Positive verbal reinforcement for appropriate behaviors and for behaviors incompatible with inappropriate behaviors were the specific procedures used most frequently by respondents. Group token economies were more frequently used by trainees who worked with homogeneous client populations than those who had clients with different types of disabilities. The need for consultants and additional training were the most frequently cited reasons for not using procedures more frequently.


Would you trust this therapist with your troubles?


A resident's internal medicine practice. The decision-making experience of residents in a primary care internal medicine training practice was examined. The patient population provided residents appropriate training opportunities but the experience of many residents making decisions about prevalent primary care problems was often inadequate. The residents' evaluation of their educational experience with patients suggests that several elements of patient care affect their ability to learn. These include the occurrence of diseases in their patients, opportunities to treat and follow patients, the chance to use diagnostic procedures, and the option of reviewing their care with supervisors and consultants or through reading. The results of this study and the current understanding of the development of clinical judgment are discussed as arguments for evaluating internal medicine training programs in part by examining the content of residents' decision-making opportunities in their ambulatory patient practices.


Dr. Moriarty's war on poison.

Dr. Moriarty's war on poison.


Feeding children back to health.

Feeding children back to health.


It's how you do it, not what you do.

It's how you do it, not what you do.


Kaiser plays growing national role.

Kaiser plays growing national role.


Promoting the group practice view.

Promoting the group practice view.


Assessment of physician competence for relicensure.


Mandatory continuing medical education.

Mandatory continuing medical education.


Let's be fair.

Let's be fair.


Physicians find a variety of uses for computers.


Can fee-for-service private practice survive competition?


The role of specialty societies in recertification.


Energy management: modifications and monitoring.


AMA contributions helped defeat cost-cap, Common Cause study claims.


Planners approve medical school "test tube baby" clinics.


Is it time that the kings of London lost their empires? It is rumoured that Patrick Jenkin is mulling over a reorganisation of the health service in London which could strip it of its traditional predominance in medical matters. Nick Davidson looks at some of the arguments for and against. Administrators in the home counties feel that they don't carry the same clout as regional officers who, they argue, do not understand problems facing rural areas. The home countries are fed up with being in regional authorities where the votes are stacked against them.


Fighting to save the future of the Mandeville miracle. Last week, 70 wheelchair-bound ex-patients occupied Stoke Mandeville Hospital in protest against proposed cuts which would further restrict the work of its famous Spinal Injuries Unit. Although the unit's achievements in treatment and rehabilitation are considerable, lack of funds have caused it to fall behind in the last ten years. The staff are distressed because they can no longer offer help to enough patients, as Alison Hyde found when she visited the unit.


Political skills and the science of diplomacy. Present NHS management structure involves relationships which are based more on political processes than authority. In the first of a two-part article Steve Harrison and Jack Hallas look at management as a political process and argue that politics are about redistribution of resources and cannot be taken out of health care management.


Health administration: good doctor's cure to quell the service's sea-sickness.


New hospitals from old stock.

New hospitals from old stock. With careful planning, existing hospital buildings can be adapted to meet current needs effectively and relatively cheaply. Author describes how one small hospital has been redeveloped and what lessions can be learned from 'the Nelson project'.


Politics and conjurers' rabbits.

Politics and conjurers' rabbits.


Joint care: a pat on the back for a unique family hospital. Over the years Stannington Children's Hospital has evolved into an hospital with a difference offering care to sick children from socially deprived backgrounds. Author looks at this remarkable home which has made 'the impossible possible'. He explains why it is a prime candidate for closure and why all concerned with Stannington, including the Health Advisory Service, feel it should be funded as a regional specialty.


Midwives of reorganisation and the still-born CHCs.


Hospital life: avoiding negative attitudes. The population of Milton Keynes continues to grow and with it the need for more facilities in its recently opened community hospital. But how can the hospital cope now that Buckinghamshire AHA has put staff replacements under an embargo? Alison Hyde finds out how the staff are facing up to disappointed hopes, delayed plans and an establishment level which is one third under target.


Health administration: the wealth and welfare wager. Taking resources away from the NHS is not an easy thing to do, as the outraged cries of protest against the cuts over the past few months have testified. But hand in hand with this process has been the Government's determination to find new ways of putting money back into the service. Drew Clode examines some of the local approaches to fund raising so warmly espoused by the DHSS and examines how successful similar schemes have been when tried out in local government.


Resource control: the seven per cent who spend the most. The medical profession has long been notorious for its reluctance either to adopt an administrative role itself, or to participate fully with other NHS professions in health service management. Here, Dr Graham Page of the Health Services Management Centre, Birmingham University, argues that this can lead to a substantial waste of resources. An answer, he suggests, is that participation in management should be an integral part of medical education.


Local packages tied up with a piece of corporate string. The arguments concerning the most appropriate means of applying and monitoring standards in the NHS were highlighted recently by Frank Pethybridge's evidence to the Royal Commission. Here members of the Institute of Health Service Studies evaluate his approach and put forward an alternative case for a locally oriented agency to exchange a 'wholehearted consensus over priorities'.


Four units under one roof.

Four units under one roof. Taking advantage of a vacant hospital building, a joint care team in Sunderland has initiated a centre for mentally handicapped children which includes assessment, physiotherapy, day nursery and residential facilities. Dr Alan Lillington, consultant paediatrician, Sunderland AHA, believes the scheme is unique in Britain in providing such a comprehensive service under one roof.


How to test for ethylene oxide concentration.


Who buys for your lab?

Who buys for your lab?


Purchase law clinic: our suppliers are increasing prices at a rate that seems out of line with President Carter's guidelines.


Alkalis and bleaches are competitively priced.


Bring the docs into your standardization program.


Hospitals responsible to patients for infection control.


CDC issues new guidelines for hepatitis isolation.


Volunteer training.

Volunteer training.


IC for mental institutions.

IC for mental institutions.


Data processing: necessary and effective for home health management.


Simple program best for small hospitals.


The role of the nurse oncologist in home care.


Discharge planning in the tertiary health care setting.


A continuing education program for the home care administrator: the first pilot test.


Changes in job satisfaction among registered nurses in a home health agency as a result of organizational restructuring.


Managers can drive their subordinates mad. This article explores the phenomenon of "folie à deux"--an aberrant relationship between manager and subordinates that is characterized by shared delusions. Though most visible among public figures like Adolf Hitler, J. Edgar Hoover and Jim Jones, the problem also surfaces among private managers and their associates with dangerous implications for the firm. In folie à deux, the unusual behavior patterns of a manager in an isolated setting become mirrored by dependent subordinates, and the organization loses touch with its original goals and strategies. The author describes the dynamics of this phenomenon and details steps to remedy the situation. Once recognized, he suggests that the manager establish a trusting relationship with the instigator as a prelude to altering the behavior patterns, then transfer the subordinates and reorient the work climate so that independence and responsibility are encouraged. If the instigator is a powerful executive, the author suggests enlisting the support of a countervailing force, such as the government or a union, to guide the organization away from possible self-destructive adventures.


Pilot program reduces LOS for mothers and newborns.


Anxiety over transfer can cause increase in illness, death in elderly.


Massachusetts law expands patients' rights.


Test your skills: utilization review.

Test your skills: utilization review.


Photo psychology.

Photo psychology.


California enacts new confidentiality law.


Our common senses: art therapy and therapeutic art.


The play's the thing: mental health in the spotlight.


Puppets with no strings attached.

Puppets with no strings attached.


Learning through Loose Association.

Learning through Loose Association.


The lively arts of healing.

The lively arts of healing.


Private philanthropy and public service policy: a New York City case.


Assessing financial position with 29 key ratios.


Children's health needs in the 1980s: a perspective on what foundations can do.


Energy special on window management.

Energy special on window management.


The role of the community health education specialist in the delivery of health care. This paper seeks to define a "model" role for a community health education specialist having due regard to the dictates of professionalism and to the potential of education and the behavioural sciences for increasing effectiveness in the delivery of health care. It subsequently examines the "goodness of fit" between existing health education services and the "model" role by matching this latter with data from a postal survey of 152 health education officers collected just prior to the reorganisation of the NHS in April 1974.


Comparing ratios shows fiscal trends.

Comparing ratios shows fiscal trends.


LIFO inventory accounting: is it for you?


Endowment fund management: does 'prudence' exclude stocks?


How to make certificate of need work for you.


Recognizing and assisting the alcoholic hospital employee.


Energy: 'ring in the new'.

Energy: 'ring in the new'.


Dignify routine jobs.

Dignify routine jobs.


How to use interviews.

How to use interviews.


Physician and hospital involvement in community health education.


Hospital attorneys update medicolegal issues. Medical staff bylaws, due process, malpractice insurance, termination of extraordinary medical care, health planning regulations, and consent to treatment were among the topics discussed at a two-day educational program sponsored by the American Society of Hospital Attorneys.


Privilege delineation system leaves room for flexibility. A large metropolitan hospital developed a formal procedure for delineating clinical privileges for new physicians and those physicians already on staff. Although the hospitalwide procedure is standardized, it is based on the use of forms that were developed individually by each department.


AMA stands firm on LCCME withdrawal.

AMA stands firm on LCCME withdrawal. The American Medical Association stood by its decision to withdraw from the LCCME and released a major report on graduate medical education at the association's interim meeting in December. The delegates also maintained their stand on national health insurance and discussed a number of medical staff issues.


The new USP-NF: drug standards and patient information.


Evaluation of a videocassette approach to pharmacology inservice training for nurses.


Evolving concerns of pharmacy and therapeutics committees.


Analysis of missing medication episodes in a unit dose system. The unit dose drug distribution system at The Buffalo General Hospital in Buffalo, New York, was evaluated by an analysis of cases in which doses of medication were missing from the unit dose administration cart. When a dose was missing, the medication administration nurse reported the occurrence to the pharmacy. When time permitted, the cause of the missing dose was determined and recorded. Thirty causes for missing doses are cited. The causes were found to arise from misuse of the unit dose system by nurses, misunderstandings between the Nursery and Pharmacy Departments, or from oversights on the part of nurses or pharmacy personnel. Missing doses can be prevented in the future by instructing nurses in the use of the system, improving communication between the Departments of Pharmacy and Nursing concerning the needs of the patients, and being aware of mistakes that can occur so care can be taken to prevent them in both departments.


Readability--its applicability to education of patients by pharmacy. The applicability of readability to the development of pharmacy educational materials is reviewed. The importance of reading skills must be recognized in all areas of education, including pharmacy patient education. If people are to perform certain tasks, they must understand the instructions for those tasks. To be understandable, the instructions must be written on the reading level of the people who will be following the instructions. Readability has been defined as those characteristics of reading materials, involving certain mental processes, that make for ease or difficulty of comprehension of the reading material. It is the task of the reader to use as few or as many of these mental processes as necessary to grasp the intended meaning of the material. It has been estimated that the average reading level of the American public is approximately 7th to 8th grade. However, many adults do not have sufficient reading skills to comprehend fully material written on these levels. Therefore, pharmacy educational material should be written on the reading level of the patient population it serves. Several readability formulas have been developed to evaluate the various characteristics of reading material that lead to reading comprehension. Among the ones recommended for use with pharmacy educational materials are the Fry Readability Graph and the Gunning Fog Index.


Hospital reimbursement and clinical pharmacy programs.


Work measurement is serious business.

Work measurement is serious business.


Foods high in potassium.

Foods high in potassium.


Literature searching by computer in a university-based drug information center: format of pharmacist-generated input data.


Ambulatory care reorganization in teaching hospitals.


Professional staff acceptance of medical nurse practitioners in ambulatory care.


Dentistry and ambulatory health care.

Dentistry and ambulatory health care.


Role of clinical information systems in controlling costs.


Low cost ambulatory medical information system. A simple, low-cost computerized minirecord system (minimal essential record) has been in operation at the Johns Hopkins Medical Clinic since mid-1975. The system has three primary components: (a) the Minirecord which contains a listing of problems and medications, plus information about visits to other clinics, (b) an appointment system used to organize materials prior to clinic encounters and assist in the follow-up of high risk special patients, and (c) an encounter data system to prepare reports used for management, quality assurance and training. This paper describes the system's operation, and reports on its utility and cost.


The ACCESS experience: a success story.

The ACCESS experience: a success story.


Consumer views of the impact of nurse-midwifery in low-income areas.


Habilitation: a health care concept with a future.


Residential care--its future and our future.


Point of view: the procedural manual--a once-a-year nightmare.


Joining a rural practice: a pilot program in primary care education in internal medicine.


The 1980 tax forecast.

The 1980 tax forecast.


Guidelines for developing an effective electrical safety program. This paper describes the steps and key factors involved in preparing an Electrical Safety Program tailored to meet the needs and resources of a patient care facility. The effectiveness of the program depends upon how well the Safety Committee completes the tasks involved. The Electrical Safety Program in use at Boston University Medical Center is described.


Regulatory affairs and product integrity. This review analyzes the regulations and control resulting from the Medical Device Amendments of 1976, and their effect on product integrity. There is a discussion on claims, safety considerations, recalls, cost factors, and the advantages and disadvantages of increasing governmental regulation of medical devices. A glossary of regulatory terms is included.


Accommodation fees: have you earned them?


How can you get your building to work?

How can you get your building to work?


A group-process approach to resident and staff abuse.


Supplemental Security Income.

Supplemental Security Income.


AHCA vice president critical of newspaper attack on industry.


Staff development--call for action.

Staff development--call for action.


Quality of life department of a nursing home.


Staff attitudes in nursing homes: is a good attitude towards the aged really important?


Combining sensory stimulation with reality orientation to promote sensory orientation.


Improving behavior options in long term health facilities.


A vacation for residents.

A vacation for residents.


Music therapy for retarded adults with psychotic overlay: a day treatment approach.


The social consequences of deinstitutionalization.


Economic barriers to patient reentry into the community.


The future of mental health services for the chronically mentally ill.


Patient reentry into the community: provision of care.


Deinstitutionalization: a transition to the future.


Patient reentry into the community.

Patient reentry into the community.


The role of management science.

The role of management science.


Patient reentry into the community: the federal viewpoint.


Pastoral care in the nursing home: guidelines for communication with institutionalized elderly.


The key to a successful PAR system: the credit professional.


Quality or discount, which one do you want?


Money by telephone.

Money by telephone.


Voluntary steriolization: legal and ethical aspects. In Canada there are no statutes specifically concerned with the legality or illegality of voluntary sterilization.  Reviewed are a few Canadian and British cases which have discussed sterilization, but only as a factor in the obtaining of a divorce on grounds of cruelty, or in an action for assault based on lack of consent.  There seems to be no legal decision in Canada or Britain on the particular issue of whether or not voluntary sterilization is lawful.  Because of this uncertainty in the law, both physicians and patients are uncertain regarding their rights and obligations in the area of voluntary sterilization.  Attention is directed to societal considerations (public policy and social morality), the rights and interests of the patient (basic human freedoms, the patient as consumer, rights of action by the patient's spouse, action for loss of consortium), rights and obligations of the doctor, breach of contract, and spousal consent.  When law is made certain, through legislation, problems can arise at several stages of its progress.  In its effort to urge to classify and make certain a difficult area of law, the legislature may overlegislate.  Problems can arise in administration of a new law, as hospitals, physicians, the public, and lawyers must adjust to a different classification of an act.  At this time it appears that no action lies against a physician who performs a voluntary sterilization, unless he/she performs the operation negligently.  Dissemination of information to the public, legal profession, and to the medical profession is an alternative to legislative reform which would alleviate some legal and ethical problems.


Psychosurgery.

Psychosurgery.


Patient package insert--legal perspective.


Experimentation on humans: controls at the international level and in foreign nations.


Law reform, privacy and nursing.

Law reform, privacy and nursing.


Fees: are they getting out of hand?

Fees: are they getting out of hand? In the past, Medical Economics has conducted an annual survey of fees charged by office based physicians in general practice, family and internal medicine, obstetrics-gynecology and pediatrics, and general surgery. This year, the data-base was expanded to include six other specialties. The article provides a series of tables exhibiting the fees charged by physicians for first office visits, return visits, history and physical exams, and other general procedures specific to particular specialties. It is pointed out that the fee for return office visits has doubled in eight years. The increase in costs of routine services accounts for much of the 9.6% increase in physicians' fees during the last year. Primary care doctors have initiated the highest fee hikes for 1978. This is attributed to young physicians entering the field and charging more than their older colleagues. Surgical fees have doubled in cost in the last ten years. For the past three years, physicians' fees have increased at the average rate of 9.5%, usually exceeding the Consumer Price Index. Physician services only account for 20% of the entire health care bill, but due to their visibility, they are subject to criticism and careful review. Since the pressure is on for health care cost containment, the author advises physicians to think again before raising their fees in the near future.


Ways to head off a new malpractice crisis.


We're making our patients too dependent.


A plan to put primary-care doctors in the driver's seat. Interview by Richard L. Peck. The Institute of Medicine has developed a report outlining a plan to produce more primary-care physicians; reimbursement of commonly accepted health education and preventive medicine procedure is proposed. Dr. E. Harvey Estes, Chairman of the Study Team, reviews the recommendations offered by the Institute to achieve this goal. The Institute directs many of its suggestions at restructuring the reimbursement system. If the federal, state and private organizations reimbursed primary care physicians and specialists on a more equal scale, regardless of geographic location, there would be more incentive for new doctors to enter primary care and to practice in underserved communities. Third-party payors are encouraged to reimburse physicians and physician extenders at the same rate to reinforce the fact that they are all part of a practice team. In addition, it is recommended that third-parties reduce the number of fractional reimbursements and bureaucratic delays that currently take place. Estes concludes that primary care should have sufficient financial incentive to attract and maintain well-trained physicians.


The 1980's: your practice: a cost crunch, new controls, more competition.


The evolution of an HMO.

The evolution of an HMO.


Howard F. Root wing of the Joslin Diabetes Foundation, Inc.


Why rip apart a health-care system that works?


Why hospitals may be giving your colleagues an edge.


Prepayment and the Genesee Health Service.


Electrical safety standards--1980.

Electrical safety standards--1980.


Overvoltage protection for medical electronics.


A financial readout on the family practice boom.


Belgium: sophisticated market with an eye on imports.


It's time to dump the law barring FMGs.

It's time to dump the law barring FMGs.


Public backs federal control of doctors' fees.


Health Maintenance Physicians, Inc.

Health Maintenance Physicians, Inc.


Legal implications of the delivery of hospital emergency care services.


Pre-hospital emergency care.

Pre-hospital emergency care.


The St. Louis Park Medical Center.

The St. Louis Park Medical Center.


Rural EMS under construction.

Rural EMS under construction.


West River HMO.

West River HMO.


Two rural hospitals respond to ambulance need.


GFAHA: EMS committee coordinates variety of activities.


Emergency medical services.

Emergency medical services.


EMS planning and categorization.

EMS planning and categorization.


Another attempt at over-regulation.

Another attempt at over-regulation.


HEW to fund program for disabled and hospices.


Unions' interest in hospitals increases.


Selecting purchasing groups.

Selecting purchasing groups.


Courting bankruptcy: the continuing saga of America's urban teaching hospitals.


British medicine/American medicine: learning closer but still an ocean apart.


"Quality of life" judgements in medicine?


A decade of rapid change: the outlook for human resources management in the '80s. The new decade also means a new chapter for personnel professionals. From our research, interviews and observations during the '70s come these predictions for the '80s.


Some further implications of the Pregnancy Discrimination Act. A follow-up to the authors' October 1979 analysis of the Pregnancy Discrimination Act, this study details the pros and cons of the various strategies that personnel managers will have to consider in order to successfully cope with PDA.


The "refined" performance evaluation monitoring system: best of both worlds. The computer is proving itself to be an almost limitless resource: it can easily refine your performance appraisal system simply by using weighted normalized ratings. A consultant explains his system and how it can save a company both money and mistakes.


The dollars and sense of motivation.

The dollars and sense of motivation. Too many middle and upper middle-class Americans are finding that their "executive" salaries are no match for inflation. Here are some solid solutions that compensation and benefit people can recommend to managements that want to restore their employees' motivation while easing their financial situation.


But I can't work on Saturdays.

But I can't work on Saturdays. Potential religious discrimination poses troubling problems for today's personnel manager, who must be careful not to run afoul of legal constraints.


Targeted Jobs Tax Credit program.

Targeted Jobs Tax Credit program. Tax credits will help reimburse employers for the added costs of hiring and training disadvantaged workers from seven target groups with especially high rates of unemployment.


Exercises draw out nursing home residents.


Counseling for children of hospitalized parents.


How demographers can help legislators.

How demographers can help legislators. Demographic change bears directly on the formulation of social policy because it determines in large part whose wealth or income is redistributed to whom. Where demographic events modify the recipients and donors in such redistribution, they may sharply alter the consequences of existing legislation or create constituencies for new laws. This article considers how current and emerging demographic changes are affecting the redistribution of wealth across generations, across income groups, and across geographic regions.


Pressure on physicians to join prepaid plans.


Van on a street corner.

Van on a street corner.


Closing up the 'snake pits'--two approaches.


Union impact on wages and fringe benefits of hospital nonprofessionals. Union effects on the wages and fringe benefits of nonprofessionals are estimated for a sample of hospitals in three midwestern states. Survey questionnaire, personal interviews, and published data are combined to determine both the compensation gains of unionized workers and the "spillover" effects on nonunion workers in unionized hospitals. The results of this analysis suggest that overall union effects on total compensation are in the order of 6 to 7 percent for both groups.


Chinese medicine: old & new.

Chinese medicine: old & new.


American medicine: an obstacle course for FMGs.


Employer acquisition of health care facilities: a possible outcome of escalating premiums? The price of health care is rising faster than most other prices; the increasing number of employer-financed health insurance plans means that insurance premiums are a significantly growing expense. Some companies might save money without sacrificing the quality of care by building or buying health care facilities. The authors analyze hospital costs and corporate experience with in-house care.


Management conflict in network development.


Priorities in the allocation of health care resources.


The right to health care: a contractual approach.


Property, pinmakers and physicians: liberal myths and American health care anomalies.


An air emergency service: the extension of the emergency department.


Prehospital care: an integrated concept of emergency medicine.


Hospital costs and distributor inventories.


Medical-legal considerations in prehospital care.


Citizen CPR: the role of the lay person in prehospital care.


Putting the skids to meals on wheels.

Putting the skids to meals on wheels.


Crisis intervention training for prehospital care personnel.


The social construction of a medical emergency.


Philosophy of prehospital coronary care.


Prehospital care--education, evaluation and medical control.


Burnout--real or imagined?

Burnout--real or imagined?


Prehospital care systems for advanced coronary life support.


Planning within an institutional setting.


Transfer of the emergency patient: avoiding legal complications.


Reason prevails in interpretation of hospital lien statute.


Orientation for new house staff.

Orientation for new house staff.


Seven forces that are shaping the future of hospitals. Among the developments that can be expected to shape the future of hospitals are the rapid aging of the population; the emergence of chronic disease as the dominant pattern of morbidity; a growing realization of limits; a slowdown in technological extravagances; a "surplus" of physician manpower; increased public sophistication about health; and the emerging legislative and administrative environment.


A medical threat produced by the closing of two nuclear waste dumps.


Productivity improvement: a voluntary effort.


In the 1980s: smaller boards, stricter standards of conduct. By the mid-1980s, the structure of governing boards and the nature of hospital governance are likely to be considerably different from what they are today. Trends such as the development of multiple-unit systems and the growing authority of regulatory agencies will result in smaller and more professionalized boards with stricter requirements and standards of conduct.


Voluntary effort success rewarded by Congress.


What's ahead for governing boards? Panelists look at the '80s.


Trustee development program: the board's role in energy management.


As companies jump on fitness bandwagon.

As companies jump on fitness bandwagon.


For "new nurse": bigger role in health care.


GAO-inspired health steps reportedly saving millions.


Former PHS administrator suggests use of hospitals as 'benchmark'. Interview by Nancy Tomich.


St. Elizabeths' patients will receive medical, surgical care at GUH.


How the British health service is doing.


Towns 'romance' physicians in southern 'blind date'.


Architect of planning law sees room for improvement.


Polio treatment center: Warm Springs Hospital to close.


Out-of-town indigent care cut by hospital.


Six physicians resign posts: dispute over midwifery splits hospital staff.


Let's put Meals-on-Wheels back on course!


Women in medicine: moving toward equality.


These doctors pay their patients' bills.


Counseling center aids victims of fastest growing violent crime: rape.


Thieves get hospitals' x-ray film.

Thieves get hospitals' x-ray film.


Hiring and retaining good laundry workers.


Automated equipment cuts costs and boosts production.


Broadening the textile cost management horizon.


Nosocomial infection surveillance techniques--a review.


Paronychial infections of nurses in clinical practice: a questionnaire survey.


Disposable humidifiers in a recovery room--a microbiological evaluation. Humidification, unlike nebulization, does not produce water droplets in the process of producing desiccated gases, and therefore is considered low risk in terms of potential infection sources. However, direct inoculation of bacteria into these units has been shown to produce contaminated effluents. Therefore, the present study was designed to determine if the airborne route of contamination was a potential source of bacterial inoculum for these units and to determine the maximum number of days units remained free of bacterial contamination. Disposable humidifiers were placed in both high and low volume patient areas of the recovery room. Units were used on multiple patients with only the cannula replaced between patients. Our results showed that these units do have the potential for becoming inoculated through the airborne route, but did not produce contaminated effluents greater than background air. Units remained sterile during the entire time in use in both high and low volume areas. In conclusion, our data suggests that each institution should evaluate the usage of disposable humidifiers based on patient parameters and environment rather than manufacturer's guidelines.


Infection surveillance and the microbiology laboratory.


A selection sheet for objective evaluation of products.


A new concept in the old practice of obstetrics.


Distribution and cost of drugs in a pharmaceutically decentralized health maintenance organization. A private, free-standing health maintenance organization, Group Health of Arizona, was established with a decentralized pharmacy distribution system. A closed formulary and monthly peer review by pharmacists and physicians influence the number of prescriptions written as well as drug cost. A study was conducted to determine: the 50 most-prescribed items by number and cost; drug cost according to certain therapeutic categories; the average drug cost per prescription; the number of prescriptions dispensed per enrollee; and the cost of drugs dispensed as a percentage of wholesale cost. The objectives of the study were achieved but additional questions requiring future studies were raised.


The North Carolina Area Health Education Center program: an overview. North Carolina has been at the forefront of the planning, development, and operation of area health education centers (AHECs). These centers have dramatically improved health manpower education and training at all professional levels. In effect, the North Carolina Area Health Education Center Program is a major decentralization and coordination of medical, dental, pharmacy, and public health education and regionalization of nursing, allied health education, medical residency training, and continuing education. The program links each of the university health science centers in North Carolina to major community hospitals that form a regional network with other institutions. The University of North Carolina at Chapel Hill School of Pharmacy has a major role in the AHEC program. A full-time faculty is located in each AHEC. In addition to providing and coordinating clinically oriented pharmaceutical services and functioning as a resource in all matters relating to drugs, they are extensions of the school's faculty. The North Carolina AHEC Program approach offers pharmacy an excellent opportunity to maximize the pharmacist's contributions to society through education and practice.


Pharmacists as instructors of health education in community colleges. The public is demanding quality information on the appropriate use of medicinal agents. The pharmacist is a potential source of this information; however, lack of time and appropriate environment often limit this interaction. An educational model has been developed, used, and evaluated in order to increase public knowledge on nonprescription medications, increase pharmacist professional visibility in the community, and provide a practical means of creating this interaction. Using the setting of four California community colleges, consumer education courses were developed during 1972 to 1977. Instructional syllabi, written and audiovisual materials, and evaluations were developed at these colleges by five pharmacists. The courses were presented in an aggregate of 17 semesters to 514 enrollees. Results from objective examination on presented topics showed a mean score increase from 18 to 82% among 62 enrollees. Subjectively, participant response was enthusiastic, with frequent reports of daily usefulness and increased awareness of the pharmacist as a health information resource person. The described model has proven to be an effective means of providing lay persons access to important health care information, while providing pharmacists with an effective means of meeting professional responsibilities, increasing professional visibility in the community, and gaining professional satisfaction.


A comparison of female and male pharmacists' employment benefits, salary, and job satisfaction. This study compared women pharmacists' job characteristics, salary, benefits, and job satisfaction to those of their male colleagues. A mail questionnaire was sent to 1700 North Carolina employee pharmacists in August 1978. Approximately 478 pharmacists responded, yielding a 28% return rate. Job satisfaction was measured with the job descriptive index (JDI). Approximately 29% of women versus 5% of men worked part-time. To avoid biasing the results, further analysis excluded all part-time pharmacists. Women earned less than their male counterparts primarily because fewer women held management positions. Hypothesizing that the discrepancy was due to the recent entry of women into the profession, the data were analyzed holding age, years in practice, and time in present job constant. The significant difference in employment status by sex remained. No differences were found in job satisfaction by sex that were not attributable to age. Possible reasons for these results are hypothesized.


Pharmacy competencies: their relative importance to consumers, practitioners, educators, and students. The pharmacy profession increasingly is involved in developing and maintaining competency standards as objective criteria in evaluating the educational process and in judging practitioners' continuing competence. This study compared the rankings of various pharmacy competencies among diverse populations, specifically, consumers, practicing pharmacists, pharmacy educators, and pharmacy students. The competencies were assessed through a questionnaire which required the respondents to rank 17 competency labels in order of importance. The questionnaire was completed by 104 metropolitan residents and additional samples included 450 practitioners, 39 pharmacy educators, and 217 pharmacy students. Interesting differences appear between the rankings of the competencies among the consumers, practitioners, faculty, and students. Results indicate that consumers highly ranked the traditional roles of the pharmacist as a drug distributor. Faculty tend to rank highly the clinical roles of the pharmacist. The highest rank correlations on pairs occurred between students and faculty (0.89) and between pharmacists and consumers (0.89). The lowest rank correlation occurred between faculty and consumers (0.64).


The Burger Court and the prima facie case in employment discrimination litigation: a critique.


The Supreme Court, 1978-79--labor relations and employment discrimination.


A further note on visions.

A further note on visions.


Use of computer drug-drug interaction program for detection of adverse drug reactions and related therapeutic problems. Pharmacies currently using computers to detect drug-drug interactions may not be fully utilizing the computers' programs. Potential drug-disease interactions and some potential adverse drug reactions not traditionally defined as interactions can be detected by extending the basic concept of cross-referencing. For example, certain clinically important ADRs are readily detected by cross-referencing drugs which are often used to treat the results of specific ADRs with certain causative agents. The potential therapeutic implications of such a system when restricted to clinically significant ADRs can be readily appreciated, especially in situations where the pharmacist's time in patient-care areas is limited. This concept is currently being practiced at Bayfront Medical Center, and has added a new dimension to the clinical services provided by the pharmacy. It seems likely that detection of therapeutic situations in this manner may be appropriate in other hospital settings.


Integrated parking for hospitals.

Integrated parking for hospitals.


Beclomethasone dipropionate aerosol: patient consultation recommendations. Patient administration errors in the use of beclomethasone dipropionate aerosol are frequent. Asthmatics once labeled "treatment failures" on this aerosol may only need adequate consultation to achieve therapeutic results. Pharmacists should monitor for patient noncompliance and provide instruction and follow-up on the use of beclomethasone dipropionate aerosol. Common administration errors associated with this drug are described, along with information patients should receive to obtain optimal benefits.


The hospital's role in drug abuse.

The hospital's role in drug abuse.


Setting the damaging defibrillator question.


Reinforcing the case for health promotion.


Earning Sherman's trust: a one-act farce (?)


Today's students in medicine: a look at the work of GMENAC. Interview by Joan Williamson.


Strategies for goal setting: options for multispecialty groups.


11 November 1979--a day to remember: the Mississauga disaster. The derailment of a train carrying potentially lethal chlorine, accompanied by exploding tank cars of propane, set into motion the evacuation of the Mississauga Hospital, Queensway General Hospital (Etoblcoke), and Oakville-Trafalgar Memorial Hospital, near Toronto. The method in which the three hospitals, along with the 220,000 residents of Mississauga, were evacuated was so highly efficient and orderly that many now question the necessity of the action. But absence of panic should not be interpreted as an absence of danger. The Economist (17 - 23 November, 1979, volume 273, number 7107) extrapolated data from a British study to show there was enough chlorine in the tank to kill 24,000 people, given the population density in the area of the derailment. The purpose of this article is to describe the involvement of hospital pharmacy in the "Mississauga Saga", and to draw some conclusions from this experience.


It's never too early for human relations. Human relations training as part of an employee orientation program can ease an employee's entrance into a new working environment. Employees who understand their own motivations and those of their co-workers are better equipped to handle their jobs and are thus a valuable asset to the institution.


The ordinary and the extraordinary in institutional litigation. Institutional litigation, in which courts are requested to oversee the operation of large public institutions, has been frequently attacked as a departure from the traditional model of litigation. In this Article, Professors Eisenberg and Yeazell argue that the procedures and remedies employed in institutional litigation are not unprecedented but have analogues in older judicial traditions. Nor, they assert, do the doctrines of separation of powers and federalism present any obstacles to institutional litigation. They conclude that the novelty lies in the newly created substantive rights which courts are asked to enforce.


Productivity up, expenses down.

Productivity up, expenses down.


Doesn't the FTC realize that the purpose of advertising is to stimulate demand?


Hospital may lose Blue Cross status over planning issue.


Personnel administration can act on cost containment. Hosiptal personnel administration programs have the potential to contain costs in a variety of areas, including human resources management, payroll costs, benefits costs, labor turnover, and recruitment costs. Recognizing this, the Maine Society for Hospital Personnel Administration presented a seminar and prepared a guide for trustees and administrators on the role that personnel administration can play in the Voluntary Effort to contain costs. The following article is an adaptation of the information included in the seminar and guide.


The past decade--the future decade: three viewpoints. The coming of age of emergency medicine.


Systematic leadership selection.

Systematic leadership selection.


The abuse of "cooling out": recognition and prevention.


Managing discretionary organizational expenses: applying the hospital's goals to department services.


Using performance standards for employee development.


The past decade--the future decade: three viewpoints. The EMT--where to from where.


The past decade--the future decade: three viewpoints. Nursing: the fight for greater freedom.


Medical devices: point-counterpoint.

Medical devices: point-counterpoint.


Hospital life: better wise before the event. Some of the problems of integrating a new casualty unit into a district general hospital are described by Dr. A. R. Dow, consultant, A & E unit, Sunderland District General Hospital. He discusses some of the advantages and lessons that can be learned for future development within the unit.


Cold wards, warm feelings.

Cold wards, warm feelings. Frenchay Hospital, near Bristol, was built in the last war and two thirds of its accommodation falls below modern standards. But Alison Hyde found that the high level of its surgical work and its good atmosphere combine to make it a success with staff, patients and the local community.


Health administration: the dustbin syndrome. Apart from a few notable exceptions, official reports and inquiries have a habit of collecting dust sometimes for years after publication. It is feared that the Royal Commission's report is going the same way and that the Government in its consultative document will choose to ignore most of the findings. Stephen Halpern looks at the fate of several recent NHS inquiries and concludes that reports can often remain to haunt successive governments long after publication.


A framework for local health service control. In a major speech recently, Dr. David Owen, former minister of health, argued the case for a genuine localist approach to NHS organisation. He outlines here the advantages of separately elected health authorities financed by local income tax. Under these new arrangements the service, he believes, would be better able to meet the challenge of the cinderella areas and central government could revert to its rightful role of upholding standards and broadly planning resources.


Exploring the twisting road to and from the staging post. Approaches developed by the DHSS's central analytical team as a basis for comparing national priorities are explained by Gordon Harris, an economic adviser to the department, and Colin Parker, who recently completed a period of secondment to the department as an operational research consultant.


Health insurance in America: a vision of health in the world's richest nation. Alone among industrialised countries, the USA does not have a comprehensive national health insurance system. There are some federal and state schemes, but for most people the choice is between hefty private insurance premiums or no coverage at all. Now the establishment of an effective NHI has become a key issue in the presidential campaign, says Reva Klein.


Purchasing performance: cost per order is misleading barometer.


Will supplier guarantee that price is lowest charged?


Is your equipment out of control?

Is your equipment out of control?


Buying for the small hospital, Part 1.

Buying for the small hospital, Part 1.


Tight control over salvage silver sales pays off.


Are you paying too much for service in radiology?


Throwaway items create new waste disposal challenge.


Industrial democracy in the public sector.


And any other duties that...

And any other duties that...


Pay beds 'bad news' for private medicine.


Geographic cost variations in the North Western Regional Health Authority.


Development of a district dietetic service.


Lack of standard FDA tests clouds handwashing agent issue.


Isolation in small nursery.

Isolation in small nursery.


Bruch outlines FDA position on washing, tests.


From the editor...in hospital circles "cost containment" certainly merits recognition as buzz phrase of the year.


Supply utilization studies: the trend of the future.


Standards for hospice address definition and quality concerns.


Hospital employees educated on hospice.

Hospital employees educated on hospice.


The vendor's role in hospital cost containment.


Supply shortage: the vendor's burden.

Supply shortage: the vendor's burden.


Coping with burn-out.

Coping with burn-out.


Systems emphasizing cost containment in the surgical suite.


Utilizing suppliers to the hospital's best interests.


The art and science of inventory reduction.


Grief--the healing pain of profound loss.


A self-assessment tool for hospital management.


The prime supplier contract: getting the most for the hospital's supply dollar.


Four models of hospice care.

Four models of hospice care.


The changing American way of death.

The changing American way of death.


Site progress and valuation.

Site progress and valuation.


"Arbitrability"--to begin with.

"Arbitrability"--to begin with.


Shopping for the best brain.

Shopping for the best brain.


AHA divided over user fees.

AHA divided over user fees.


Responsibilities toward the hopelessly comatose.


Group buying--a game of Russian roulette.


Testifying at a coroner's inquest.

Testifying at a coroner's inquest.


Hospitals need business instincts too.

Hospitals need business instincts too.


Drop-in centre eases emergency.

Drop-in centre eases emergency.


Multi-unit systems--a means to an end.

Multi-unit systems--a means to an end.


Trustees take on quasi-legal role.

Trustees take on quasi-legal role.


Prevent ill health--promote wellness.

Prevent ill health--promote wellness.


Feds seek role in infection control.

Feds seek role in infection control.


Getting together for better or worse.

Getting together for better or worse.


"Real" approach to disaster planning.

"Real" approach to disaster planning.


Health care v. the law--and the verdict is...


Competition: the name of the game.

Competition: the name of the game.


Bargaining units--who's in, who's out.

Bargaining units--who's in, who's out.


Teenagers and health care: a growing right to choose.


Teaching teenagers to cope.

Teaching teenagers to cope.


Caring for adolescents. Tailoring the delivery system.


Has job loyalty become an anachronism?

Has job loyalty become an anachronism?


Anatomy of a fire drill.

Anatomy of a fire drill.


Standing orders: a medicolegal perspective. Standing orders are a routine part of patient care in hospitals. They add significantly to the efficiency of patient management, but they should be reviewed by the medical staff on a routine basis to avoid the rigidity that may lead to inappropriate, slavish reliance in certain situations. Standing orders should also be reviewed in view of cost containment.


How to use malpractice data in quality assessment. Although some may doubt that malpractice claims data are a useful quality assurance device, a recently released volume compiled by the National Association of Insurance Commissioners dispels much of this criticism, according to the author. The article details how the data were derived and suggests how they might be used in the hospital setting.


Therapeutic devices and the P&T committee.


Prescription drug use and patient education.


Discrepancies in unit dose cart fills.

Discrepancies in unit dose cart fills.


Drug-distribution problems in a Friesen-concept hospital.


Recognition in the 80's.

Recognition in the 80's.


A network analysis of an inpatient/outpatient department.


The regulation of health care delivery.

The regulation of health care delivery.


Viewpoint: a regulatory mentality.

Viewpoint: a regulatory mentality.


AMRA Bylaws and Code of Ethics (amended October 1979).


Performance appraisal as a management tool in two hospitals.


A personal filing system.

A personal filing system.


The philosophical foundation of medical records.


Filed for easy reference: a method for maintaining personal files of medical articles.


Home care record systems and the medical record professional.


Reflections on working "Down Under".

Reflections on working "Down Under".


Proposal writing: essential first step to research.


Patient's progress notes: an approach to improved patient care through a team effort in maintaining the patient record.


Update on nursing diagnoses.

Update on nursing diagnoses.


Analysis of graduate study questionnaire results.


How we reduced medical record deficiencies.


Product markets of the 1980s--the accent on patient access.


Human blood use market could triple by 1988.


State-of-the-art care demands a CT scanner in every hospital.


Protesters barred from distributing leaflets in hospital.


Physician recruitment: the Hastings Method.


Health care costs and the smaller hospital.


Contract management in a small hospital.


Designed for a personal atmosphere: Nashville Orthopaedic Associates, P.A.


Does small hospital equal small auxiliary?


Retirement planning: an examination of the factors involved in a clinic's determination of an appropriate retirement plan.


Small, rural hospitals: an exciting future is possible.


How the smaller hospital can be attractive to the "new" family practitioner.


Reducing malpractice claims through proper maintenance of medical records.


Medical records and malpractice claims.

Medical records and malpractice claims. The importance of the hospital medical chart in a medical malpractice case is well known. This article gives hospitals and their medical records directors guidance on what should and should not appear in the patient's medical chart.


Physicians' compensation: what is everyone else doing?


The trial of a malpractice case: part two. The following discussion was presented by the late Mr. Levine, one of the country's most successful malpractice lawyers, during a series of lectures on medical malpractice. It is an invaluable, no-holds-barred introduction for administrators, risk management directors, physicians and attorneys to the real world of malpractice litigation. Part One of this article appeared in the October 1979 issue of this journal.


Diagnostic tests--a source of potential malpractice lawsuits.


Substantive law of legal medicine.

Substantive law of legal medicine.


How to reduce the chances of malpractice legal action.


An arbitration plan for patient, hospital and physician.


State of the Union: asks NHI, cost curb action.


Hospital use by Blues subscribers declines.


Ill. medics blast Blue Cross 'necessity' clause.


The Rhode Island Medical Record Association's position statement on confidentiality.


The manager under stress.

The manager under stress.


The elderly: selected studies on the health condition and hospital care of geriatric patients.


Introduction: health projections of an aging kind.


Cancer time trends at older ages.

Cancer time trends at older ages.


Autopsy rates: the decline with age.

Autopsy rates: the decline with age.


Recertification and the American Board of Pathology--its position and proposal.


TNP'S housestaff forum: the leaders of the RPS and the PNHA offer their views on the housestaff movement.


Certificate of need.

Certificate of need.


About health, who's to teach what to whom?. Interview by Rick Honey.


Audit at the Given Center: better patient care through self-assessment.


Office audit how-to: choose your own approach to self-audit.


What's the estimated cost of a national outpatient Rx program?


How pharmacists can reduce hospital costs.


Geriatric population health care systems in urban and rural areas: a structural equation model.


Getting what you want from disposables.

Getting what you want from disposables.


Common anesthesia mishaps pinpointed by studies.


The changing federal role in medical technology.


The financial administrator and cost containment.


Hospitals are saving more than lives--the Texas voluntary effort.


Natural Death Act re-examined.

Natural Death Act re-examined.


Physician orientation: private hospital perspective.


Medical readiness key DoD concern.

Medical readiness key DoD concern.


Preventative health: a prescription for the 80's.


Primer on leasing.

Primer on leasing. The science of leasing is a complicated one, full of special terms and technical angles. This article explores the various types of leasing contracts and financing alternatives, as well as shedding some light on technical aspects.


Birthdays as stressful life events in the elderly.


AF: more health care at less cost.

AF: more health care at less cost.


Hyperbaric oxygen therapy: high-pressure solutions for oxygen deprivation and other conditions.


New quality assurance standard for psychiatric facilities.


Can Southern hospitals fight the unions? As unions turn their attention southward to the vast, largely untapped potential here; can they find widespread success in organizing hospitals in the region? They can, according to the author, a High Point, NC labor attorney, unless hospital management becomes more skilled. Sheahan points out that legislation and other factors have created a climate favorable to organizing activity in even non-profit hospitals.


Blood utilization patterns by age.

Blood utilization patterns by age.


The contribution of the operational researcher.


Needs: importance and satisfaction in respiratory therapy personnel. Using Maslow's hierarchy of needs as a base, this article attempts to determine the motivational level of respiratory therapy personnel. Also analyzed was the importance of these needs to the individuals studied. The instrument used to obtain the necessary data was a questionnaire designed to indicate a mathematical score relevant to a person's position in the hierarchy. This instrument was designed by Lyman Porter and is called the Porter needs-satisfaction index (PNSI). The respondents, who were representatives of all classes of respiratory therapy personnel, showed high levels of satisfaction in areas concerned with helping others, autonomy, and prestige. They ranked ability to help others, self-fulfillment, and feelings of accomplishment as highly important. Further analysis of the questionnaires is presently under way. It is hoped that data relative to position in the hierarchy based on demographic data will soon be available.


International undercurrents may affect U.S. medical programs.


Cost containment--an overview of US experience.


The development of hospital activity and hospital costs.


Continuing education for respiratory therapists and technicians: a positive approach.


Beyond the categories: human service managers view the new federal aid. Social agency chief executives in six program areas--welfare, health, mental health, community action, model cities, and community mental health centers--were surveyed to determine their reaction to the recent revenue sharing/block grant efforts to decentralize the federal aid system. Despite their strong belief that social initiatives and values were advanced principally by federal action, and that excessive reliance on state and local officials could severely jeopardize social programs with weak constituencies, agency executives also recognized major weaknesses in traditional categorical grant policy and, to varying degrees, supported revenue sharing and block grant alternatives. Those agencies largely dependent on federal support for their survival--model cities, community action programs, and community mental health centers--tended to support the new aid efforts only reluctantly. Those agencies more fully integrated into the regular policy-making arrangements of local government--health, welfare, and mental health agencies--were considerably more positive in their endorsement of greater decentralization.


Mutual influences of architectural design and engineering services.


Leasing: an attractive alternative to equipment purchases?


The contribution of the epidemiologist.

The contribution of the epidemiologist.


The engineer's brief for the construction and the redevelopment of health buildings.


Design for retrofit--planning for future change.


WHO objectives and programmes on health manpower planning and distribution.


The problem of providing non-medical professional and technical staff in hospitals.


Reorientation of medical education to improve health care staffing.


The community health aide in the Commonwealth Caribbean with special reference to Jamaica.


Once a model IPA, ChoiceCare is dead.

Once a model IPA, ChoiceCare is dead.


Health service access and utilization by children.


Kaiser physicians proud of health plan's private roots in free-market economy.


Prevention: the second public health revolution.


Proposed federal rules for labs 'catastrophe' pathologist warns. Interview by Brenda Stone.


Prison riot victims keep hospital busy.

Prison riot victims keep hospital busy.


Saudi Arabia's advanced medical centre.

Saudi Arabia's advanced medical centre.


Public policies for the aged in Japan.

Public policies for the aged in Japan.


A medical group's visit to the People's Republic of China.


Development and application of an antimicrobial-susceptibility guide. Computer analysis of results of hospital antimicrobial susceptibility tests had lead to the development of a tabular-form clinical guide. The tables allow comparison of differences due to variables, such as hospital service and source of specimen. They also provide a basis for the initial selection of an antimicrobial agent. Several of these applications are discussed in this paper.


Elderly housing in Northern Europe.

Elderly housing in Northern Europe.


Legionnaires' Disease.

Legionnaires' Disease.


Hospital infection control.

Hospital infection control.


Data bases on-line in 1979.

Data bases on-line in 1979.


Accreditation of medical education.

Accreditation of medical education.


Organizing for better medical school management. Growth, increasing organizational diversification and specialization, and public demands for accountability make it mandatory that medical school managers begin to move beyond simple administration and into true management. This article describes an organizational structure that is designed to help medical schools deal with critical management problems. Within this structure, newly appointed "department managers" work with an independent manager in the central administration office, provide staff assistance to their department chairmen, and participate in a problem-solving group that provides assistance on specific technical projects anywhere in the organization.


Appendix A to hospital resources document. Qualifications of trauma care personnel--American College of Surgeons Committee on Trauma.


A ten point model for home care delivery.


Multiple trauma: early management in the emergency department.


Psychiatric consultation in alcoholism agencies.


Appendix C-1 to hospital resources document. Interhospital transfer of patients--American College of Surgeons Committee on Trauma.


Appendix C-2 to hospital resources document. Air ambulance operations--American College of Surgeons Committee on Trauma.


Trauma appendices: Committee on Trauma of the American College of Surgeons.


Appendix D to hospital resources document. Treatment protocol for prehospital management of the trauma patient--American College of Surgeons Committee on Trauma.


Appendix E to hospital resources document. Field categorization of trauma patients and hospital trauma index--American College of Surgeons Committee on Trauma.


Appendix F to hospital resources document. Quality assurance and education in the emergency department--American College of Surgeons Committee on Trauma.


A report to the Fellows--American College of Surgeons.


Up is not the only way.

Up is not the only way.


Superkids? A sperm bank for Nobelists.

Superkids? A sperm bank for Nobelists.


Home care pays off.

Home care pays off.


Public Health Service--health systems agencies and state health planning and development agencies; certificate of need reviews. Notice regarding certificate of need programs. This Notice sets forth advance information regarding amendments to the regulations governing certificate of need reviews by health systems agencies and State health planning and development agencies. This Notice is intended to provide early guidance to States prior to publication of interim final regulations implementing the amendments to certificate of need provisions of the Public Health Service Act made by the Health Planning and Resources Development Amendments of 1979 (Pub. L 96-79). This early guidance will assist the States in beginning to revise their certificate of need laws. Under the amended provisions of the Public Health Service Act, the planning agencies are required to review and determine the need for proposed capital expenditures, institutional health services and major medical equipment. The Secretary intends to publish these interim final regulations within a few weeks. Following consideration of comments which will be solicited with regard to the interim regulations, the Secretary will publish an analysis of the comments and will revise those regulations as appropriate.


Hazardous waste management; Environmental Protection Agency. Final rule. The Resource Conservation and Recovery Act, as amended, provides for the development and implementation of a comprehensive program to protect human health and the environment from the improper management of hazardous waste. A fundamental premise of the statute is that human health and the environment will best be protected by careful management of the transportation, treatment, storage, and disposal of hazardous waste, in accordance with standards developed under the Act. In today's Federal Register, the Environmental Protection Agency is publishing several documents setting in motion a series of events which will culminate in full implementation of the hazardous waste control program. This document sets forth definitions of words and phrases which appear in the subsequent Parts as well as general guidance for the use of these regulations and provisions which are generally applicable to all Parts.


Public Health Service--assignment of National Health Service Corps personnel; requirements. Final regulation. This regulation sets forth the requirements for the assignment of National Health Service Corps personnel to public or nonprofit private entities to provide health services in or to health manpower shortage areas.


Rules and regulations for reporting disclosure; summary plan description requirements; final regulations--Department of Labor. Adoption of final regulations. These regulations, which were effective on an interim basis, relate to the summary plan description, which is filled with the Department of Labor (Department) and is furnished to, and describes the rights and benefits of, participants and beneficiaries under an employee benefit plan. The regulations affect all plans required to file and furnish a summary plan description under the Employee Retirement Income Security Act of 1974.


Medical benefits; nursing home care in foreign countries--Veterans Administration. Proposed regulation. This proposed amendment is necessary to correct an error concerning authority of the Veterans Administration to furnish medical care in foreign countries. Nursing home care at Veterans Administration expense may not be furnished in a foreign country other than the Republic of the Philippines. There has also been a change in the name of the government hospital in Quezon City, Republic of the Philippines. It is now called Veterans Memorial Medical Center instead of Veterans Memorial Hospital.


HEW presses for spending priorities in slicing NIH's basic research pie.


Portable self-treatment devices liberate patients from expensive hospital stays.


New Mayo Clinic X-ray scanner promises to add to medical knowledge--and costs.


City of doctors: will surplus of M.D.s be good for patients? Look at San Francisco.


Labor puts on a show for its hospital workers.


HMO obstacles: program use will depend on motivation.


Firms push HMO use, dabble in development.


Cost-control coalitions.

Cost-control coalitions.


Lack of commitment on all sides stymies health cost reduction.


Doctors on call.

Doctors on call.


Finger painting: a projective technique. Finger painting was used in a diversified program with two different groups of patients, primarily as a medium for expression of feeling that facilitated the collection of diagnostic data and the detection of change in mental status. It was found to be an economical method of eliciting data and monitoring change during therapy. In this technique the patient produces his own material and verbally associates to it thus giving a more objective profile of personality and psychopathology. Perusal of the literature revealed no recent studies of the technique and prompted a documentation of this project at the Reddy Memorial Hospital. The technique proved itself a worthwhile method of eliciting data but needs to be scientifically evaluated. Attempts should also be made to assess its ability to discriminate between different diagnostic categories in psychiatry.


Developments in a rehabilitation service for psychiatric patients. This paper deals with the operation of the Rehabilitation Services of the Clarke Institute of Psychiatry in Toronto, Ontario. It is particularly addressed to developments in the service during the last two and one-half years. Included are: a brief historical review; a description of current goals and procedures; plans for the future; a description of the work adjustment program--a new adjunct to the service; some demographic information on clients served in 1977 and 1978; and a discussion of the computerized data collection, outcome studies, program analyses etc. now underway. The tasks of the members of the rehabilitation team will be outlined. Emphasis is placed on the work of occupational therapists who have played a major role in planning, establishing and conducting the service. Flow charts of service procedures are included.


A comparison of children's electric wheelchairs. During the past few years, the Occupational Therapists at the Kitchener-Waterloo Rotary Children's Centre have explored and prescribed electric wheelchairs for handicapped children from 2-19 years of age. This paper presents a comparison of three children's electric wheelchairs, the Bec, Solo, and Everest and Jennings.


The importance of standards.

The importance of standards.


The unit value system: if you're not interested you should be. This paper, based on an address delivered at the 1977 C.A.O.T. Conference in Halifax, contends that, generally speaking, occupational therapists are neither well informed about, nor proficient in the use of statistics. This is unfortunate in an age when its use of has become a powerful administrative tool. It is important for Occupational Therapists to become knowledgeable about the use of statistics in order that they can communicate with the administrators who speak the language of numbers. Statistics can be used and abused. Improved knowledge and understanding will protect occupational therapy from abuse and enable us to concentrate on our real specialty, service delivery.


Antishock garments.

Antishock garments.


Equipment acquisition.

Equipment acquisition.


Communicating with nursing and other departments.


Hospital nuclear waste facilities judged adequate.


Silver recovery crucial, as X-ray film prices rise.


Children, cancer and death: a discussion of a supportive care system.


Reorganizing your storeroom: a game plan.


Not all disasters are drills.

Not all disasters are drills.


Blue Cross plans experience sharp 10-year decline in hospital utilization rates.


Tennessee hospitals get high marks from business leaders.


Health consumers at the crossroads: which way to go?


Consumer participation: sinking or swimming?


Consumer participation: futile efforts in a misguided system.


End of the decade: a consumer view.

End of the decade: a consumer view.


Microbes to Monticello.

Microbes to Monticello.


Optimizing reimbursement.

Optimizing reimbursement.


Nosocomial postsurgical infections.

Nosocomial postsurgical infections.


The great HMO debate: will affiliation help or hinder your hospital's future?


New design process for hospitals keeps soaring costs in check.


Fantasy environments promote health-care therapy.


Three existing hospitals convert to one modern facility.


Treatment and environment inseparable in children's psychiatric facility.


Function first sets hospital pace.

Function first sets hospital pace.


Ronald McDonald showcase house: rooms for families of ailing children.


Owens/Corning compiles fire codes on hospital draperies, cubicle curtains.


Doctors, dyscommunication, and death.

Doctors, dyscommunication, and death. The problems of dyscommunication between physician and the dying patient are discussed. A personal encounter with cancer is shared. The experience helped the physician-author to communicate openly with his patients and to regard them as persons with needs for care, comfort, and reassurance.


Patient education TV need not cost $.

Patient education TV need not cost $.


Employee satisfaction procedure leaves no room for grievance.


Caring for the dying: advocacy or paternalism. Moral dilemmas in the care of a dying person ideally should be decided in the context of that person's own freely determined understanding of death. At the philosophical, the clinical, and the personal levels, the primal question of how to understand death must be addressed before decisions are made concerning much ethical problems as euthanasia. Philosophers and practitioners who fail to do this are guilty of an a priori paternalism toward the dying, on whom their conclusions will be imposed. Until we have determined, together with the person involved, the way in which that person wants to view his or her death, any prior ethical judgment not only is presumptuous but infringes on the most basic freedom, that of determining the meaning that one's own experience shall have. The role of advocacy is an alternative to the traditional paternalism toward the dying. The essay attempts to (a) develop the distinctions among paternalism, consumerism, and advocacy; (b) propose a concept of advocacy as the assistance to the dying in freely determining how to understand their dying and death; (c) describe three of the views of death (naturalistic, religious, and existentialist) that need to be understood by those who assist the dying in exercising their freedom of self-determination.


Assessment of client/patient satisfaction: development of a general scale.


Job performance improved after hospital-based education.


Case management: lessons from earlier efforts.


A small fire that stayed small.

A small fire that stayed small.


Co-op care arrives.

Co-op care arrives.


Halfway house fire in Washington, D.C. kills ten.


The numbers game: mathophobia & you.

The numbers game: mathophobia & you.


Hospital fire shows value of planning, design, training.


The numbers game: budgets that work.

The numbers game: budgets that work.


Problem: how to control your budget. Solution: watch tray counts & meals per patient day.


A time for change in space.

A time for change in space.


Problem: how to make a non-selective menu attractive. Solution: creative serving.


Recession strategy: renewal efforts up, prospecting down. This computer pro offers insights into non-profit strategy during a recession. Renewals, prospecting, basics, visibility and markedting are keywords to plan a successful route through recessionary periods.


Two views on philanthropy: what does the future hold. What is the philanthropic outlook for the 1980's? Will giving be consistent with the decline of the dollar? How can non-profits deal with the skyrocketing costs of management and fund raising? These issues are surveyed in separate points of view from two leading philanthropic experts, drawn from their years of experience in the non-profit sector.


Inflation's impact taking toll on non-profit groups. This thoughtful and detailed analysis on inflation's impact on charity shows an uneven future. Marketing, budgeting and fund raising will become key words in offsetting inflation's devastating impact.


How one hospital started new development program. Starting from "scratch," this development director was able to expand her hospital's annual giving program from $1 to $100,000 last year. It took ten years to reach that goal, but the success of this program has lessons for all institutions starting a fund raising department.


Managerial concepts get top priority in '80. Before the 1970's rarely did the non-profit area make use of the management theories which have so long determined the future of commercial businesses. Today, with costs on the upswing, non-profits are seeing their way towards employing the strategies of business and committing themselves to institutional development for greater giving. The author discusses the components of this concept and the performance evaluations of each.


Strong proposals make easy going on solicitation road. "Just get out a proposal," is a command that is heard all too frequently from the officers of an institution, notes this author. The result is a slap-dash replica of what should have been a carefully constructed piece. With advise on the do's and don'ts of proposal writing, the author explains how any fund raiser can reach what at first seemed an unobtainable goal.


Gallup charity survey shows giving patterns. The Coalition of National Voluntary Organizations undertook this survey to broaden understanding of contribution habits. The results provide a rich source of knowledge about giving patterns and insight into America's giving habits.


More emphasis on bequests needed in balanced program. Sure direct mail, special events, membership appeals, computers and annual giving techniques are important, claims the author. But he chides fund raising for the lack of attention paid to planned gifts. He outlines how his program generated insured income for his group.


Resource development is key to non-profit success. Developing a non-profit's resources produces a successful fund raising program, maintains this foundation program director. Found at the tip of every non-profit's fingers, they include volunteer services, innovative campaigns and good proposal writing. An aggressive implementation of these resources is in order if a non-profit desires to effectively address its long and short term goals.


AGPA's patient/health education program.


Patient education reimbursement.

Patient education reimbursement.


Abortion laws in Commonwealth countries.


Guidelines for prescribers of controlled substances: a joint statement of the Drug Enforcement Administration (DEA) and the DEA/Practitioners Working Committee.


Two ways of using behavioral science to improve management.


Compensation for HMO physicians:what program is best for them and their patients?


Need analysis in the healthcare facility: a marketing approach to the community.


Political pendulum swings as clocks chime in the decade. It's only decades that inspire which are given the accolade of a memorable prefix; the naughty nineties, roaring twenties, swinging sixties. Perhaps in this respect the past decade never stood a chance. For, as Professor Brian Abel-Smith, a long time adviser to successive governments at the DHSS explains, the high hopes with which the seventies started were soon dashed. Looking further ahead through the next ten years he outlines the major difficulties which will beset us and asks whether we have the political will and economic ingenuity to face up to them.


The eighties in perspective as a millenium passes. It has been a long and busy decade for the health service. But what of the years to come, the lead up to the turn of the millenium. Robert Jefford, planning administrator, Cambridge AHA(T) has stepped into an NHS time machine and sent us this report, first given as a talk to the IHSA, from 2001. The Government is a coalition, muddling through is a respectable art, and the service has survived twenty years in which computer planning has 'transformed strategic planning, not only by relating it to feasibility but by bringing together the isolated concepts that had previously been at war with each other. The NHS was saved'.


Driving force behind day care for the mentally ill. The Croft is a focus for mental health services in Derbyshire, writes Graham Harper, development officer (community services), Derbyshire Social Services. In a Joint Care Award entry he describes the enthusiasm and work which went into setting up a day centre for the mentally ill in a house scheduled for demolition to make way for a new by-pass.


Hospital day nurseries: a survey.

Hospital day nurseries: a survey. In view of the fact that the NHS is one of the largest employers of women, there is a surprising dearth of discussion in staff periodicals about the problems of recruiting or retaining staff with young children, and about the extent to which child care provision should be made available to staff. This report aims to redress the balance by presenting information gathered from day nurseries for the children of staff in NHS hospitals.


Health authorities: the time is ripe for a new model. Health authorities are charged with the management of the NHS on behalf of the Secretary of State. They are expected to provide leadership and guidance to their chief officers. How realistic is this expectation? Brian Watkin suggests Patrick Jenkin should think again about the constitution of health authorities as essentially lay bodies.


Facts of life about industrial relations training. It is likely that the role of all line managers will come to include an element of industrial relations, write Steve Harrison and Stuart Dimmock. The emphasis on conflict resolution rather than how it is generated means that the line manager's role will become overwhelmingly important.


The no-fault principle.

The no-fault principle. The number of claims against doctors and health authorities for negligence, though not on the scale of those in the USA are, nevertheless, increasing. Harry Orriss looks at the recommendations of the Pearson Commission and compares these with compensation schemes in New Zealand and Sweden.


Health administration: two and two making five. Gerard Vaughan expects to save pounds 30m by streamlining NHS administration, but where did that figure come from--thin air perhaps? Nick Davidson has been doing some calculations and reckons that to save anything like that amount, many heads must roll. But at what point does a reduction in administrative costs become a reduction in efficiency?


Health centre's success story.

Health centre's success story. The success of Selly Oak's new health centre is apparent from many points of view. Jane Dicks, Richard Miles and Stan Young, all of South Birmingham Health District describe the problems faced and how they were solved to maintain a prodigious building schedule.


When do hospital pharmacists violate antitrust laws?


Vendors think small to grow big.

Vendors think small to grow big.


A methodology for space evaluation and programming for the materials management function, Part 1.


How much space for materials management?


Through the organizational looking glass: you can't plan tomorrow's organizations with today's assumptions. It's hard to imagine what our industrial society would be like if, for instance, there were no factories. How would things get produced, how would business survive? But are we, in fact, an industrial society? Are factories going to be the prime production place for a society that is conserving energy and doesn't need to travel to work because the silicon chip makes it more efficient to work at home? Who knows what the impact of energy conservation and women in the work force will be on future organizations? One thing we can be sure of, this author writes, is that whatever tomorrow brings, today's assumptions probably cannot account for it. We are, he asserts, entering a period of discontinuous change where the assumptions we have been working with as a society and in organizations are no longer necessarily true. He discusses three assumptions he sees fading--what causes efficiency, what work is, and what value organizational hierarchy has--and then gives some clues as to what our new assumptions might be. Regardless of what our assumptions actually are, however, our organizations and society will require leaders willing to take enormous risks and try unproved ways to cope with them.


Competition continues to restrain hospital supplies price indexes.


Rural clinics try out patient education in four demo projects.


Managing your boss: a compatible relationship with your superior is essential to being effective in your job. Good managers recognize that a relationship with a boss involves mutual dependence and that, if it is not managed well, they cannot be effective in their jobs. They also recognize that the boss-subordinate relationship is not like the one between a parent and a child, in that the burden for managing the relationship should not and cannot fall entirely on the boss. Bosses are only human; their wisdom and maturity are not always greater than their subordinates'. Effective managers see managing the relationship with the boss as part of their job. As a result, they take time and energy to develop a relationship that is consonant with both persons' styles and assets and that meets the most critical needs of each.


Insurance company's admission preview cuts hospital stays.


Committee reports ruled discoverable by Wisconsin court.


Instilling activism in trustees.

Instilling activism in trustees. One of the great challenges in America today is the stewardship of its not-for-profit institutions. While the profit motive may be absent in the running of such organizations, the demand for thoughtful budgeting, cost accounting, and financial skills still exists. Voluntary community hospitals in particular--given the economic realities of the day--need leadership, reciprocal education, and future planning. Speaking from his own experience, the author presents an activist's perspective on hospital boards; but service to other types of not-for-profit institutions involves similar demands for change.


Let first-level supervisors do their job. Performing well as a first-level supervisor is like walking the circus high wire. In both positions, the ability to maintain one's balance when shifting forces pull in opposite directions is a measure of one's success. First-level supervisors must be able to harmonize the demands of management, the demands of the collective work force (often represented by unions), and the demands of workers with the requirements for doing the tasks at hand. These needs are more often than not conflicting and even at times mutually exclusive. First-level supervisors usually have mixed emotions about their situation and often lose their sense of identity as they try to perform this precarious balancing act. Today these supervisors are part of management, but chances are they were once among the employees they are now trying to supervise. Although first-level supervisors have the responsibility for implementing the goals of upper management, their organizational authority to carry out the necessary actions is frequently unclear and often insufficient. By allowing these lowest-level managers to use the levers of influence inherent in their position, higher-level managers will be improving the performance of the whole organization.


Committee lowers number of long stays in pediatric facility.


The energy outlook: combining the options. Where can we get all the energy we will need for the rest of the century to heat our homes, cool our offices, run our hospitals, and keep our factories going? Not from the conventional sources of energy at home and certainly not from foreign oil, say these authors. According to their calculations, U.S. supplies of oil, natural gas, coal, and nuclear power will be inadequate, and U.S. importation policy has already made us dangerously dependent on the unstable, unpredictable Middle East. To lessen our dependence on imported oil, they say, requires a balanced program of adopting reasonable conservation measures, developing solar power, and producing energy from our usual domestic sources under new incentives.


Diocese of Austin leases hospital to Sisters "To retain Catholic identity.".


Administration reduces aid to health professions schools.


Satellite hospital: innovation in rural health care.


Southern Illinois consortium targets shared services, planning.


'Invisible' resource: women for boards.

'Invisible' resource: women for boards. Despite the increased appearance of women on corporate boards in recent years, only 1.8% of the directors of the top 1,300 boards are women. Almost without exception, these women have been highly "visible" for their achievements in government, education, and nonprofit circles. But there are hundreds of other high achievers who are not so visible. The problem for chairmen and nominating committees is two-fold: (1) identifying and selecting the best of this "unknown" but talented pool of candidates and (2) defining and communicating their expectations from women.


Employees, community members join in good neighbor breakfasts.


Personalist humanism: value system for medicine. Medical science and pastoral care should support a personalist humanism that values the inherent dignity of all persons. Religion enhances such humanism, affirming the physicians' responsibility for themselves and for those in their care.


Do suffering patients turn to God?

Do suffering patients turn to God? Interpretative data from 300 Catholic hospitals and 48 interviews with Catholic health professionals suggest that patients who have always had faith will turn to God when in distress; patients who did not have faith may still not turn to God; and some patients may reject God entirely through pain and disablement.


Health care delivery in the 1980s: the consumer's perspective. Consumers are calling for more choices in health care services in the 1980s. They want to be able to choose among private physicians, HMOs, nurse practitioners, paraprofessionals, and insurance coverage. Faith in technology will decrease, while appropriateness and accessibility of care for population groups now poorly covered will be emphasized.


Statewide hospital productivity center offers managerial expertise, scientific standards. The Texas Hospital Association's (THA's) nearly 600 member hospitals in 1977 formed a statewide productivity center in response to rising labor costs, excess services and beds, uneven personnel allocation, activity duplication, and delinquent accounts. By developing and applying scientific standards formulas, and programs difficult for individual hospitals to implement, the center has increased productivity and cut costs.


"Split management" corporation balances central authority, autonomy. Three hospitals' boards of directors voted to create a multihospital split management corporation to allow each hospital to function effectively in a cooperative effort while retaining as much autonomy as possible. Each hospital preserves its mission and philosophy, selects its personnel, retains ownership of its assets, and receives specialized management expertise from the corporation, especially in budgeting and long-range planning.


Woman has incapacitating pains after ovarian surgery.


Nursing home patient discharged for noncompliance with rules.


Catholic health care's mission: fact or myth?


Institution acquires city land, avoids relocation.