Drug selection in a regulated society: the Norwegian experience. Norway has strictly regulated the introduction and marketing of drugs for more than 50 years. The system is a state owned whole-sale monopoly with nationwide distribution. Marketing approvals must satisfy a medical "need" clause and are granted and reviewed every 5 years by the " Specialties ' Committee." Although clinical trials are not mandatory for drug approval, relative efficacy and benefit/risk considerations make them desirable. Assessment of clinical data is based on reviews by outside consultants. Because of such strict regulation, the total number of drug products available is smaller than other Western European countries, however, only a few therapeutic classes are not represented. The impact of regulation on the drug market and the therapeutic armamentarium available for health care in Norway are discussed.


Physicians offered stock in innovative financing venture. Offering physicians 300,000 shares of convertible preferred stock in a for-profit subsidiary of a multihospital system is an innovative means to involve physicians in controlling costs and increasing profitability.


Community mental health--the mouse that roared or marketing a public agency. As the market place becomes increasingly competitive, marketing has been more aggressively undertaken by private business, and more recently, by proprietary and not for profit hospitals and other human service organizations. This article describes the efforts of an urban, publicly supported, multi-provider mental health system to develop an assertive, positive marketing stance. Following a brief historical development, the authors describe the current public relations campaign and some of the specific techniques used.


Cost of wastage in a hospital intravenous admixture program. The wastage in a hospital centralized pharmacy intravenous admixture program was assessed. The loss rate was similar during two separate 36-day study intervals, averaging 6.2% of intravenous admixture preparations, accounting for an estimated loss of $26,077 for the year. Discontinuation of intravenous therapy accounted for half of the returned intravenous admixtures. Patient unavailability, drug changes, and malfunction of intravenous equipment were also causes for returns. Improved communication between hospital ward units and pharmacy personnel as well as increased flexibility in admixture preparation scheduling may reduce wastage. Ultimately, pharmacists assigned to individual ward units as part of the unit-dose pharmacy dispensing system may resolve the problem.


Perspectives on the hospital formulary.

Perspectives on the hospital formulary. The hospital formulary system will become increasingly important in future years with the transition to target-rate third party reimbursement. This paper provides an overview of the hospital formulary and its management. A brief history of the formulary system is provided along with some key definitions. The potential benefits and actual effectiveness of a formulary system are described. Various potential problems in managing a hospital formulary are identified along with recommendations to minimize their occurrence.


Marketing employee assistance programs to industry.


Survey of 24-hour, 7-day/week hospital pharmacy service. Emergency after-hour pharmacy services in many hospitals have been replaced by 24-hour, 7-day/week pharmacy services. A survey questionnaire was published in Hospital Pharmacy, February 1983, to be completed by hospital pharmacies that provide a pharmacist in the hospital 24 hours a day, 7-days a week. Usable responses were received from 185 hospitals. The type of hospitals and the number of beds of these hospitals varied greatly. The differing responses concerning staffing, scheduling, hours of the post-midnight shift, arrangement of vacations and holidays, the factors used in selling the concept to administration, and the handling of compensation are presented.


Financing for diversification: opportunities and alternatives.


Divestment as a corporate strategy.

Divestment as a corporate strategy.


Employment survey of Montreal dietetic internship graduates, 1975-77. A mail survey of graduates for the previous three years from Montreal area dietetic internships was carried out in 1977-78. One objective of the survey was to collect data on employment status and job turnover. Mailing lists for graduates were obtained from internship program directors. One hundred and ninety-three questionnaires were mailed. Forty-nine percent of the questionnaires were returned. Sixty-one respondents (64%) reported they had left their first position; 73% of these left within one year. The major reason for leaving first positions was 'temporary position' (43%), and 'family reasons' was cited by 10%. Eighty-one percent of respondents were employed at the time of the survey. The major reasons for unemployment were: 'education' (33%); 'family reasons' (22%), and 'no position' (16%). Family reasons for not working were less common in this survey than in a national survey conducted in 1974. Results presented here indicate that recent dietetic graduates who are married and/or have a family are more likely to work today than in 1974, as is the trend for women in other areas of employment. The implications for new graduates are: higher job turnover, fewer permanent positions, and an increase in the number of post graduate degrees.


Awareness by consumers and the adoption of a new service: an HMO example. Researchers and managers of health care organizations must take two fundamental issues into account when examining the process by which consumers decide to use a new service. First, one cannot assume that if one member of a family uses the service, everyone in the family does. Historically, these points have not been given sufficient heed in the design of adoption studies. By using HMO enrollment as an example, the authors show the problems that could result from the above assumptions.


A conjoint analysis in outpatient clinic preferences.


Nurses as image emissaries: are role conflicts impinging on a potential asset for an internal marketing strategy? This article addresses role conflict and image problems nurses have with role partners. If these problems were corrected, nurses could be valuable assets in a "team selling" effort to help hospitals build their images. This research integrates sales management concepts and cites literature alluding to sales management research on identical problems.


A strategic alternative for community hospitals: the principle of peripheral penetration.


Supreme Court upholds exclusive contract in Hyde antitrust decision. If there is no evidence that a hospital is using market power to "force" its contracting physician upon patients and if the exclusive contract does not adversely affect price or quality, an exclusive arrangement should not violate the federal antitrust laws. These are the insights gained from the decision handed down by the Supreme Court in Hyde (Jefferson Parish Hospital District No. 2 v. Hyde, No. 82-1031).


Offering free preventive mental health information as a means of generating patient self-referrals.


Home health care: the opportunity for health care marketing.


A market model for the purchase of mental health services.


The 1983 tax-exempt market: a review and a look forward.


Priority dispatching vs. call screening.


Welfare for profit: moral, empirical and theoretical perspectives. Since the 1960s there has been an increasing number of proprietary agencies engaged in the delivery of social services in the United States. This development has generally been greeted with disfavour by welfare state advocates. Various arguments have been put forward against welfare for profit on moral, empirical and theoretical grounds. This paper analyzes these arguments and proposes several basic conditions that would seem to have significant bearing on the choice between profit and nonprofit providers for a given service.


Clerical employees, religious enterprises, and collective bargaining.


Mergers and acquisitions: a how-to perspective on...2. Risk-management implications.


Guide to a 90-day success program.

Guide to a 90-day success program.


Louisiana hospital renovates laundry to make it profitable contract operation.


Low temperature washes are standard in some hospitals.


Patches--a wrap-up of the issues.

Patches--a wrap-up of the issues.


Designing a capital budgeting system that works. Conventional capital budgeting systems do not fully reflect or adequately respond to the way in which capital expenditure decisions are actually made. Evidence also exists that the nature of this decision process is dependent on the type of the organization. This paper describes an empirically developed understanding of how capital expenditure decisions are being made, identifies ways to support and improve these decisions, and proposes an approach to linking the design of capital budgeting systems with the type of organization in which they are to operate.


Piggybacking for business and nonprofits: a strategy for hard times. This article explains the conceptual foundations for the piggybacking strategy from the general strategic management, adoption of innovation, product life cycle, specialization and diversified portfolio strategy literatures. The strategic piggybacking strategy is compared and contrasted with the diversified portfolio and specialization strategies. Intention, dynamic investment flow, short vs long term, and mission similarities and differences are addressed. A case is made for considering strategic piggybacking as a synthesis of the specialization and diversified portfolio strategies. The conditions appropriate for adoption of a piggybacking strategy are also discussed.


What America's toughest cost controls are doing to doctors.


Trustee profiles. Ronald W. Sondee, Mickey Bowman, Edward N. Hodges III, Lawrence D. Prybil.


MAHA: why not an auxilian?

MAHA: why not an auxilian?


Flint invests in future.

Flint invests in future.


Old market, new allure. In following the flow of patients, more distributors are arriving at nursing homes' doors.


Trustee attitudes revealed in survey.

Trustee attitudes revealed in survey.


Service with love. A community commitment.


Liability: a mounting concern.

Liability: a mounting concern.


Patient education helps in collections.

Patient education helps in collections.


New bankruptcy rules force swift action by creditors.


VIP program improves admissions, public relations.


Why docs stay away and what should be done.


What one resident found.

What one resident found.


Providing alternatives.

Providing alternatives.


Research findings and recommendations for management. Physical fitness and employee effectiveness.


Sound recruiting with BMC soundsheets.

Sound recruiting with BMC soundsheets.


Market indexed compensation.

Market indexed compensation.


Getting through the maze: knowing the fundamentals of employee health benefit planning.


Sensitizing radiation therapists to the psychological needs of cancer patients. Radiation therapists are trained to focus on physiological and medical aspects of administering radiation therapy to cancer patients. They often ignore patients' psychological needs because they are inadequately prepared to understand and intervene in this area of patient care. We sought to remedy this educational gap by using a generic crisis-intervention training program as a method of sensitizing radiation therapists to the emotional and psychological concerns and problems of patients undergoing radiation therapy. After the training, radiation therapists were cognizant of the presence and effects of the special dependency needs of severely ill patients. Training helped them respond more empathically, to establish better rapport with their patients, and to provide more holistic and effective medical management as an integral part of radiation therapy. This included greater ease in knowing how, when, and where to make psychological referrals. A case vignette illustrates the usefulness and application of enhanced psychological awareness and interviewing skills learned by the physicians.


Make informed consent work for you.

Make informed consent work for you.


Abandonment and the nonpaying patient.

Abandonment and the nonpaying patient.


Exclusive contracts with hospitals OK, Supreme Court rules.


The social policy of the Reagan administration: a review.


A window cleaning contract.

A window cleaning contract.


Common countertransference issues related to inpatient/residential psychiatric treatment of children. The contemporary conception of countertransference as potentially useful therapeutically is presented within a Sullivanian -interpersonal framework. A typology of countertransference is outlined with illustrations common within inpatient/residential treatment settings for children. Several clinical vignettes follow which demonstrate the therapeutic application of countertransference. Finally, guidelines are provided for inservice training programs to promote staff understanding and therapeutic management of countertransference in the treatment setting.


23 do's and don'ts for more effective spray cleaning.


Capturing the small business market.

Capturing the small business market.


Project outreach: volunteer transitional employment. The importance of individual and group volunteer transitional placement as work activity is addressed as a primary component of the hospital-based psychiatric rehabilitation process. The current model synthesizes traditional volunteerism and transitional employment as a viable rehabilitation step to facilitate vocational awareness, vocational choice, or re-entry into the work world. The model has further application for vocational counseling and exploration, goal development, and rehabilitation planning. Aspects of program development, implementation, and maintenance are presented. Discussion of community resource development and public relations strategies which have helped this project expand and improve are included. Client contribution and involvement is emphasized.


Antineoplastic drugs.

Antineoplastic drugs.


What's in the future for doctor-hospital competition?


Goal directed informal sessions: their impact on an adolescent unit. Goal Directed Informal Sessions ( GDIS ) were utilized on an inpatient adolescent unit in an attempt to facilitate communication between adolescents and their parents, to neutralize partially the almost universal fantasy that adolescents know more than their respective parents on any given topic, and to maximize the impact of the therapeutic milieu in other ways. The vehicle for the GDIS was discussions of various aspects of human sexuality. Thirty-four adolescents (average age 14.8), their parents, and staff were asked to respond to a questionnaire relating to human sexuality prior to the onset of GDIS . Adolescents speculated that their parents would perform least well. The average test scores for the adolescents, their parents, and staff respectively were: 65 percent, 79 percent and 81 percent. There was no significant difference between the scores of staff and parents. The difference between adolescents' scores and those of the parents and staff was significant (p less than 0.05). Framework for the GDIS is outlined, and illustrative vignettes are offered. Based on one year's experience, GDIS are recommended for other adolescent facilities.


Gaining leeway: activities in an open psychiatric institution. "Gaining Leeway : Activities in an Open Psychiatric Institution" describes the philosophy and instructional work of the Activities Department at the Austen Riggs Center in Stockbridge , Massachusetts. The paper also discusses some of the limitations and problems of the department in this particular environment. Goals of both the hospital and the patients are cited, as well as some discussion of the importance of creative expressiveness and competence as agents of change in restoring mental health.


Making the case for health promotion: a summary of the scientific evidence.


Third party buying: the trend and the consequences. The trend toward more buying of health insurance, life insurance, and pension or annuity plans through employers brings up problems of consumer sovereignty , problems of the incentives of service providers, and problems of availability of the services of insurance which are only available through group buying. In order to specify what social indicators would be useful in this area, this paper analyzes the incentive systems for consumers, for service providers, and for employers as they are affected by the trend toward third party buying. It assesses the indicators that are available on the trend, and the literature in health economics which tried to analyze the impact of the trend on the provision of health services and health costs. On this basis, needed social indicators for policy assessment in the area of third party buying are suggested.


Doctor-patient communication: a social and micro-political performance. In the United States the medical relationship is asymmetrical. Doctors not only control medical knowledge, they also have an institutionally based authority which allows them to act as gatekeepers, providing options to some while denying them to others. This study, conducted in a model family practice clinic of a teaching hospital, examines how decisions to do, or not to do, Pap smears are negotiated as residents and a potentially high-risk group of patients communicate. Decision-making occurs in layered phases--opening, medical history, physical examination, and closing. Each phase expresses the doctor's control and the patient's trust. Doctors initiate phases, develop topics and make key choices. They decide when patients undress--a choice which shapes the later Pap smear decision. Decisions to undress patients and to perform Pap smears or decisions not to undress patients and not to perform Pap smears produce no conflict. When there is a conflict, avoidance strategies--bowing to higher-level specialists, selling and unselling, and letting silence speak--are used negotiating devices. The doctor's choice and the patient's agreement produce a specific and a more general outcome--managing the presenting complaint and providing medically adequate health care, respectively. Although interactionally accomplished, these outcomes are institutionally constrained, and, thus are both a social and a micro-political performance.


Common knowledge in medical malpractice litigation: a diagnosis and prescription.


Network links wellness program to private practice physicians.


Fire suppression systems...what they can, cannot do.


Fire alarm systems: state-of-the-art.

Fire alarm systems: state-of-the-art.


"Am I in heaven now?": case history, literary histories.


On the ethics of advertising by the professions.


Case study: aseptic meningitis.

Case study: aseptic meningitis.


Confidentiality of QA documentation.

Confidentiality of QA documentation.


Teaching therapists to teach.

Teaching therapists to teach.


What is the key to a successful rehabilitation program?


Team approach. Rehabilitation of the stroke patient.


Coordinated care: rehabilitation of the spinal cord injured.


Disease category rehabilitation: benefits of a unique approach.


Awareness. A case study on educating the public about physical rehabilitation.


Crisis communications: Hurricane "Alicia".


The Supreme Court upholds THFC procedure.


Some recent advances in respiratory therapy. Many changes have occurred in the field of respiratory therapy during the past few years, and further changes are likely. A number of diagnostic techniques, many of which can be performed at the bedside, are available to the therapist. New treatment modalities have been devised, and pulmonary rehabilitation is an increasing part of the therapist's responsibilities. This paper is a summary of what the authors feel are some of the significant recent changes in respiratory care, and their predictions.


What every trustee should know about hospital information systems. Many hospitals are investing heavily in computer-based information systems. How can the board evaluate proposed and existing systems? What are the critical factors underlying the successful acquisition and implementation of a hospital information system? The author identifies six questions trustees should ask to become better informed about the status of information systems in their hospitals.


Advance refunding: a technique to capitalize on lower interest rates.


Promoting self-help in pulmonary patient education. Ideally, rehabilitation restores an ill or injured person to a condition of health and useful activity. Toward this goal, patient education shows persons how they can take control of their lives and participate in their own health care. In chronic obstructive pulmonary disease, a program consisting of only classes and demonstrations on breathing exercises, oxygen therapy, and physical reconditioning is not enough. The programs that have had the greatest success establish a support network that continues long after the workshops or classes have ended.


Respiratory therapy department at Hartford Hospital.


As I see it: considerations in board operation.


New opportunities for diversification. Expanding into home health care.


Health care system offers construction consultation.


Resident belongings: solutions to the challenge.


Nursing home salaries, benefits detailed in survey.


DoD auditors uncover credentialing problems.


Perspectives. Legislators prescribe malpractice reforms.


Pediatric hypertension risk reduction: a city-county-state cooperative effort in Wayne County, Michigan.


Perspectives. Reassessing technology.

Perspectives. Reassessing technology.


Infant mortality analyses and program initiatives in Fulton County and Atlanta, Georgia.


Baroness Erlanger Medical Center. How a hospital with predominantly private patients maintains a mandated role of indigent care and looks to the future in a changing health care marketplace.


Cutting costs = using health resources properly.


Firing line: new limits on employee terminations.


Public speaking: mastering the spotlight.


Do nonprofit organizations compete unfairly with business?


How television tells our story.

How television tells our story.


When should you cancel a meeting?

When should you cancel a meeting?


Wellness health promotion program.

Wellness health promotion program.


Rationing by waiting lists.

Rationing by waiting lists.


Video replaces bulletin boards at Himmelfarb medical library.


Using video to train medical interviewers.


Imaging the eye.

Imaging the eye.


The ethos of medicine.

The ethos of medicine.


Ethical ingredients in organ replacement.


Applying for and negotiating federal contracts.


Ethical ingredients in critical care.

Ethical ingredients in critical care.


Computer-assisted critical care information management. A well-designed, reliable, flexible computer system has a place in the modern critical care unit. Such a system may be designed in-house, or a commercial system may be adaptable to specific needs. The features of such a specialized system are outlined, with emphasis on the importance of user-modifiable and expandable software and hardware.


Congressional initiatives to reduce malpractice costs.


Ethics in housestaff training.

Ethics in housestaff training.


Ethics and surgical clerkships.

Ethics and surgical clerkships.


The ethicist in clinical surgical education.


Nuclear magnetic resonance imaging: surgical applications.


The surgeon's liability in endoscopy.

The surgeon's liability in endoscopy.


Preferred provider organizations.

Preferred provider organizations.


A Toledo compromise.

A Toledo compromise.


Facing up to health care costs of retirees.


Assessing the health and job performance of older workers.


The art of healing thyself.

The art of healing thyself.


State laws and retiree benefits raise legal obstacles to cost reform.


No-fault malpractice bill seeks to curb legal fees, size of victims' awards.


Day care offers relief from absenteeism, stress and employee turnover.


The nurses walk out.

The nurses walk out.


Business has a role in trustee education.


Privacy Act of 1974--PHS. Notification of establishment of a new Privacy Act system of records. In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of intent to establish a new Privacy Act system of records 0937-0016, "Users of Health Statistics, HHS/ OASH / NCHS ." This system will be used to support the work of the National Center for Health Statistics ( NCHS ) by ascertaining from data users how NCHS can improve the usefulness of its health statistics to the public through changing content of data systems, statistical methodology used, or the nature or content of statistical publications. We are also proposing routine uses for this new system. PHS invites interested persons to submit comments on the proposed routine uses on or before June 29, 1984.


When a booming population of old vets checks in for VA health care, look out.


Privacy Act of 1974; system of records--PHS. Notification of a proposal to add routine uses. In accordance with the requirements of the Privacy Act and the Debt Collection Art of 1982 ( Pub . L. 97-365), the Public Health Service (PHS) is publishing a notice of a proposal to expand one routine use and to add one routine use to three systems of records in the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). We are adding a further routine use to system of records 09-30-0031 only. PHS invites interested persons to submit comments on the proposed routine uses on or before July 2, 1984.


Pharmacists' role in smoking cessation.

Pharmacists' role in smoking cessation. "Time to quit", a program piloted in Winnipeg in 1983, is an example of the importance of the pharmacist in the smoking cessation issue. Through the Manitoba Pharmaceutical Association, pharmacies were utilized as distribution centres for a self-help smoking cessation booklet. In the city of Winnipeg, 82% of city pharmacies received a total of 40,500 books; 93.5% of these booklets were picked up by the public. Pharmacists also had the option to become more involved in the anti-smoking campaign if they so desired. Pharmacists not only have the knowledge to discuss the area of smoking cessation, they arein a strategic position for dissemination of that knowledge.


Ethical dilemmas--a need for values clarification education.


Preceptor-preceptee relationship in critical care nursing.


Ensuring competence: toward a competency-based orientation format.


An interactive systems approach to critical care education: the Anderson model.


Preoperative intervention for the reduction of anxiety in pediatric surgery patients. Hospitalization and surgery can have adverse psychological effects on children that may be prevented by preoperative intervention procedures. The present study compared an in vivo preparation in which 3- to 9-year-old patients who were about to undergo tonsillectomy/adenoidectomy surgery experienced a preview of the procedures and equipment, a slide show condition depicting hospitalization and surgery, or a standard nursing care control group. The in vivo group was rated as significantly less anxious than the slide show and control groups at each of the three assessment points. The in vivo children also took less time to drink following surgery than the slide show and control groups.


Where did you get that scar?

Where did you get that scar? The way in which children perceive illness and hospitalization is most often conceptualized by adults who interpret their worlds for them. Per Rosenbaum poignantly illustrates how those childhood perceptions grow and mature...and how our sick children are often marathoners long before they even run a mile.


Impending hospitalization: timing of preparation for the school-aged child. The current consensus on the optimal time for preparing children for impending hospitalization rests on clinical expertise and experimental group data. The study reported here has demonstrated marked heterogeneity of temporal preferences across age and sex of children 5 to 12 years old and, as such, questions the validity of applying general guidelines on the timing of preparation to the case of an individual child. Instead, it appears that the parents' knowledge of how the child reacts when confronted with impending events of a potentially threatening nature should be the primary basis for such decisions.


Selecting a microcomputer for the doctors' offices.


Marketing: making a commitment to survival.


Bar coding basics.

Bar coding basics.


In-office or service bureau?

In-office or service bureau?


Time is money: here's how to save money with computers. Just three years ago, Loyola University Medical Center, with a 92 percent occupancy rate, instituted a computerized approach to housekeeping under the auspices of its building service contractor , Admiral Maintenance Service Company. To date, the Maywood , Illinois-based medical center has operated with a dramatically reduced budget and reduced its staff by 10 percent, and "is still the cleanest place in town," some patients say. I spoke with Loyola 's Director of Housekeeping, Minnie Samp 'l, and to computer designer and systems analyst Donald Campbell, of the Chicago-based contractor , to learn details.


The therapeutic effects of a playground apparatus on children with behavioral problems. The " Moonwalk ," an apparatus consisting of an air-filled trampoline, was evaluated as a reward for children with emotional and behavioral problems. Two age groups of hospitalized children, 23 aged 5 to 12 and 12 aged 13 to 18, were evaluated utilizing (a) a 26-item teacher's rating scale; (b) a 4-item, 5-point scale to assign ratings to the students before and after the Moonwalk activity; and (c) the students' response to a 7-item consumer questionnaire. Teacher observers found the younger age group showed improvement in behavior at school after the Moonwalk was offered as a reward. The Moonwalk , as a reinforcement, offered a simple method to improve emotional or behavioral problems in an institutional setting.


Life-saving technology in neonatal ICU enables Jamie and other "premies" to survive.


States face over 400 health cost bills, NCSL survey shows.


A problem for Social Security: can we afford a $20 trillion surplus by 2045?


Hospital's neonatal ICU helps save life of 15 1/2-ounce "premie" baby.


Private sector technology assessment institute proposed in legislation by Indiana senator.


NMR progress report: name changed to MRI; FDA says it will approve marketing.


Technology and rationing.

Technology and rationing.


Philanthropic employment growth from 1972 to 1982.


The function of lists: a fund raising primer.


On-line database system raises ALA's fund raising capabilities. Interview by Raymond Roel.


AMI/DSI and California university to build MR facility; firm plans diagnostic network.


States are addressing problem of care for medically indigent.


Low-key employee fund drive proves successful for Institute.


22 predictions on the future of direct mail fund raising.


Increasing contributions through effective writing.


Premiums: an innovative way to increased gift giving.


How marker piggybacking affects your exempt status.


Supreme Court's Hyde decision: what is its significance?


AMI spreads Olympic fever, prepares for health care role.


From total paralysis to valedictorian: a rehabilitation story.


"Hands on": deferred giving: letting the donor have his cake while you eat it too.


Clinical case report forms design--a key to clinical trial success. Clinical case report forms--from both a content and format point of view--play a key role in the successful completion of a clinical trial. However, as many of us are too well aware, the design of these forms are often given less attention than they should be in the rush to get a clinical trial underway. This session will highlight the importance of well-designed case report forms and offer some suggestions on how to improve the effectiveness of these forms. The obvious and not so obvious benefits in the use of "standardized" forms will be presented and some sample "standardized" forms presently in use by Merck Sharp & Dohme Research Laboratories will be discussed. Since both the cost and timing of the formal composition and printing of these case report forms are always key management concerns, a time and cost effective solution to these concerns will be presented.


A comprehensive on-line collection system. In the normal conduct of a clinical drug trial, a considerable time lag exists between the point when drug response data are collected, usually by means of a standard written case report form completed at the time of an individual patient visit, and the time when it is entered into the computer system (and thereafter available for assessment) in the sponsor 's facility. This lag period may range from a matter of days to one or several months. Previous efforts to reduce this time span by providing electronic data entry capability within the clinical investigator's office have generally proven unsatisfactory for reasons of complexity and relative inaccuracy. A recently-developed potential solution to this entire problem will be described. It involves the provision of a microcomputer equipped with sophisticated customized data entry software that offers a means to substantially reduce this long-standing source of delays in the completion of clinical drug trials.


Public accountability and confidentiality.


Work simplification: a supervisor's challenge.


Matrix management in the health care organization.


Not by words alone.

Not by words alone.


Team-building techniques for the health care supervisor.


The supervisor's guide to oral presentations.


Case in health care supervision.

Case in health care supervision.


The supervisor's role in the disciplinary and grievance procedure.


Dealing with the angry employee.

Dealing with the angry employee.


Health care environmental assessments: for and by supervisors.


Reflections: disease prevention/health promotion--bridging the gap to wellness.


Productivity monitoring for every supervisor.


Linking biomedical research to prevention in the community.


Bioethics and health instruction: issues, questions, and advocacy. The purpose of this article is to define bioethics and illustrate some current bioethical issues facing society today, provide an overview of arguments opposing teaching about bioethics by health educators, describe selected aspects of the who, what and how of the teaching of bioethics, and advocate the teaching of bioethics at all levels of health education curricula. The intent is not to provide conclusive solutions to the many complex issues related to the teaching of bioethics, but rather to discuss some of the issues and stimulate debate.


The future of nursing: combining humanistic and technological values. Technology is increasing. "The most stable characteristic of the present health care system, is change, characterized by expansion and experimentation . . ." To date, nursing has taken a reactive role, adapting out of necessity rather than taking an active part in initiating or promoting specific change. Consequently the health care system has had and continues to have a greater impact on nursing than nursing on the health care system. Two hypothetical frameworks, humanistic and technological, are presented with which to approach the problem of increasing technology. The values and implications of each are examined within the context of the nursing profession.


Vietnamese in America: a case study in cross-cultural health education. The rescue of the "boat people" from Vietnam is not over when they reach American shores . Adjustment problems abound . Health professionals are in a good position to help immigrants, but because of the language barrier and unfamiliarity with foreign cultures, there has been little success, despite the best of intentions. This paper attempts to highlight the importance of understanding culture in health education, using the Vietnamese as a case study.


From grievance through arbitration: a supervisor's perspective.


Staff evaluation: an assessment of approaches.


Solving the nursing shortage: drawing nurses back to the hospital.


Reflections on GMENAC.

Reflections on GMENAC. This month HCSM interviews W. Jack Stelmach , MD. Director of the Family Practice Residency Program at Baptist Memorial Hospital and a Clinical Professor of Medicine at the University of Missouri, Kansas City School of Medicine in Kansas City, Missouri. He is the past President of the American Academy of Family Physicians and the American Board of Family Practice. Dr. Stelmach served as the first Chairman of the Graduate Medical Education National Advisory Committee (GMENAC) from 1977-1978 and now is actively involved in an AMA committee studying health manpower, health care resources, and technology. In this interview, he discusses his thoughts on the accuracy of GMENAC's predictions and the future practice of medicine.


The future of medical assistants.

The future of medical assistants.


How would you meet a hospital's variable staffing needs for nursing services? In house.


Case in point. The Affiliated Health System.


Case in point--the answer. Spring Lake Hospital.


Modern medical practice: a profession in transition. Modern medical practice is in a state of transition. The solo practitioner is slowly giving way to the large organized groups of health care providers. Driving this force of change is a change in payment for health care services from cost plus to preestablished pricing. For the first time, medical practice patterns are having a direct impact on the financial viability of the health care institution. To maintain quality of patient care and contain costs, more and more physicians are becoming involved in the administrative side of running a hospital. This article describes the forces of change, the change itself, and the future of medicine.


Who will pick up the tab for Tadworth?

Who will pick up the tab for Tadworth?


The role of the nurse in hospital marketing. The nurse is introduced as a vital component of the hospital's marketing process. As the major provider of patient care, teacher, counselor, and patient advocate, the nurse has a direct impact on the quality of care delivered and ultimately, the patient's choice of health care delivery site. Marketing strategies for nurses include daily rounds, constructive communication, physical appearance, and educational level. Through such strategies, nurses play an active role in increasing patient revenue.


Long-stay hospitals. Keeping chins up as services run down.


Mental handicap. Training for an adult world.


Restructuring. Canny Scots keep options open.


Computers in control.

Computers in control.


Second opinion: clinical freedom.

Second opinion: clinical freedom.


Catering management. How we won over the staff to Whinney's Oven.


Industrial relations. Anatomy of a dispute.


Rundown of long-stay hospitals. Training for a changing world.


Oil shake-up in Wessex.

Oil shake-up in Wessex.


Consensus management. Will we lose our team spirit?


Self-help groups. Second chance for the head injured.


Warning: smoking can damage your child.

Warning: smoking can damage your child.


Community health. 10,000 projects blossom.


Why some people just never make it to the surgery.


Voting with their feet.

Voting with their feet.


Patients like to be 'an emergency'.

Patients like to be 'an emergency'.


Psychiatric services. Strategy for transition.


Paramedical performance. Manipulating physiotherapy.


Finland's health care. Health in a cold climate.


Taking in the community's washing.

Taking in the community's washing.


Careers. Up the ladder to the top.

Careers. Up the ladder to the top.


Collaboration in care. Sheffield needs a solution.


Patient information. Is ignorance bliss?


Legislating for life.

Legislating for life.


US health care. Assessing the evidence.

US health care. Assessing the evidence.


Health education. Smoking out effectiveness.


Management consultants. Are consultants value for money?


Solutions from outsiders.

Solutions from outsiders.


Consensus management. Training for teamwork.


Australian health care. Coverall care for six states.


Ambulance service. Lincoln gets carried away.


Public cash and private care.

Public cash and private care.


Breaking the boundaries for mental health.


Huntingdon builds up its independence.

Huntingdon builds up its independence.


Can the NHS be marketed like a detergent?


Microcomputers. Ten ways to terminal happiness.


Many micros make light work.

Many micros make light work.


Retirement. Take the money and run.

Retirement. Take the money and run.


Video age comes to A&E.

Video age comes to A&E.


Griffiths and Bains...the losses and gains.


Residential homes. The code of practice that bites back.


What Humana is doing to control supply costs.


US health care. Does the language of the marketplace speak with forked tongue?


Employment law. Finishing time finishes Evans.


Reducing reference laboratory costs.

Reducing reference laboratory costs.


Inflation rate for hospital supplies slows dramatically.


Materials management at Massachusetts General. Interview by Dean Ammer.


Disputes over what was delivered.

Disputes over what was delivered.


Coordinator is the key to successful group purchasing. Part II.


How one hospital combined offsite warehousing and exchange carts successfully.


An interview with: Neil Shayne, Esq.

An interview with: Neil Shayne, Esq.


Paring down losses in food service: an update.


Innovations in obstetric design that meet professional and consumer demands.


Tales from the trails: a journey into the existential underbelly of American business.


How a top business analyst ranks the hospital industry. Health care as investment.


More on entrepreneurship. Thirteen questions for hospital CEOs.


Brass tacks. Straight talk about the health care industry and the entrepreneurial spirit. Interview by Joe Flower.


Caring: putting patients first begins with management skills.


Transferring lessons from high performance organizations.


A conversation with the new AWH chairman Fred Pritchard.


Carner's codes. Demonstrate your integrity (who willingly employs a person he cannot trust?).


Health care manager's notebook. Microcomputer use in hospitals.


Bring some magic into your hospital.

Bring some magic into your hospital.


Supply needs of the works organisation.

Supply needs of the works organisation.


Plant performance and energy budget control.


Developments in the water industry.

Developments in the water industry.


Sexual harassment: defining the problem and avoiding the risk.


Protestant Hospital Association changes name, purpose.


Supreme Court approves hospital's exclusive contract.


Newborns in intensive care hear tapes from home.


Adolescent pregnancy program stresses family counseling, educational services. Pathways, and adolescent family life demostration program at St. Ann's Infant and Maternity Home in Hyattsville, Maryland, which initiated activities in March, 1983, served 268 clients in its 1st year.  59% were 17 years of age or under.  A 5-year grant from the Department of Health and Human Services Office of Adolescent Pregnancy Programs provided for residential care for pregnant adolescents lacking family to assist them in the last phase of pregnancy; a day program offering accredited educational services and community vocational resources, training in parenting skills, individual and family counseling, and prenatal care for teenagers; an aftercare residence for adolescent mothers and their infants with an intensive program of vocational and parenting education; and a community outreach program offering health care, counseling, family life education, adoption, and other services.  The program differs from previous programs at St. Ann's in 5 main ways:  1) substantial care is available to teenage mothers after delivery 2) educational services have been expanded for mothers living at home and attending during the day 3) a more comprehensive counseling program with more intensive family focus in included 4) the program is raching out into the community with a range of services to adolescents seeking assistance, regardless of race, religion, or financial status, and 5) an evluation program has been developed to monitor the operating program, the adolescents receiving services, and their children.  The National Center for Family Studies at the Catholic University of America has assisted in staff training and service delivery design.  Follow-up studies on clients who have left the program are only beginning.  Counseling plans are formulated to fit individual needs, but all residents participate in group therapy sessions led by a psychiatrist and social worker.  The infants' fathers and the adolescents' parents recieve services when possible.  Although the grant finances the basic program, additional funds are contributed by foundations, United Way, program service fees, and public agencies.  Client fees are based on a sliding scale which ranges from 30-100% of the acutal cost of care.  Maximum enrollment in the program is 8 mothers and babies in the Aftercare Program, 25 adolescents in the residential program, 10-16 in the day programs, and 40-50 in the coumunity outreach program.


Shaping public policy: a challenge in faith. Religious health care's involvement in public policy is an essential part of Christian life. The most important way in which Catholic hospitals and health care systems can contribute to public policy is through faith-reflection upon their identity and calling. To guide the shaping of public policy, several theological models have been set forth. The theology of democratic capitalism is based on individual human creativity. As a system of political economy organized to prevent the centralization of government power, it thrives on free competition. Well- intentioned social programs that seek to equalize results, according to democratic capitalists , inevitably lead to greater government control and should be avoided. Inequality, in fact, according to this theory, can create incentive for individuals and industry to be more productive. The stewardship approach to theological reflection calls for a distribution of goods and services based on need. The right to health care, for example, is founded in God's gift of creation to all inhabitants. The resources of creation are allotted to individuals as property in a sense of cooperation and sharing. Thus, according to this notion, government programs that help society steward its resources wisely should be promoted. The U.S. bishops ' 1981 pastoral letter on health and health care presents a third model, which reflects on the dignity of human beings as images of God to guide public policy. Models, however, must not replace personal theological reflection. Catholic health care providers share a responsibility to evaluate social issues from their perspective as members of the healing ministry and to participate in public policy development.


Study of education programs identifies members' needs.


Patients' informed consent requires understanding of treatment risks. The need for patient consent to medical treatment derives from the idea that the patient is morally obligated to take ordinary means to preserve his or her life. The physician has only that right over the patient which the patient gives him. To ensure that patient treatment decisions are responsible, consent must be both free and informed. Free consent generally implies that the patient is under no pressure to choose a particular course of action. Informed consent suggests that the physician has a duty to give the patient sufficient information about a proposed procedure's significant risks and benefits. The patient need not receive comprehensive knowledge of the treatment, however, since overdisclosure can interfere with the freedom to decide by playing on patient fears. Though some patients simply disregard treatment information or rely on other factors in their decision making, physicians should not abandon attempts to attain patient understanding. They must develop communication skills and exercise patience in their efforts to explain treatments and obtain consent. Proxies and patient advocates also may be requested, and physicians may consult with their colleagues to guarantee that the patient's best interests are met.


Theological reflection enhances pastoral care skills. Theology can contribute to pastoral care by interpreting experiences in a faith context, reinforcing the pastoral care giver's identity, and orienting one's ministry style to be more congruent with that of Jesus. Models for theological reflection generally begin with an analysis of the patient's experience. In addition to gathering information on the factual level, the pastoral care giver seeks to discern the experience's dominant theological meaning. The next step is to identify and explore a theological parallel to the experience. For example, images of "stopping for a stranger" or "taking a detour " would suggest the theological parallel of the Good Samaritan. The final step is to enact the reflection, that is, to apply the theological interpretation to the patient's situation. Besides sharing the interpretation with the patient, the enactment may include changing one's style of ministry.


How should Catholic hospitals respond to the AIDS problem?


Ambassador to Vatican finds trustee role rewarding.


Bioethics course helps care providers clarify values.


Hospital art collection emphasizes Catholic identity.


Outpatient program maintains good will during 13% work-force cut.


Rite of Annointing of the Sick. Scripture readings illuminate meaning of suffering. The lectionary for the Roman Catholic Rite for the Anointing of the Sick provides insight into the nature and theology of illness which can be helpful not only for the person who is ill but also for the community that serves that person and for people involved in medical or pastoral care of the sick. The readings address two major questions: Why is there suffering? What is the purpose of chronic illness and of sickness unto death? Responses to these questions involve perception of illness as part of the mystery of iniquity (although there is no simple cause-and-effect relationship between particular sins and a person's illness) and understanding of God's power over sickness. The sick person's configuration to the suffering Christ also plays a part in this mystery. The paradoxical mystery of illness, which cannot be understood outside the context of faith, is reflected in the richly nuanced readings. To avoid a simplistic or incomprehensible approach to the problem, pastoral sensitivity to the sick person's spiritual, physical, and emotional condition is required in the selection of readings to be used on a particular occasion.


Customer-oriented management important to hospitals, survey finds.


Reflections on Sr. Mary Angelina's dying.


The search for meaning: a pastoral response to suffering. To help those who suffer, pastoral care ministers must understand what suffering is, its meaning, and the hope that is offered in the Christian message. Suffering involves the entire person--body and spirit. Fear, stress, guilt, and other kinds of emotional distress are as much a part of suffering as physical symptoms. The sufferer sees his or her wholeness being threatened, and seeks explanations for the suffering. The pastoral care minister must help the sufferer to understand that suffering is not divine retribution but a call to discipleship . Because in Jesus' person God has suffered and known powerlessness, pain, and death, he not only understands the sufferer's needs but shares in them with compassion. To help the patient transcend suffering and find its meaning in the context of faith and revelation, the minister must appreciate the patient as a complete, unique, and spiritual being. The minister must be the sufferer's friend, offering respect, tenderness, and love--not merely because the patient is suffering but because as a human being he or she is entitled to such care . Patients who experience such concern from another will be better able to value themselves in moral and ethical terms, experience oneness with the suffering Christ, and triumph over suffering and death.


The physician as a source of hospital capital. As hospitals search for means of financing renovation during the next decade, physicians will represent a source of capital through tax-shelter financing. Limited partnerships, condominiums , and joint ventures in acquiring medical equipment or syndicating existing facilities are among the most promising investment vehicles for taking advantage of tax benefits that normally do not apply to nonprofit institutions. In a hospital-physician limited partnership, tax deductions are passed through to the partners, of which there are two kinds: general partners and limited partners. Income (or loss) and tax credits from the entire venture can be divided among the partners and reflected on an individual limited partner's tax return. Rather than shouldering the whole cost of renovating a medical office building, thereby losing the potential tax credit, a hospital could carry out the renovation through a limited partnership with physicians. This would reduce the hospital's capital costs and debt requirements, maintain its credit, and enable it to take advantage of the depreciation deduction. In a condominium venture, the individual physician actually owns the office within which he or she works. As with the limited partnership, the hospital will want to restrict physicians' ability to dispose of their ownership interests.(ABSTRACT TRUNCATED AT 250 WORDS)


What ethical liabilities are posed by PPOs?


Hospital continues uphill struggle to survive.


Productive behavior through the life course: an essay on the quality of life. Present patterns of productive activity are neither well recognized, optimal for society, nor in accordance with individual preference. Although a great deal of attention has been given to meeting people's needs for income, medical care, and other services, the quality of their lives must also be defined by what they do for themselves and for others. In discovering present patterns of productive activity throughout the life course and optimizing those patterns, we will raise the quality of American life. To accomplish this task, two great changes are needed: we must recognize the full range of productive activities throughout the life course and give people the opportunity to modify the allocation of paid employment.


Gainsharing: a few questions, and fewer answers. Gainsharing is an important organization development intervention, yet many of the basic questions have not been answered. This paper addresses these questions by developing a conceptual model and using the model to review the case study literature on gainsharing . The plans varied in terms of structural factors, implementation factors, and situational factors, and a majority were successful. Gainsharing impact was found in five key areas: organizational effectiveness, individual quality of work life, ideas and innovation, labor-management cooperation, and pay. Relevant research is briefly reviewed and several unanswered questions are identified for future research.


Obituary for Hill-Burton challenge: U.S. Supreme Court refuses to hear Hill-Burton case.


OMB publishes revised not-for-profit lobbying rules.


Nevada Supreme Court holds county responsible for emergency care provided to indigent patient in a private hospital.


Kansas coalition to help employers compare hospital prices.


Court of Appeals denies government petition for rehearing in case of handicapped infant.


District Court judge invalidates Baby Doe regulations.


The homemaker needs of the rural frail elderly from a client versus agency perspective. The clients, aides, and staff of a homemaker services program for the rural frail elderly were individually interviewed concerning client's met and unmet needs. While the overall response from all three groups suggested a highly effective program, significant differences existed among the three groups with regard to what they considered the most important needs, both met and unmet by the program. It was concluded that although the perceptions of all three groups of participants in such programs might differ, such differences may not necessarily work to undermine the program.


The adequacy of the Older Americans Act home care mandate: a front line view from three programs. Title III-B of the Older Americans Act authorizes closed-ended formula grants for state and area home care program contractors. To what extent, however, does this legislation enable localities to address the complex needs of the functionally impaired aged? This study inquired into staff perceptions (N = 91) of the adequacy of service in 3 urban-based, OAA home care projects. Program adequacy was empirically gauged by mean net difference scores derived from two scales designed to tap worker perceptions of program capacity and program responsibility in dealing with a series of 8 potential client needs. Results revealed significant program inadequacies in both small and large scale agency settings in the client domains of temporary (p = .02), permanent (p less than .001), emergency (p less than .001), emotional (p less than .001), and medical (p less than .001) need. These deficiencies were apparent at the points of service application, delivery and termination. Workers acknowledged greater success in addressing the practical, daily needs of elderly clients. Findings lead to a set of policy guidelines for shaping more responsive home care program legislation in the future.


Utilization and referral patterns for home health services: a data base for needs determination. This paper presents and discusses utilization and referral patterns for home health services in Mississippi. The universe of agencies delivering services in an eleven (11) county sample area is surveyed for patient demographic characteristics, modes of referral to home care and diagnostic characteristics. Comparisons are made of diagnoses of the 65 and over population utilizing home health services and a sample of hospital discharges in that same age group. A home health diagnostic index is derived and used in a home health "needs" determination formula.


Future trends in hospital purchasing.

Future trends in hospital purchasing.


Quality assurance in materiel management.


Product evaluation--the nurse's role.

Product evaluation--the nurse's role.


Integrated care--a model for others.

Integrated care--a model for others.


A systemic-developmental model of day treatment for young adult chronic patients. The young adult chronic patient is a recently designated dysfunctional group which is growing significantly in numbers. These patients' multiple deficits in independent functioning and their extreme dependence-independence conflict make them difficult to engage and help in traditional forms of outpatient therapy. A day-treatment program which systematically and flexibily intervenes over many levels would seem to increase the likelihood of successful treatment. F. S. DuBois Day Treatment Center, Stamford, Connecticut, has established such a program based on an integration of general systems theory and separation-individuation theory. This systemic-developmental model of day treatment involves both systems-oriented multimodality therapy and developmentally phased expectations for gradually increasing independent functioning. This paper presents theory and applications of the systemic-developmental day-treatment model and a 2-year pilot program evaluation demonstrating its effectiveness.


Development and current status of partial hospitalization in the Federal Republic of Germany and West Berlin. Since the opening of the first partial-hospitalization program in 1962, the development of partial hospitalization in the Federal Republic of Germany and West Berlin has markedly accelerated, especially in recent years. As of July 1, 1982, there were at least 60 such programs with approximately 1200 places in the country. A review of the current status is given regarding the individual programs' perceived mission and their integration into the existing network of psychiatric services. Summary statistics are provided regarding patient census, duration of stay, staffing, therapeutic activities, and clientele. Problems such as the low number of direct community referrals, the preponderance of chronic patients, and the underutilization of programs are discussed.


PPOs: will they pay off? Approach with caution.


PPOs can work--if....

PPOs can work--if....


PPOs can improve reimbursement for 'thinking and caring' services.


Business coalitions look at PPOs to lower employer costs.


Physicians and PPOs: antitrust considerations in setting fees.


Preferred Provider Act: sensible balance or federal intrusion?


Telling the inside story. ASIM launches its public education program.


1984: novel in its complexity.

1984: novel in its complexity.


Are PPOs preferable?

Are PPOs preferable?


PPOs: will they pay off? A true alternative or simply a new acronym?


Cancer line--an experiment in communication.


Verbal probability and expected frequency expressions used in relation to immunisation.


Smoking habits of nurses within the Leeds Area Health Authority (teaching).


Community mental health--past, present and future.


Blind tests lead to savings in radiology.


Proper use of the blanket purchase order.


What EPA's final EtO rule expects. Product label changes that will require modifications in workplace design and practice in hospitals and health care facilities.


In support of the maverick.

In support of the maverick.


St. Mark's shifts to bar code mode.

St. Mark's shifts to bar code mode.


Merger creates largest U.S. buying group.


Going full circle with supply replenishment systems.


Question. What is the ASHMM "Code of Ethics"?


Vein dreams. Rural health care in a troubled economy.


Martin Luther King, Jr./Drew Medical Center. They have a dream.


Shoplifting. Let the manager beware!

Shoplifting. Let the manager beware!


Unit-dose systems: drug waste and drug processing time in a long-term care facility. This study compares the effectiveness of two drug distribution systems--a conventional prescription and a modified unit-dose system--in a small, rural, long-term care facility ( LTCF ). The 72-hour modified unit-dose system was superior in minimizing drug wastage and the time required for drug processing by nursing personnel. Drug waste was reduced by 64% in dollar value; time for drug processing in the LTCF was reduced by 46% on a daily basis. These data are consistent with three early studies evaluating two such systems in a LTCF and conflicts with one recent report.


An introduction to the clinical laboratory for pharmacists. The intent of this article is to provide pharmacists with an introduction to the clinical laboratory. As clinical pharmacy services expand, interactions between pharmacists and the laboratory will increase. Laboratory results are an essential tool for pharmacists involved in monitoring drug therapy and adjusting dosing regimens. Laboratory medicine, however, is a complex and rapidly changing field with new analytical techniques and instruments continually being developed. Thus, methodologies vary greatly from one laboratory to another and even within the same laboratory from time to time. Quality control procedures are necessary to ensure accurate and reliable results. The medical technologists who staff clinical laboratories are highly trained professionals. Pharmacists should utilize the medical technologist as a consultant on the interpretation and limitations of laboratory tests. Likewise, there are many areas, such as therapeutic drug monitoring, in which the pharmacist can serve as a consultant to the laboratory. Pharmacists involved in patient care will benefit from a greater understanding of the clinical laboratory, and may also find new opportunities for clinical pharmacy practice and interaction with other health care professionals.


Turnaround time in a unit dose system.

Turnaround time in a unit dose system.


P & T Committee roundtable discussion: Eastern region. Part I. A series of regional roundtable discussions regarding the successful operation of Pharmacy and Therapeutics (P & T) Committees has been conducted by Hospital Formulary. Representatives from private hospitals, university and teaching hospitals, as well as Veterans Administration medical centers discuss committee profile, constituency, function, mechanics, and criteria for establishing a successful formulary within an institution. The sessions were taped, and the edited transcription is provided in the following article.


The design and implementation of task oriented employee evaluations. In an effort to improve the performance review system from both the employee's and supervisor's perspective, task oriented evaluations were designed and implemented for all pharmacy employees. The system is based on clearly defined responsibilities and performance criteria for evaluating all employees. The development of responsibilities and performance criteria is discussed, highlighting the role of employee and supervisor input in the development process.


Twenty-four hour pharmacy service in hospitals with less than 300 beds--Part 8.


Why multihospital systems will continue to grow. The limitations of federal and state spending on health care indicate difficult times are ahead for hospitals. Rising costs are challenging their continued existence. Construction and renovation, for example, are normally not feasible in light of the present economic situation. To meet this financial challenge, Multi-Institutional Arrangements ( MIAs ) are proliferating. This phenomenon, which is particularly prevalent in the Southern United States, seems to be increasing geometrically, principally because many of the officials who operate hospitals see such an affiliation as an answer to their serious fiscal problems. Faced with myriad financial problems resulting from overcommitment , hospital boards are looking for a way out of the quagmire . While the boards do not want to give up control of the hospital to an outside group, they are beginning to realize that it may be the price that must be paid for fiscal solvency (i.e., keeping the hospital open to serve the public). Hospital boards usually are favorably impressed by the promised benefits accruing from association with a MIA.


Hospital equipment financing options multiply.


A model for design of health administration curriculum and instruction. Faculty members in health administration programs as in other professional programs tend to be trained in content appropriate to their field rather than as educators. Enhancement of the teaching skills of faculty will potentially improve the quality of the students' educational experience. Of particular note is the tendency of faculty to teach at the basic knowledge level and expect students to perform at the application and problem-solving levels. The purpose of this paper is to aid faculty in health administration improve their teaching activities and student evaluation. This goal will be accomplished through presentation of a model for systematic design of curriculum application of this model at the course and lesson levels.


Linear and nonlinear models of patient satisfaction with medical care. The relationship between overall patient satisfaction with medical care and satisfaction with various aspects of health services is explored in a community survey of 225 service consumers. Three alternative models are examined: (i) linear compensatory model; (2) nonlinear conjunctive model; and (3) nonlinear disjunctive model. The results indicate that the nonlinear, noncompensatory models predict overall satisfaction as well as does the linear compensatory model. The pattern of findings is different for men and women. The implications of the findings are discussed.


Behavioral community psychology: an introduction to the special issue. An overview of this special issue, and of behavioral community psychology, is provided, beginning with a summary of terminology and history. Five dimensions on which behavioral community interventions may be classified are then described: (a) subject matter/target behavior, (b) behavioral procedures used, (c) experimental design, (d) intervention level, and (e) time focus. The studies composing this special issue serve as illustrations of these dimensions. This is followed by a discussion of issues important in designing and implementing behavioral community projects. Finally, challenges facing the field are noted.


Community medicine in the medical curriculum: a statistical analysis of a professional examination. This paper analyses the examination results of two cohorts of medical students at the University of Glasgow. It discusses the usefulness of Scottish higher grades as predictors of ability to pass examinations in medicine. Further correlations are made between the results from community medicine and other fourth- and fifth-year medical school examinations.


Measures of equity and efficiency in medical manpower planning. A prediction of internists needed in the Finnish national health service. Several difficulties regarding manpower planning in health care based on need for service can be demonstrated. Easily obtainable utilisation numbers do not directly reflect demand or need for service, nor can they be used as an approximation of morbidity. Epidemiological studies, on the other hand, do not reveal "non-clinical" demand factors. Unmet demand cannot automatically be interpreted as undersupply or lack of resources. Planning according to predicted need has furthermore been severely handicapped by a nongrowing economy; it is rather asking for development through reallocation of resources. Consequently, another approach was chosen in this study - a prediction of internists needed in the Finnish national health service to ensure an equal supply and an efficient provision of services. Equity between regions was measured as number of specialists' positions, hospital admissions and out-patient visits per population. The number of admissions and visits per specialist's position was used as a measure of system efficiency. A density of specialists equal to the national mean in all regions would require a 21% increase in specialists' positions. A sensitivity analysis according to different levels of service supply as well as improved efficiency projected a 23-127% growth.


Medical staff organization in three European multi-hospital systems: an exploratory study. Multi-hospital systems have increased rapidly in number in recent years. This development is based primarily on hoped-for economies of scale, better access to the capital market, and more expert management. The place and the role of doctors in this process has, to judge from the literature, been passed by almost unnoticed. Is this also a case of the "benign neglect" that prevailed with respect to the medical organization when management structures were established in the separate hospitals? The present article reports on an exploratory study of the situation of doctors and the medical staff organization in three European multi-hospital systems. Two important structural elements, the strengthening of management and the medical staff organization, appear to be of fundamental importance for the determination of the place and the role of doctors in multi-hospital systems and of the way the doctors themselves experience the system. There are a number of factors that one may assume affect the situation of doctors in such systems: the process of system formation, the size of the system, the influence of the general environment, cost-consciousness of the doctors, and the force of strong personalities.


The National Commission for Health Certifying Agencies: an introduction.


Enhancing leadership skills for community self-help organizations through behavioral instruction. Group members with skills to lead effective meetings are valuable resources of any community organization. The effects of a behaviorally based textbook and training procedures designed to teach members of community self-help groups to chair effective meetings were analyzed. Measures were collected during regularly scheduled meetings on chairperson performance, member participation, and the closure of discussion topics. The results showed that the use of specified chairperson activities increased after training for each of two chairperson trainees. Further, outcome data suggest that more decisions were made. These findings suggest that the chairperson training procedures may enhance the leadership and decision-making resources of community self-help groups.


At Northland Terrace perspective sets the pace.


Pain killers. Merck & Co. comes to Ireland.


The teaching nursing home: bringing together the best.


Temporal effects of prompting on acceptance and follow-up in a community-based hypertension screening program. This study evaluated the effects of prompts and reinforcement on two aspects of hypertension control: a) attendance at a community-based blood pressure screening program and b) follow-up visits to a physician's office by persons identified through screening as at-risk clients. Baseline data showed a decreasing trend in attendance at the screening sessions and a 51% "no show" rate for physician follow-ups. Screening session attendance increased following intervention; however, attendance rates across weeks appeared to vary mainly as a function of the prompting schedule (monthly newsletter announcements ) rather than the availability of reinforcement. Finally, the intervention not only increased the percentage of at-risk clients who saw a physician, but also decreased the latency between the time of initial screening and the follow-up appointment.


Psychogeriatric education adds new dimension to nursing.


Long term care administration: past, present and future.


Coming of age in long term care.

Coming of age in long term care.


Ohio's new professionalism in action.

Ohio's new professionalism in action.


Continuing education a priority at Mayfair.


Facility design for the times.

Facility design for the times.


The evolving role of the activity coordinator.


The U.S. Supreme Court looks at hospital-physician relationships: the Hyde decision.


AHCA policy perspective: the Older Americans Act.


Law, ethics and professionalism.

Law, ethics and professionalism.


The resident's room.

The resident's room.


The People's First Social Welfare Institution for the Aged: a Chinese nursing home.


Research collaboration between programs in health administration and hospital associations.


The chief administrative officer of the academic health center--a post of growing impact on both higher education and health services delivery.


Managing interdependence: report from a collaborative graduate program in nursing administration.


Healthcare credentialing issues demand increased attention.


Guilt by association: pigeons and other flights of logic.


Hospital mergers and the antitrust laws: major roadblock or minor constraint.


What happens when trade associations do research?


Faculty development in health administration: a case study of faculty internships.


The reshaping of an academic program in hospital administration in a developing country.


Quality control.

Quality control.


Computer records prove as vital to health care as medical efforts.


The impact of regulation on the administrative structure of hospitals: toward an analytic framework. The dramatic and recent regulatory changes in the hospital industry (e.g., TEFRA , DRG-based reimbursement) have given added impetus to the analytic framework developed here. Regulation will play an increasingly important role in the future of hospitals, affecting not only fiscal operations, but organizational and administrative arrangements as well. The conceptual framework developed in this article will be refined and augmented through empirical research. Healthcare executives will then have a stronger basis for adapting organizationally to changes in their regulatory environments, thereby increasing the effectiveness and survival of their institutions.


EtO monitoring equipment--an evaluation.


Positive image promotion.

Positive image promotion.


Installing a patient charge system. A case study.


Buffalo Memorial Hospital. Buffalo, Minnesota. First owned and managed by a group of local physicians, then operated as a municipal hospital, and now a division of a private, multi-hospital group, Buffalo Memorial Hospital's growth has mirrored that of the rural Minnesota community it serves. From 1918 to 1951, the hospital was located in 12 rooms above the local drugstore . Then, as a city-operated hospital, it occupied a free standing building in the center of town. During the next 25 years, two additions were required to meet the growing demand for health care services in Wright count. In 1977, shortly after the hospital became a division of Health Central, plans were initiated to replace the over-crowded facility with a completely new hospital. In October 1980, Buffalo Memorial Hospital moved into its new home--a sprawling single story, energy efficient building. Now renovated, the old hospital provides housing for senior citizens.


Pricing behavior of non-profit agencies. The case of blood products. In this study we examine the pricing behavior of a non-profit agency, the American National Red Cross blood service units. Two alternative hypotheses are presented: one in which the agency maximizes profits,, and one in which output is maximized subject to a breakeven constraint. Following a general approach developed by Eckstein and Fromm , pricing equations for separate blood products are applied to cross-sectional data from Red Cross blood centers to determine the impact of demand, cost, competition, and subsidy variables. The impact of these variables, in particular the impact of the fixed subsidy on price, is shown to be consistent with the output-maximizing model.


Hospital rate review: a theory and an empirical review.


Husband's health and wife's labor supply. This paper examines the labor supply response of the wife to deterioration in the husband's health. Unlike past cross-sectional studies, responses over time are directly examined through the use of longitudinal data. The empirical results suggest that the magnitude and direction of the response depend crucially on the attractiveness of transfers which the family may qualify for when the husband's health deteriorates. When no transfers are available the wife increases her market work in order to replace the lost earnings of the husband. However, as transfers become more attractive, the wife begins to reduce her labor supply, enabling her to spend more time at home caring for her husband.


Pyrolytic incineration: it can save your hospital energy and money.


Is cream-skimming a problem for the competitive medical market?


Cream skimming, asymmetric information, and a competitive insurance market.


Commercial laundries. Should your hospital use one?


Balancing the failure modes in the electronic circuit of a cardiac pacemaker: a decision analysis. Cardiac pacemaker malfunctions are of continuous concern to the medical profession as well as to the electronics industry. Certain failures in cardiac pacemaker performance are critical and can result in patient deaths. Cardiac pacemakers are vulnerable to certain malfunctions in the electrode, batteries and the electronic circuit. This paper focuses on failures and reliability of the electronic circuit and how they affect its choice and design. The paper discusses the issues of balancing the various failure modes by considering both failure rates and failure outcomes. As the choice of an appropriate pacemaker is a decision problem under conditions of uncertainty, we employ decision analysis as the analytical and conceptual framework. Use of utility theory enables a systematic quantitative evaluation of such seeming intangibles as the various failure outcomes. Probabilities are assessed using specific engineering and reliability literature. The method is demonstrated on a choice problem between two specific electronic circuit designs. The methodology can be useful in designing the electronic circuit to meet certain reliability specifications, deciding whether or not to introduce redundancy, decisions affecting components and technology, and establishing minimal reliability standards, with regard not only to cardiac pacemakers but to other electronics as well.


The voluntary organization and the business school: a partnership waiting to happen.


Personal information tools (personal computers): the changing environment and its management. The potential of the personal computer as a universal information tool for professional and managerial work is explained and illustrated. Forms of implementation, as desktop computer systems (hardware and software) and as virtual personal computers in the context of online mainframe systems, are differentiated. Reasons are given why personal computers are becoming essential for various major types of information work. The need for planned and coordinated introduction of personal computers to prevent the negative effects of uncoordinated applications without attention to compatibility and redundancy is stressed.


The fourth R: a case for releasing volunteers.


Continuing professional education for volunteer administrators.


Interplast: caring for children worldwide.


Firm foundations.

Firm foundations.


Transition strategies for the volunteer world.


The practice of excellence in the voluntary world.


Chicago hospital embarks on study of on-premise vs. outside operation.


CS work attire.

CS work attire.


Interviewing/Part II.

Interviewing/Part II.


Medical malpractice and the 'time-bomb' effect: a matter of geography?


Health requirements.

Health requirements.


Don't throw the baby out with the bath water ... or questions you should ask yourself when choosing a supplier.


Cutting corners can be costly.

Cutting corners can be costly.


New central laundry to be built in Toronto to serve homes for chronically ill.


Dayton hospital makes switch to higher temperature, liquid formula.


This competition isn't real friendly.

This competition isn't real friendly.


Helping the family when the patient's beyond help.


Medical Electronics buyers guide 1984, Part 2. Blood flowmeters; blood pressure instruments; cardiac output meters; ECG-EEG-EMG-ENG; pacemakers; scanners, imaging and accessories; computer hardware--modems; computer software--patient management.


Consumers report need to know more about Rx drugs, illnesses.


Drug delivery systems: aiming for bull's-eye precision.


Solve problems using comparative analysis. Comparative analysis is a methodology that may be applied to problem solving in medical group practice. Whenever problems are complex enough to warrant more than applying either a subjective or quantitative approach, comparative analysis can be utilized to provide a systematic in-depth examination. By applying this technique, a medical group manager can analytically examine and compare all plausible alternatives for the purpose of identifying the optimal course of action.


An organizational structure of the future. The not-for-profit clinic. It used to be unthinkable . How could a small, freestanding group practice attain tax-exempt status without engaging in teaching or research activities? In the late 1960s, four internists in northeastern Ohio did just that. This case study chronicles their ordeal in seeking, obtaining, and maintaining a not-for-profit designation from the IRS, and closely examines the laws which detail tax-exempt qualifications. Undoubtedly, there are freedoms relinquished when a group operates under the close scrutiny of the IRS, but the numerous benefits gained by the not-for-profit clinic could well make it the organizational structure of the future.


Inner-city hospitals find benefits in community role.


Enter the world of the microcomputer.

Enter the world of the microcomputer. Step aside prejudices and fear, it is time for all medical group managers to find a friend in the microcomputer. This useful tool can eliminate the drudgery of number crunching and help solve the many practical financial and operational problems daily confronting the manager. The purchase of a $4,000 microcomputer system may at first seem ridiculous when a $100,000 system is already in use, but the software available for a microcomputer can offer specific applications for day-to-day management activities for which a " supercomputer " may not be well suited. The electronic spreadsheet applications for medical group financial management available through a microcomputer are explored here in detail.


Acupuncture: an old art coming of age in America?


Patients can become victims in some clinical trials, authorities claim.


Bed rails for the elderly: protective or hazardous?


The microcomputer as a management tool.

The microcomputer as a management tool.


Uniform fee schedule to affect all labs.


Nurse practitioners--co-providers of health care. What single program can a group practice institute to increase patient satisfaction, contain costs, improve provider accessibility, expand patient education and other services, increase market share, and most importantly, improve the overall quality of patient care? Expanding the role of nurses as co-providers of care can do all this and more for your group. The experience over the past eight years of a large multispecialty group in central Illinois offers many lessons in the successful integration of a nurse practitioner/clinician program into a group practice. Discussed in this thorough report are the scope of practice, benefits to patients and the organization, and identification of issues needing further resolution: legality, third-party reimbursement, income, distribution, and control of practice.


Microcomputers in the lab: the sudden boom. Part I.


Sampling laboratory medicine in Spain.

Sampling laboratory medicine in Spain.


Microcomputers in the lab: putting the magic to work. Part II.


Workload recording with an electronic spreadsheet.


A guide for evaluating word processing system.


A microcomputer network for interlaboratory QC.


HCFA still bent on competitive bidding trial.


The medical group urgent care center.

The medical group urgent care center. The Riverside Medical Clinic in Riverside , California, recently created an urgent care center which achieved a breakeven point after only four months of operation and has exceeded all expectations ever since. The many areas of concern when implementing an urgent care center program are presented in the article, including choosing the provider group, philosophy of the center, organizational structure, operational plan, developing a marketing program, and possible pitfalls. Not only has the extended-hours medical service offered by the Riverside Medical Clinic Urgent Care Center been an answer to increasing competition, it has added a critical dimension in the clinic's development of a truly integrated medical delivery system.


Supervisor selection: how to pick a winner.


Physician "supply-side" economics.

Physician "supply-side" economics. The medical group manager who fails to come face to face with competition and its future impact may be ignoring his fundamental administrative responsibility for strengthening his group for long-term growth and stability. The author has focused his attention on the broad effects of excess physician supply on internal group economics and external competitive economics, and quantitates their impact. Each manager will have to move from the broad to the specific in "bringing home" the points presented in this discussion. And, they must be "brought home," because they will soon be there whether you bring them or not!


Survey of alternative health systems for business. There is a new climate of deregulation and increasing competition in the healthcare marketplace. Until recently, methods for moderating the cost of health care have focused on inpatient care to the virtual exclusion of other delivery systems. Thus, ambulatory care has been almost totally ignored. The prominence of business/health coalitions has begun to highlight outpatient providers. Furthermore, medical group practices are beginning to negotiate directly with businesses and industries to provide an agreed upon set of outpatient services. As a part of its ongoing activities and through a grant from the Western Network for Education in Health Administration in Berkeley, California, the Center for Research has initiated a project, New Perspectives for Affordable, Quality Health Care. The research underlying this upcoming Center publication was conducted by Dr. Tynan of the University of Colorado at Denver, School of Public Administration. Dr. Tynan 's survey findings provide an excellent description of the activities of MGMA member groups in alternative arrangements for delivering medical services.


Move your group ahead by hiring an assistant. Have you considered hiring an assistant as a solution to handling the increasing responsibilities of your job? While creating the assistant administrator position may contribute to an effective management team, many factors must be considered as you select the most qualified candidate. How will the relationship between administrator and assistant affect the team? Is it best to hire from within or outside the organization? What professional and personal qualities will cause physicians to accept the new assistant? How should the assistant be compensated? The author examines these issues and more as he gives advice to administrators considering this addition to their staff.


Using work station balancing to increase productivity.


Guidelines for laboratory administration--Part I.


An evaluation of MT nonfinancial job rewards.


Marketing a new product from your lab.

Marketing a new product from your lab.


An in-service training program for the nontechnical staff.


Wrongful discharge and hospital liability.


Learning from litigation.

Learning from litigation.


Noncustodial parent's right in child's health care.


Hospital-physician joint ventures: an opportunity and a challenge.


Survey of 1983 Public Acts.

Survey of 1983 Public Acts.


Survey of 1983 Michigan appelate court cases and attorney general opinions.


Memorial sells stock to physicians and shelters earnings from taxes.


MDPH and comparative CON reviews.

MDPH and comparative CON reviews.


Medicine and the media: searching for a common ground.


Court affirms hospital boards' right to revoke medical staff privileges.


'Catalyst' molds regional medical center.


Computer-aided scheduling can put scalpel to costs of operating room.


Austin questions HCA's loyalty to town.

Austin questions HCA's loyalty to town.


Hospital systems race to form PPO networks to regain market share.


It's time to reconsider old way of running ICU.


Employers cut healthcare spending, but few use most successful methods.


Employers lean on employees in fight against rising healthcare costs.


Ambulatory & alternative services. Alternative services offer hospital systems local market control.


Joint ventures. MRI paints picture for imaging center partnerships.


Joint ventures. Market forces set off skyrocketing interest in hospital-doctor ventures.


Joint ventures. Assign marketing to skilled partner.


Ambulatory & alternative services. Home care tops consumers' list.


Ambulatory & alternative services. How to dodge legal pitfalls of setting up primary care centers.


Ambulatory & alternative services. Emergicenters fight state regs.


Alternative services. Freestanding units less money, but that doesn't stunt growth.


Hospitals turn from acquiring to building new psychiatric units.


HMO chains grow fast, but hospitals could edge into their market.


Alternative services. Surgicenters will mushroom if hospitals don't hobble growth.


Franchised, retail dental operations record major gains.


Dialysis centers will be gobbled up if they can't reduce costs.


Consumers see chain ownership as minus for hospitals: survey.


For-profits adding home healthcare to aid bottom lines.


Short-term debt is popular but risky.

Short-term debt is popular but risky.


Major clinics may unite to boost market share.


Alternative services. Freestanding centers' growth raises questions about corporate practice laws.


Proctoring can be a legal quagmire.

Proctoring can be a legal quagmire.


Alternative services. More outpatient cardiac rehab units circulate in freestanding market.


AIDS patients' bills add up to trouble.

AIDS patients' bills add up to trouble.


Easy, inexpensive tests will diagnose many diseases in minutes, not weeks.


Chicago hospital hangs up on Bell.

Chicago hospital hangs up on Bell.


Sicker patients spur teaching links.

Sicker patients spur teaching links.


Labs will trim staff as high-volume testing provides economies of scale.


Multi-unit providers. Survey plots 475 chains' growth.


Devices tied to microprocessors may open markets, boost productivity.


Breakthroughs in artificial veins, bones produce real benefits for patients.


Hospital circles itself with physicians' offices to stave off competitors' attack.


Hospital purchasing 'changing dramatically': national survey.


Stock deal finances VHA firms.

Stock deal finances VHA firms.


Short-term debtors flirting with danger.


Feasibility studies fell in '83 despite record bond volume.


Court forces state's cost containment program to bow to U.S. Constitution.


Understanding private givers' motivation is key to fundraising.


CONs shield hospitals from antitrust challenges.


Frankness and integrity are keys in CEO's relationship with board.


Competition may stifle cooperation.

Competition may stifle cooperation.


Investor-owned hospital systems tap into growing HMO, PPO markets.


Illinois hospital awaits IRS ruling on prototype physician incentive plan.


Decline ahead in admitting privileges?

Decline ahead in admitting privileges?


Alternative services. Friends' recommendations pull more patients to emergicenters than ads do.


PPOs' efficiency, not their discounts, is prime drawing card for Stouffer.


White paper recommends state aid to California public hospital system.


Write down no-code policy to avoid liability.


New drug-monitoring exams hold a two-edged sword for hospitals.


A needs assessment in continuing professional education. This paper describes a systematic approach to an assessment of the learning needs of practicing nurses, and a computer-based solution to marketing the resulting CE offerings. Demographic, educational and employment information was collected in a data base survey from more than five thousand professional nurses in a thirteen county region of upper New York State. Based upon three mini-surveys, a questionnaire assessing learning needs was then developed and sent to a large subpopulation of these nurses. An analysis of fifteen hundred responses to the questionnaire identified continuing nursing education priorities in the region. Responses to the data base survey and the learning needs questionnaire were merged into a computerized data base management system, which is used to select topics, design courses, and communicate with nurses in the region regarding continuing education. This approach to needs assessment, program planning and dissemination of continuing education information should be useful in solving analogous problems in other areas of continuing professional education.


Regional coordinators of continuing pharmacy education. Seven years later. In 1976 a regional network of coordinators of continuing education was established in British Columbia to increase the accessibility of programs to all pharmacists. The purpose of this paper is to report the contributions of the network to continuing education since its inauguration. As of 1983, 94 pharmacists have been trained to assist with the design and management of continuing education programs and they have had a significant impact on regional programming. When yearly summary statistics from the four years prior to the network are compared to the seven subsequent years an approximate five-fold increase in the average number of programs is found. There is also a greater than two fold increase in the average number of contact hours and an approximate six-fold increase in the average number of registrations. The network of coordinators has increased not only the quantity but also the relevancy of programs by focusing on regional needs. In addition, the network has had spill-over benefits to the University of British Columbia and the licensing body in some of their other province-wide activities such as teleconferencing competency assessment, and poison prevention programs.


Recruiting physicians for a continuing medical education research study. The authors describe the methods and results of a major effort to recruit physicians in the San Francisco Bay Area for a continuing medical education research study. Twenty six hundred primary care physicians were asked to participate in the project, which was designed to assess ambulatory management of Chronic Obstructive Pulmonary Disease (COPD). Two hundred and seventy-seven (11%) returned a postcard declining to participate, and 171 (7%) expressed an interest in participating. Of this latter group, 89 (3%) verbally agreed to enroll, while 63 (2%) actually followed through. Those who participated were representative of the local physician population from which they were drawn in terms of age and sex, but participants included more family practitioners and fewer internists, as well as more board-certified physicians, than would be expected by chance. Shortcomings in the recruitment process are analyzed, and suggestions are offered for securing higher participation rates.


California's durable power of attorney for health care.


Systemwide QA leans heavily on board talks.


Investor-owned growth shifts from numbers to niche. Part I.


QA is more effective, comparatively speaking.


System ties boost small, rural accreditations.


Executive profile. A 12-month overnight success. Interview by Kelly F. Guncheon.


More work needed on MD/multi relationships.


Corporate structure 'check up' spots potential problems.


Final bar code standard approved and available.


Firms see growth spurt for hospital equipment rental.


FEC chain purchasing moves into big time.