A patient care success story.

A patient care success story.


Employee suggestion programs net hospital/patient savings.


Timbrell reassures small hospitals.

Timbrell reassures small hospitals.


Time waits for no one.

Time waits for no one.


Nursing survival in the executive jungle.


Administration in a bilingual community.


Hospitals merge laundry operations.

Hospitals merge laundry operations.


Contract services--food for thought.

Contract services--food for thought.


Crombie isn't jumping the gun.

Crombie isn't jumping the gun.


Pharmacy Q's & A's: communication problems.


Australians find TV sets cut monitoring costs.


Basic services vital for small pharmacy.


The impact of role clarity on job satisfaction for hospital managers.


What are the standard qualifications and compensation for hospital cardiologists? How are they selected?


Imaging from all points of view.

Imaging from all points of view.


Technique caters to hospital needs.

Technique caters to hospital needs.


Evaluation of a new generation ethylene oxide sterilizer relative to reduction in operator exposure to ETO.


Shared services: a long term commitment or a short term fad?


A quality control program for central supply.


Should you invest in a solar energy system?


Material management Q's & A's.

Material management Q's & A's.


Beneficial by-products of decentralization.


Trustees have power--grab it and use it.


Health ministers chart course for 80s. Interview by Nicole-Marie Squires.


Cut cleaning costs--it's all in the timing.


Low morale spurs Canada's brain drain.

Low morale spurs Canada's brain drain.


Competence: the main determinant.

Competence: the main determinant.


Let's swing the pendulum back.

Let's swing the pendulum back.


Hospitals: a triple play for power--defining who does what.


Regulation: the fourth power.

Regulation: the fourth power.


New assertiveness among trustees.

New assertiveness among trustees.


Community consumers seek access to the board room at Roxborough Memorial Hospital.


From SAC's to DAC's--will consumers' voices be muted?


HSAs and the representation of consumer interests: conceptual issues and litigation problems.


Hospital cost containment: unpleasant choices, unpleasant prospects.


Hospital cost containment: a voluntary program for Pennsylvania.


Hospital cost containment: New Jersey's rate regulation system.


Blue Shield and the nurse-midwives.

Blue Shield and the nurse-midwives.


The evolving practice of midwifery.

The evolving practice of midwifery.


Training: key to efficient security system.


BAD program increases employee cost awareness.


Two approaches to energy conservation.

Two approaches to energy conservation.


Health sector vs. public utility regulation.


Cost containment committees: slowing down the increases.


Adaptation to environmental change: the board's role.


Understanding professional job attitudes.


Primary care group practice: impact on a community hospital.


Filling empty board seats.

Filling empty board seats.


HSAs versus physicians--health planning adversaries.


Bakke-ing up the wrong tree.

Bakke-ing up the wrong tree.


Making pediatrics residency training a community affair. A successful community pediatrics residency training program was created through a university/community hospital affiliation agreement. Residents get firsthand experience with children on an ambulatory basis through the special office rotation program, and they are exposed to a broad panorama of pediatrics that is not primarily tertiary in nature. Residents also become familiar with community hospital settings--the facilities that they will use most often in their careers.


Strengthening doctor's office/hospital ties. Relations between the physician's office and the hospital are important to patients, physicians, and to the physician's office staff. Lack of communication, misinformation, and mistakes often can put unnecessary strain on the relationship and can cause conflict between the physician and his staff and the hospital. Several hospitals and their medical staffs have worked to promote good physician's office/hospital relations through programs that improve communications.


Developing an educational safety program for pharmacy employees. The need for developing educational safety programs for pharmacy employees is discussed. A three-part program is offered as a guide for structuring a departmental safety program. Part I deals with environmental hazards such as wet floors, poor lighting, and cluttered walk areas. Precautions that should be taken to avoid accidental exposure to patients with communicable diseases are also included. Hazards that may result from improper handling of materials or equipment are addressed in Part II. Included are precautions for handling chemicals, needles, ladders, and electrical equipment. Proper methods of lifting heavy objects are also discussed. Part III details plans to protect staff members in the event of a fire. Plans for reporting fires and evacuating the pharmacy and hospital are discussed. The outlined program requires self-study by staff members during initial employee orientation, followed by annual retraining. Employees are tested and graded on safety topics, and training records are filed for future reference. The program outlined is thought to offer a simple yet effective means of acquainting staff members with established institutional and departmental safety procedures.


Financing hospitals and clinical pharmacy services. This article describes the existing health care operating environment and specifically details the reimbursement pressures within the hospital milieu. The paper outlines several financial management subjects that have special relevance to financing clinical pharmacy services. The process of developing new clinical pharmacy services which were subsequently approved for third-party payment is highlighted. The article optimistically concludes that new and extremely relevant clinically oriented pharmacy programs that offer valuable service to the patient population can be developed and implemented with approval for reimbursement.


Unit dose packaging for long-term mental health facilities. A study was conducted by two mental health institutions to determine the usage and the cost of providing oral solid unit dosage medications to 1400 patients. The results in the two institutions were as follows: 1) 257,732 (12%) and 73,956 (17%) doses were not commercially available; 2) 656 and 134 technician hours per year could be saved by employing a vendor packaging service; 3) only 119,802 (5%) and 66,627 (15%) of the doses were available commercially at little or no additional cost compared to bulk purchase; and 4) 1,856,752 (83%) and 298,712 (63%) doses were available commercially at a premium price of $34,138 and $8,544 per year. The unusually high quantity of medications not commercially available in unit dose packages and the high cost of purchasing those that are available may be the result of the specialized care provided by a mental health facility. Therefore, methods of providing unit dose products in acute-care hospitals may not be adaptable to mental health facilities or to other specialized care providers.


Education and training for computer-based reference services: review of training efforts to date. This article raises several questions regarding training for computer-based reference services, including who is to be trained and who is responsible for training. It discusses these issues and then provides a summary of the training provided to date by search service suppliers, database suppliers, library schools and extension programs, library cooperatives, and professional organizations. The available training materials are also discussed. Some projections are made of likely future activities.


Implementation of a unit dose distribution system for respiratory therapy medications. The development and implementation of a comprehensive unit dose distribution system for respiratory medications is described. Initially, an evaluation of carts and unit dose packaging materials for respiratory medications was conducted. Subsequent to the selection, a unit dose processing and packaging program was developed in accordance with the Respiratory Therapy Medical Director's Standard Treatment Orders. A 24-hour exchange system, separate but paralleling the already operational unit dose system, was implemented. The primary advantages attributed to the implementation of this system were 1) a decrease in potential respiratory medication order interpretation/transcription errors; 2) a decrease in the waste of medication solutions; 3) a decrease in potential preparation errors by the respiratory therapists; 4) standardization and accuracy of respiratory medication dosages; and 5) a more equitable method of charging patients.


"Human rights" for FNGs.

"Human rights" for FNGs.


Preparation and the hospitalized child.

Preparation and the hospitalized child. The whys and hows of preparation for children with special emphasis on the young child. It discusses under what circumstances preparation is most valuable. The role of the parent as an essential ally in successful preparation is explored. The emotional "set" of the person doing the preparation is discussed. The very conscientious worker will be consoled that despite all earnest efforts there will be instances of failure.


Parent aides: an intervention program in cases of child abuse and neglect. The article describes a program at Childrens Hospital of Los Angeles that has developed a treatment modality for child abuse and/or neglect families using nonabusive parents as a critical link between the patient families and community and professional resources. A component of a larger intervention program, the Parent Aide Program involves nine aides recruited from the community and given orientation and training to some of the probelms of child abusing and neglecting families. Under supervision they are assigned to selected families identified at the hospital and function in a variety of ways. They provide many of the services of a "good neighbor" (e.g., emergency transportation and babysitting) as well as emotional support and encouragement.


Association for the Care of Children in Hospitals: position statement on involvement of parents and families in health care settings.


Association for the Care of Children in Hospitals: child life activity study section position paper.


Going beyond the cosmetic: a Southern California community hospital supports design in depth.


Red Cross Blood Center: Buffalo's new AIA award-winning facility designed by Hamilton Houston Lownie Architects.


At Mount Sinai: John Saladino's prototype patient rooms presage a planned four-floor renovation.


The business aspects of hospital design.


Musical psychodrama: a new direction in music therapy.


Comparison of a reality orientation program for geriatric patients with and without music. Reality orientation (RO) is a technique used with patients exhibiting confused or disoriented behavior. The purpose of RO is to reverse or halt confusion, social withdrawal, and apathy characteristic of elderly institutionalized patients. The purpose of this study was to compare the effects of a traditional versus music-based RO program. Eight residents of the Chateau de Notre Dame Nursing Home were randomly assigned to experimental and control groups. A pretest was administered to identify any significant differences in RO and behavior functioning between the two groups. The specific goals and objectives for the RO program were then formulated from information gathered on the pretest. The experimental group received two 30-minute music-based RO sessions a week for 8 weeks, while the control group received the same number of traditional RO sessions without music. Upon completion of the treatment, the posttest was administered to each subject. A two-way "mixed effects" analysis of variance was used to analyze the data. A significant interaction (p less than .05) was found between the groups and the treatment condition, with the control group remaining at the same level across trials and the group receiving the music-based RO showing marked improvement.


Litigation as a tool for social change.

Litigation as a tool for social change.


Mental health law and administration: who is "on the side of the angels"?


Geriatrics beyond 1980.

Geriatrics beyond 1980.


Trends in hospital labor relations.

Trends in hospital labor relations.


Self-image and age group perceptions of the institutionalized elderly.


Gerontological health care: from a hospital perspective.


The effects of socioeconomic characteristics and off-reservation contacts on the service awareness and usage patterns of elderly native Americans.


Does the aim of human medical experimentation affect its legal or ethical validity?


Artificial insemination and semen cryobanking: health and safety concerns and the role of professional standards, law and public policy.


Laundry and nursing departments should work together, says nurse.


Two burn care units create serious stain removal problems.


Soviet medicine from the inside: 2. Nothing works, including some doctors.


A model for cost control? Not this teaching hospital!


How to mine the silver lode in your office.


How our model IPA went bankrupt.

How our model IPA went bankrupt.


Electronic thermometry.

Electronic thermometry.


ASTA evaluates findings of GAO report.

ASTA evaluates findings of GAO report.


Thoughts on the salesmaker's nemesis -- inflation.


Certificate of need revisions on the way.


Regulating the diffusion of hospital technologies.


The backbone of health care economics: community hospitals.


Preferences of a proprietary hospital purchaser. Interview by James D. Snyder.


The hospital vacuum cleaner: mechanism for redistributing microbial contaminants. Carpeting patient care units in acute care hospitals is increasingly common. While the safety of carpeting has been heavily debated, there has been little epidemiological data to document risk to the hospitalized patient. With the report of a two-year study documenting human contamination and potential colonization by microorganisms spread from hospital carpeting, a need was established to document modes of transmission. The objective of this study was to define the potential of hospital vacuums for dispersing particles of a size comparable to the microbial cell. Both filter efficiency and vacuum exhaust turbulence are evaluated. Results document that of eight units claiming high efficiency filtration, none was capable of meeting advertising claims. In addition, exhaust air velocities for one unit reached 175 feet per minute at 30 inches above the floor.


Computers--use in health care.

Computers--use in health care.


Legal criteria for orders not to resuscitate: a response to Justice Liacos.


'Surgicenters'--knifed by hospitals?

'Surgicenters'--knifed by hospitals?


HEW advisers eye physician 'oversupply'.


How to make the Massachusetts patients' bill of rights work.


What's right with patients' rights.

What's right with patients' rights.


Hospital engineering in the 1980s.

Hospital engineering in the 1980s.


Hospital industry leans toward GOP, but candidate support still divided.


Step up discussions of SEIU-RWDSU merger.


Defeat of Carter's cost cap bill confirms Voluntary Effort success.


Consumers will have larger role in formulating healthcare policy.


Planners warned of anti-reg mood.

Planners warned of anti-reg mood.


Diploma schools fight ANA proposal.

Diploma schools fight ANA proposal.


Multiunits boost nursing's clout.

Multiunits boost nursing's clout.


Multilevel garages solve parking problems of land-locked hospitals.


Medicine turns to non-X-ray modes.

Medicine turns to non-X-ray modes.


Inflation boosting labor costs 9% from 1979's moderate 7.5% rise.


Building costs rising, so find project financing now, analysts recommend.


Recession will worsen in 1980, but with little impact on hospitals.


Court's decision uncovers some ambiguity in state's conscience law.


Hospital execs spend more time and money on trustee education.


Hospitals shifting planning emphasis from facilities to programs, services.


Healthcare antitrust litigation threatens shared services.


Antitrust suit may affect all group purchasing.


Religious opposition raises cost of setting up 'test tube baby' lab.


Employee benefits: no abortion benefits, no contracts. The new U.S. federal pregnancy benefits law requires companies and organizations to pay for employee's abortions performed to save the life of the mother and to pay for any medical complications resulting from an abortion on the same basis as they pay for other illnesses.  In December 1979 the Labor Department issued a proposed regulation which would bar companies, which failed to comply with the new benefits law, from obtaining federal contracts.  The proposed rule would apply to companies which do more than $10,000 worth of business with the government.  300,000-600,000 firms annually hold federal contracts worth $100 billion, and if the rule is approved it will serve as a powerful sanction.  The regulation could prove costly for Catholic employers, including many Catholic universities and hospitals, and the U.S. Catholic Conference and the National Conference of Catholic Bishops are expected to challenge the regulation.


Closing hospitals won't generate any savings.


See 14% design dollar volume rise; renovation's share grows rapidly.


Banks buy hospital bonds again.

Banks buy hospital bonds again.


PRRB's independence questioned.

PRRB's independence questioned.


1980 construction volume will rise sharply following slight dip in 1979.


Alternative birth centers prove their popularity with patients, physicians.


Facility replacement troubles boards.

Facility replacement troubles boards.


Hospital moves can run smoothly.

Hospital moves can run smoothly.


New designs cut construction costs.

New designs cut construction costs.


Codes: too broad, too brief and inflexible.


Computer-design trims building cost.

Computer-design trims building cost.


Small hospitals' computer usage will increase rapidly through 1983.


Administrator must share authority.

Administrator must share authority.


Accounting for multi-unit systems.

Accounting for multi-unit systems.


I.V. manufacturers compete with new products, better management.


Hospitals owe incapacitated patients extraordinary supervision and care.


Hospitals cut inventories by 20%.

Hospitals cut inventories by 20%.


Hospitals turn to energy consultants.

Hospitals turn to energy consultants.


It's a nurse's market.

It's a nurse's market.


Financing healthcare: soaring rates force new strategies.


Conservation and solar power bridge energy gap during 1980s.


Employe must complain to EEOC before feds force abortion payment.


Basic, energy-conserving design principles take high priority again.


HEW incentives depend on Philadelphia study.


Garbage fires hospital steam boiler.

Garbage fires hospital steam boiler.


Long paybacks slow solar power, but more widespread use expected.


Boiler coal retrofit will save millions of dollars.


Energy awareness nets savings.

Energy awareness nets savings.


Pre-placement medical exams.

Pre-placement medical exams.


Early disease detection services.

Early disease detection services.


Buying first aid.

Buying first aid.


Insurers urge catastrophic health plan.

Insurers urge catastrophic health plan.


Applaud health care quality, boo high cost.


Medical ethics and social reality.

Medical ethics and social reality. The Ad Hoc Committee on the Principles of Medical Ethics of the American Medical Association currently is working to revise the Principles of Medical Ethics, first adopted in 1847 and last revised in 1957. In this article, the author examines the rapidly expanding and changing society that has made a revision in the Principles necessary.


Instrument quality assurance for test result quality and laboratory operation. To assure the quality of the clinical laboratory analytical process, each element composing that process must be tested for quality control--including the laboratory instruments. This article concerns itself with three areas of instrument quality control, areas which result in a prolongation of equipment life and a general improvement in laboratory quality.


Hot shots: unauthorized photography.

Hot shots: unauthorized photography.


Training first-line supervisors to criticize constructively.


Employee relations and union organizing campaigns.


An EEO examination of employment applications.


Seattle agency provides home care for shut-ins.


Illegal aliens: employment restrictions and responses.


The dying patient.

The dying patient.


Parrying attacks on medical confidentiality.


How to prepare a radiology policy and procedure manual.


The impact of government regulation on radiology.


Can radiologic technologists form their own collective bargaining unit within a hospital, exclusive of other employees?


Patient acuity determines staffing at Miami Valley.


Radiologic administration: structure and style.


Procedures for isolation techniques.

Procedures for isolation techniques.


Controlling linen usage.

Controlling linen usage.


A landmark decision re: the $3600 exclusion?


Product liability and the vendors' endorsement.


How to succeed as a risk manager.

How to succeed as a risk manager.


The public health issues in nursing home care. Characteristics of patients in nursing homes and the nursing homes in the United States are reviewed. Issues concerning the selection of right nursing home for the right patient are discussed in the context of measuring the needs of the patient, describing the environment of the home, and involving the patient and family in the selection process so that the best patient-environment mix can be obtained. The major issues after nursing home placement relate to quality and cost of care. The problems in measuring quality of care in the nursing home are addressed, and a goal-attainment model is proposed for both quality assessment and cost containment. Examining alternatives to nursing home care and encouraging research into diseases that lead to placement in nursing homes are seen as high priority goals in the field.


Adapting chronological stabilization to property risks.


The psychosocial needs of the Chinese elderly. Changing Chinese family patterns caused by immigration have contributed to the breakdown of traditional community and familial control in Chinese-American families. As a result, the Chinese-American elderly are faced with unique psychosocial problems that workers must consider when providing services to this population.


The regulation of family involvement in deinstitutionalization. Conflicting legal, administrative, and professional policies surround family involvement in the deinstitutionalization process. This article addresses these discrepancies and makes recommendations for developing effective and consistent channels of policy among social workers and other helping professionals.


Short-term treatment with the adolescent client. Short-term treatment is proposed as the treatment of choice for adolescents because it is consistent with the developmental needs and goals of that age group. Several case illustrations have been provided to show the value and benefit of such an approach for the adolescent client as well as for the therapist.


Sex differences in the use of psychiatric outpatient facilities. Previous research has shown that both symptoms and sociocultural factors are related to use of psychiatric outpatient facilities. However, the utility of using treatment rates from these facilities to make etiological inferences depends on whether sociocultural effects on utilization are trivial or substantial. In this paper data are presented for one such inference, that women are more in need of treatment than men. We find that observed sex differences in the use of a student psychiatric clinic are due both to differential propensities to seek help for problems and also to differential numbers of problems, both of which are higher among women than men. However, the differential propensity to seek help is found to be by far the more important of these two effects.


Wealthier is healthier.

Wealthier is healthier.


Forecast '80: $9.5 billion bonanza.

Forecast '80: $9.5 billion bonanza.


The hospital supply market in the '80's: a study.


Case studies to challenge the nursing home activity coordinator.


Therapeutic recreation services as a component of optimal health care in a general hospital setting.


The marketing mystique.

The marketing mystique.


Hospital marketing: a first hand account.


Marketing research tools for hospital management.


Risk management education: program development--Part two.


Cost containment ideas....the increase in silver has some significant cost considerations for hospital radiology departments.


Crime victims compensation act.

Crime victims compensation act.


Marketing mania: a brief look at what the process is all about.


"The recruitment effort is an extensive and time consuming one.".


Hospitals are $aving more than lives--the Texas voluntary effort: focus on the nursing shortage.


Pipeline or panic.

Pipeline or panic.


The shortage of nurses.

The shortage of nurses.


Risk management education program development.


Hospital auxiliary.

Hospital auxiliary.


Nurse shortages: the growing crisis.

Nurse shortages: the growing crisis.


Release of medical records.

Release of medical records.


Quality assurance coordinator: what are the qualifications?


The chairman's page: the nursing shortage.


"Communicating information about the hospital's nursing program is the nurse recruiter's greatest challenge.".


Report from Washington: the hospital cost containment issue.


Psychotropic drugs: a constitutional right to informed consent.


Demystifying quality assurance.

Demystifying quality assurance. At Methodist Hospital of Indiana, trustees participate as observers on certain medical staff committees. In addition to its educational and other advantages, the method has helped to increase understanding between trustees and medical staff members.


The legal perspective: leasing office space to physicians. The leasing of space in medical office buildings should be undertaken only after a careful study of the tax, certification-of-need, and reimbursement consequences. Under some circumstances, income from the leasing of space is taxable, and the goal of achieving favorable tax consequences may conflict with the goal of achieving favorable CON and reimbursement results. The question of obtaining public charity status for a freestanding medical office building also should be addressed.


Where have all the donors gone?

Where have all the donors gone? Hospital philanthropy is not going to vanish, although it may change with the changing society. Some observers believe that the hospital share of the philanthropic dollar may diminish in the future, but there are balancing circumstances suggesting that hospital philanthropy may grow instead of shrinking.


'Mr. Trustee' as Under Secretary of Health, Education, and Welfare.


Community responsibility ain't easy.

Community responsibility ain't easy. Although the confrontation politics of the '60s have mellowed, hospitals shouldn't be lulled into thinking that they have met all their community responsibilities. Hospitals can respond to their communities by, among other things, including community representatives on their boards, communicating with as many groups as possible, and seeking to reduce fragmentation and increase comprehensiveness of care.


Hospital trustees to face tough rationing decisions, analyst says.


As I see it: the defeat of the Administration's cost control legislation.


Pay parking brings new problems: six VA hospitals win exemptions; unrest continuing.


Abortion services lacking in local areas, study says.


The role of government in health-care delivery in the 1980s: private initiative or government coercion?


A panel discusses health manpower legislation in the '80s.


Federal health programs: the Health Services Administration.


Productivity and efficiency in human service organizations as related to structure, size, and age. A study of the relationship of productivity and efficiency to the organization's structure, size, and age (or "time") indicated that a highly centralized authority structure is the most powerful direct determinant of productivity and efficiency. Conclusions focus on the pervasive conflict between quality and quantity of services delivered and the implications of this for the human service administrator.


AMA brief challenges FTC ad ruling.

AMA brief challenges FTC ad ruling.


Canadian physicians urge funding changes in Medicare program.


Physician-market analyst plans to develop medical investment banking firm.


Budget outlook bleak for health programs.


Patients urged to examine MDs.

Patients urged to examine MDs.


New hospital policy voted.

New hospital policy voted.


California MDs vote to set up bargaining unit.


Overdue accounts? Ten ways to minimize the problem now.


Prescription drug use and patient education--the critical role of the pharmacist.


Candidates' views on NHI.

Candidates' views on NHI.


New boom in alcoholism therapy brings growing pains to industry.


HCFA backs study of federal programs for reimbursing MDs.


Overcoming the barriers to pharmacist intervention in problems associated with the use of drugs--institutional pharmacy.


Civilian hospital use by military in wartime likely, Pentagon MD says.


Protecting privacy.

Protecting privacy.


Dying as failure.

Dying as failure. With the changes over the past forty years in the way people die and in the ways they are cared for when ill, the attitudes toward death have changed. When death seemed a metaphysical event, it commanded a kind of respect. Today, with the process of dying protracted--sometimes for years--it seems an evidence of failure.


Moral and ethical dilemmas: seven years into the debate about human ambiguity. Developments in modern medical technology force many questions upon the health professions and the public. To what extent should technology be used to extend life when doing so seems futile, perhaps brutal? Who should decide such questions? What options should be available? Conditions in which such questions arise are often chaotic because of the nature of illness and treatment and because many extremely important issues in life have been poorly deliberated by the health  professions and the public. This essay is an attempt to clarify some of the issues.


Talking about death: patterns of lay and professional change. For the past thirty years, researchers have surveyed attitudes of providers and patients to the disclosure of the diagnosis and prognosis to the dying cancer patient. Though the lay population has expressed the wish to know over time, a change in provider attitudes is apparent: physicians are now more likely to inform their dying patients of the truth than before. This trend is viewed against a number of precipitating factors: changes in perception of the impact of disclosure and changes in the basic ethical norms related to disclosure with new cohorts of younger physicians reflecting these changes. These correlate with changes in underlying social structure brought about in part by the shift to chronic disease as the paradigm for medical care. With increasingly bureaucratized health care delivery, the physician must collaborate with others who may hold different judgments about what ought to be disclosed. Some nurses not only find it right to disclose, but also in their professional interest. In such settings, honesty may be necessary to avoid conflicting messages to the patient. These shifts may signal underlying shifts in the sick role and in the medical professional role with the patient more active and more knowledgeable in medical decisions and the physician serving as a source of information and counsel.


Nursing the dying: implications of Kübler-Ross' staging theory. Society's failure to value the work of nurses, the professionals most frequently involved in the care of the dying, is attributed to a cultural definition of nursing as a second-class occupation and the public's need to deny the realities of the suffering and indignities often associated with the process of dying. Efforts within the field of nursing to improve the care of the dying, by shifting emphasis from a narrow physical focus to a more holistic patient and family focus, preceded the past decade's contributions of Elisabeth Kübler-Ross. Although her staging theory has been cited as having limitations in development and in interpretation, Kübler-Ross' influence towards increasing awareness of the needs of the dying and others experiencing major losses has been substantial as evidenced by many references to staging theory in nursing literature, by a marked increase in attention to holistic care of the dying in the basic and continuing education programs of nursing, and by specialty role development in nursing care of the dying. This decade has also witnessed the major growth of professionalism in nursing, including strides towards professional autonomy. Conflict with the traditional pattern of medical dominance and bureacratic constraints in institutions is inevitable, especially when the medical goal of cure is not attainable. Change to an interdisciplinary model of care is viewed as essential for optimal care of the dying and their families.


The hospice movement and its implications. Hospices, unheard of in this country a few years ago, have become a fast-growing American phenomenon. They promise effective pain relief for terminal cancer patients as well as a warm, homey atmosphere where fear and loneliness are minimized. Hospices are basically a creation of the British and it is still unclear how--or even whether--the principles they embody can be successfully incorporated into American medicine. However, hospices can make an important philosophical contribution by showing the way toward removing the stigma attached to death. Hospice principles also have implications for all of health care, in emphasizing the importance of treating the whole person rather than just the disease.


Is death and dying merely an ethical issue? Some people worry about the current tendency to ignore the distinction of religious and ethical issues in the area of death and dying. This article attempts to identify sources and consequences of such blending. One of the countries offering a microcosm of religious and ethical trends with regard to death and dying is the Netherlands. Issues identified in Dutch society are, therefore, being compared with similar listings in North American and European literature on death and dying. In an even more paradigmatic way the unfinished debate on the distinction between active and passive euthanasia remains representatives of a religious approach to death and dying.


The health-care merry-go-round.

The health-care merry-go-round.


On the critical list.

On the critical list.


Deregulation fever spreads to HEW's rules on using human guinea pigs. The federal deregulation effort has reached all the way to the use of human guinea pigs in medical and social science experiments. But in the views of many critics, the Health, Education and Welfare Department hasn't gone far enough with its current proposal to add flexibility to the operations of the boards that review experiments involving human subjects at institutions that receive HEW research money.


FTC is cautious about health-plan rule on eve of Senate debate of agency power.


Administration studies ways to control some hospital costs without legislation.


Health care and the poor.

Health care and the poor.


Alcohol abuse: employe benefit plans start to cover treatment as insurers alter attitude.


HMO option keeps costs down: survey.

HMO option keeps costs down: survey.


Hospital execs start society.

Hospital execs start society.


Blount Memorial aids county in trustee selection process.


Patient opinion surveys: costly showpieces or valuable commodities.


Subscriber advisory councils provide plans with informational pipeline.


CS technician: a career job at St. Mary's.


Engineers say heat exchangers can help cool off fuel costs.


How to deal with Ma Bell.

How to deal with Ma Bell.


Handling small orders fast with a requisition/purchase order form.


Patient telephone service: covering costs.


Containing telephone costs--Part II.

Containing telephone costs--Part II.


The competitive response of Blue Cross to the health maintenance organization. The health maintenance organization (HMO) is an alternative to the traditional fee-for-service health care system in the United States. Other studies have shown that the HMO reduces hospital utilization and offers greater benefit packages than fee-for-service. This paper tests whether the presence of HMO's provides effective competitive pressure on Blue Cross, the largest insurer of hospital costs. The cross sectional regression analysis supports the hypotheses that Blue Cross has reduced hospital utilization and increased benefit packages in response to HMO competition. Consequently, competitive forces are shown to be operative in at least one area of health care.


Shared CS: the norm in the United Kingdom. Interview by Dan Dildine.


Borrow and loan made simple.

Borrow and loan made simple.


Anti-pilferage plan held legal in court.


Pauley on purchasing: policies and procedures.


1980: innovation or defeat?

1980: innovation or defeat?


Barry Hutchings, ASHFSA, forecasts hospital foodservice in the 80's.


Staff and patient participation in decision-making in residential treatment programs. The merit of increasing the involvement of staff and patients of residential treatment programs in decision-making has been discussed by numerous writers, but few studies have provided extensive measurement of this concept. The authors have developed a twenty-four-item scale that assesses in detail the nature and extent of participation by staff and patients in decisions about treatment planning and routine patient care.


Looking ahead: HCFA in the 80s.

Looking ahead: HCFA in the 80s.


The personnel director: a cautious hero indeed.


The growing role of clergy in wholistic medicine.


Regulatory relief ideas for hospitals in '80s: some viewpoints from an observer.


Cost containment: a permanent idea.

Cost containment: a permanent idea.


Deinstitutionalization: the church as a resource.


Deinstitutionalization: our Fairweather friends.


Deinstitutionalization: mental health and religious community.


Therapy improvement in two out-patient mental health clinics. This study describes clients, therapists, treatment characteristics, and therapy outcomes for 551 consecutive, first-time clients at two out-patient mental health clinics. Significant improvement was found on target problems, global outcome ratings, and Hopkins Symptom Checklist scores for clients who mutually terminated therapy. The target problem and outcome ratings remained higher for this group than for dropouts at a six-month follow-up interview. Clients who improved most were those who were initially most uncomfortable and disturbed. Improvement was also strongly related to the number of therapy sessions. The implications of these and other results are discussed.


Issues in mental health management and administration. Administrators and middle managers from six CMHCs in Tennessee and Alabama were interviewed during site visits for the purpose of determining the main issues in mental health management. A step-by-step conceptual methodology was followed to process the field notes and interview responses. The views of a senior-level management professor specializing in mental health management and a senior-level professor in community psychology were used to further interpret and refine the results of this investigation. Although many diverse issues surfaced, an integrating theme emerged in the form of a need for management to motivate and inspire CMHC staff to a sense of mission.


A study of coordination of services: referrals. This article reports a study of referrals among social service and mental health agencies. Staff from human service agencies were interviewed about the process of referring and asked to make simulated referrals using mock clients constructed for this study. Interview data show lack of communication and inappropriate referrals as the biggest problems with the referral system. Interjudge agreement about the simulated referral choices was found to be not significantly different from chance. The data also suggest that agency staff refer on the basis of "habits" as much or more than on the basis of client problems. The frequency of inappropriate simulated referrals was relatively high (15%) considering that agencies included in the sample are large public agencies with broad definitions of what clients are appropriate for their services. Implications of these findings are discussed in terms of existing incentives for agencies to cooperate or compete and need for methodology to evaluate service delivery systems or networks.


Victory in the House. Greater challenges seen for VE after House rejection of Carter cap.


Application of the training in community living program to rural areas. In previous work, The Training in Community Living program has been shown to be an effective and feasible mode of community treatment for markedly impaired patients. However, questions have been raised regarding its potential for dissemination to clinical settings in communities other than Madison, Wisconsin. Described are successful experiences in consulting with three rural Wisconsin counties to help them establish community treatment programs modeled on Training in Community Living principles. Also described are the factors responsible for the success of these consultations.


Silver: a futures commodity for hospitals.


Director points out the advantages in bridging linen and housekeeping.


Legal, ethical risks make doctors hesitant to stop life support systems. Part 3.


Executive housekeeper fights for 2nd laundry expansion.


The hospital energists team: in place in Virginia.


Columnist tells how to judge cost effectiveness of bed linen.


Hospital loss control consultant tells how to prevent accidents.


Planning--a cycle or a steamroller?

Planning--a cycle or a steamroller?


Filing room.

Filing room.


The information room.

The information room.


Discharge procedures including ward clerk involvement and HAA.


"Do-it-ourself" health care plans--prescription for inflation.


A practical approach to determining training-solvable problems. Training is a necessity to progressive companies, but how do you decide which problems would benefit from it? The authors' model, based on current literature and consulting experience with a large organization, stresses the importance of using existing data for a more exact and cost-effective diagnosis.


A neglected and intelligent alternative to arbitration is finally coming of age. Although not a substitute for arbitration, grievance mediation can be an effective, readily available and inexpensive means of resolving some disputes. Educator/arbitrator Bowers also sees it as an unjustly neglected preventive measure and seeks here to remedy that neglect by examining mediation's role in labor relations.


Starting an assessment center the correct way.


Controversy over physicians on Blue Shield boards.


Rural practice: why some physicians prefer it.


How to establish physicians' salaries in group practice.


Coping with OSHA.

Coping with OSHA.


Abortion policy in Britain and the United States. This article compares the number of legal abortions performed in the United States and Great Britain. It reveals that the rate of abortion in the United States is more than twice that of Britain. The author analyzes the reasons for the different rates. The British abortion act became effective in 1968; before that date about 100,000 illegal abortions were performed each year, causing, in 1966, 47 maternal deaths.  In 1976 legal abortion rate was 11/100,000 and maternal mortality had dropped to 2.2/100,000 abortions.  The highest number of abortions is in the age group 20-24, and among single women.  Abortion on request was legalized by the U.S. Supreme Court only in 1973.  In 1976 the abortion rate was 23.2/100,000, and maternal death rate about 3/100,000 abortions.  Thus, the abortion rate in the U.S. is more than twice that of Britain.  Reasons accounting for such great disparity may be: 1) in Britain contraception was always more popular, legal since 1930, and mostly free; 2) abortion rate among minorities in Britain has little effect on the general ratio, which is not the case in the U.S.; 3) public censure for an unmarried mother is much less in Britain than in the U.S.; and, 4) contrary to public opinion, sexual equality between sexes is much more advanced in Britain than in the U.S.


How to conserve O.R. garments.

How to conserve O.R. garments.


Use of the telephone in child play therapy.


Survey on hospital penetration of rental service.


A sewing room that cuts costs.

A sewing room that cuts costs.


Significant issues in medicine and law 1978-1979.


A voice of reason: balancing new technology with health & safety.


VA clinic saves space with automated records retrieval.


Health Resources Administration: determination of population of health service areas.


Medical participation in control of certain open-panel medical prepayment plans: Federal Trade Commission. Request for comment and advance notice of proposed rulemaking. This Notice requests comments on two staff reports dealing with medical participation in control of Blue Shield and certain other open-panel medical prepayment plans and on alternative courses of action that the Commission might take to deal with this subject, one of which might be rulemaking.


Food and Drug Administration--infant formulas; interim guidelines for nutrient composition; notice to manufacturers, packers, and distributors. Notice. The Food and Drug Administration (FDA) is announcing in this notice a statement of policy concerning interim guidelines for the nutrient composition and nutrient levels in infant formulas. The recommendations on standards for nutrient levels in infant formulas made by the Committee on Nutrition of the American Academy of Pediatrics in 1976 should be followed by infant formula manufacturers as interim guidelines until revision in the existing infant formula nutrient composition regulation (21 CFR 105,65) is completed. This statement of policy from the U.S. Food and Drug Administrative (FDA) states that the standards for the nutrient levels in infant formulas, set by the Committee on Nutrition of the American Academy of Pediatrics (CON/AAP) in 1976, be followed by infant formula manufacturers until revisions in the existing infant formula nutrient composition regulation is completed.  Because the list of essential nutrients in the current regulation which was established in 1976 is not as comprehensive as that given for the CON/AAP recommendations, the FDA is recommending to manufacturers that the additional information be used in conjunction with the current regulations.  Based on recent analytical data the FDA believes that if the infant formula industry strictly adheres to the 1976 CON/AAP recommendations they will reasonably ensure the nutritional safety and adequacy of their products.


Health Resources Administration--grants to state health planning and development agencies, determination of population of the states.


Hospitals and the government.

Hospitals and the government.


Meals on wheels: how to turn victory into defeat--and back into victory.


Floor maintenance.

Floor maintenance.


NLRB bid to ease recognition of unions in nonprofit hospitals fails in top court.


Medical costs and the drug industry.

Medical costs and the drug industry.


Apathy over HMOs.

Apathy over HMOs.


Minn. hospitals challenge state in maternity case.


Nurse/midwives: most Blues plans won't pay.


Pressures are building: extended health or medical benefits to workers in the event of layoffs or plant shutdowns.


The right to die by choice. (Whose life is it, anyway)?


Should doctors be on hospital boards?

Should doctors be on hospital boards?


IAHCSM releases salary survey.

IAHCSM releases salary survey.


Hospital stays decline for Blues' patients.


Implementing a perpetual inventory system.


Health care in America: a purchaser's perspective.


Centralized vs. decentralized purchasing.


Cessation of treatment--euthanasia--suicide of patients.


Changes in Tennessee Certificate of Need program.


The relationship of institutional planning to areawide planning.


Euthanasia.

Euthanasia.


Data for health planning.

Data for health planning.


The current judicial interpretation of the 1969 abortion law. The author, D. Dehler, is seeking to get the Canadian Courts to recognize that an unborn child is a fully legal person.  A lower court judge refused to hear the case brought by Dehler.  The judge claimed that Dehler failed to cite case laws to demonstrate that an unborn child was a legal person.  Dehler argues that judges must recognize that they are law-makers.  Courts historically have assumed law-making powers when basic human values were at stake.  If laws, passed by politicians in legislative bodies, are contrary to the ethics and values of the society, these laws must be struck done by the courts.  Society places its highest trust in judges, not in politicians.  Society expects its judges to uphold the values of society.  If the Supreme Court judges do not understand that they have law-making powers, they should reexamine the Bill of Rights.  Dehler expects to take his case to the Court of Appeals.


Sterilization.

Sterilization.


The fiscal crisis of New York City: the conflict in allocation of resources to the public and private health sectors.


Surgical intensive care unit--University of Rochester Medical Center.


Opting out of social security: a multihospital system tells why it quit.


Hospital merger in Buffalo yields first-year savings of $700,000.


Engineering in health care: technology transfer.


Work effectiveness programs.

Work effectiveness programs.


Setting 'service levels'--a practical approach to measuring departmental performance.


A method for post-marketing screening of adverse reactions to drugs: initial results. The FDA is pilot-testing a methodology for signaling previously unsuspected relationships between drugs and important adverse events. This method uses data it receives through the FDA spontaneous reporting program. Reviewing drugs used primarily on an outpatient basis, this screening methodology focuses on "tracer" adverse events and the organization of these reactions into body/functional systems. This review process enables a clinical evaluator to perceive more easily the clinically important drug-adverse event patterns. The method can incorporate drug use data; this enables a drug's proportional share of specific adverse events, relative to its therapeutic class, to be compared to its respective proportional share of drug use. The assumption is that the adverse event distribution of drugs in a therapeutic class should be the same as the distribution of drug use in that class, if all drugs in the class were to carry the same risk. Actual examples of drug-adverse event associations signaled by the screening method are presented. The potential uses of this methodology in other settings, and under other data situations, are discussed.


Technology in nonhospital medicine.

Technology in nonhospital medicine.


Moral leadership in a socialized health care system: a new challenge to Catholic health care service.


Clinical engineering practices: BMET training at the high school level.


Legal and ethical issues in clinical pharmacy research--informed consent, Part I. The continued growth of hospital and clinical pharmacy should be paralleled by the development of sound research methods justifying innovative practices. Such research will, on occasion, require experimentation involving human subjects. The principal means of assuring that the welfare of research participants is not compromised is through the procurement of effective informed consent. Pharmacists, like many other health professionals, have had relatively little exposure to methodology involved in the writing of an informed consent instrument. A comprehensive document must not only conform to the requirements of federal regulatory agencies, but must also satisfy various institutional guidelines. Past instances of unethical human experimentation are discussed, and a format for preparation of an informed consent instrument is examined. Circumstances requiring informed consent and identification of the basic elements of consent are also explained.


The patient package insert--rhetoric versus logic.


The Mississauga "saga".

The Mississauga "saga". At approximately seven minutes to midnight on Saturday, November 10, 1979, a Canadian Pacific Railway (CPR) train travelling from Windsor to Scarborough, Ontario, was derailed in an industrial area in the centre of Mississauga in Peel County (near Toronto). The accident was attributed to an overheated axle bearing on a propane tank car. The resultant fire which ignited the gas created a huge column of fire that lit up the sky. Firefighters noticed the flames from their stations. The nine fire stations in Mississauga were alerted and the first units arrived on the scene at 2355 hrs. (In 15 minutes, 55 firefighters were on the scene, and within the next half hour there were 110). This was the start of what was to result in the largest peace-time evacuation in recorded history. What follows is an account of the events that took place during the tense days that followed, and includes information available as of 17 December 1979.


Essentials and guidelines of an accredited educational program for the EMT-P.


Some specific problems in the care of the geriatric patient.


Social work in EMS.

Social work in EMS.


Levels of training for a rural state.

Levels of training for a rural state.


Needs assessment for continuing education: a guide for EMT instructors and training officers.


Hassle management workshop.

Hassle management workshop.


Burnout: the most probable causes and the most likely solutions.


Rural EMS problems.

Rural EMS problems.


Emergency vehicles and the speed limit.

Emergency vehicles and the speed limit.


Women in health care: today's goal is strength through unity.


Synthesizing the interests of consumers, citizens, and administrators in gathering client feedback.


Evaluations of patient education programs: a meta-analysis. A literature search located 23 evaluations of patient education programs that utilized a randomly selected control group (i.e., an experimental design) or a nonequivalent control group (i.e., a quasi-experimental design), Meta-analysis procedures were used to combine the findings of these studies. The effect size for each of 102 dependent variables was derived from the mean of an experimental group and the mean and standard deviation of an untaught control group. The effect size is a =-score that can be converted into the mean percentile rank of taught patients relative to the untaught controls. The mean effect size for all studies was .74, which is equivalent to improving the average taught patient from the fiftieth to the seventy-seventh percentile relative to the untaught patient group. Suggestions for improving the usefulness of patient education research design and report content are discussed.


Organizational effects on mentally retarded adults: a longitudinal analysis. Normalization has gained wide acceptance as a goal that residential institutations for the mentally retarded should strive to achieve, but many organizations have been shown to have difficulty achieving the goal. Theories developed from the organizational contingency perspective suggest that organizations with bureaucratic structures will have particular difficulty accomplishing the nonroutine tasks associated with normalization. Our major purpose was to test the usefulness of such theories for the evaluation of mental retardation facilities by ascertaining whether a less bureaucratic organization for the mentally retarded would achieve greater success than a more bureaucratic organization. The closing of a large public hospital and the subsequent transfer of most of its residents to two new facilities (one of which was more bureaucratic than the other) allowed us to examine bureaucracy's effect on treatment. As predicated, the analysis showed that the less bureaucratic organization produced a greater average positive change in behavior than did the more bureaucratic organization. A number of clinical and demographic characteristics of the residents which could have influenced the observed changes in behavioral level were identified and controlled. They were not found to explain the differences between facilties. Other factors, which could not be controlled in this study, provide suggestions for future research.


"Hospitals face image problems which affects all non-profits".


Caring for the geriatric patient.

Caring for the geriatric patient.


Quality assurance and risk management: linking both benefits all.


Kellogg grant fuses quality and delivery: a prototype program to fit many settings. Just as any business enterprise involving many personal interactions, group practice medicine can suffer from organizational parallax, narrowed by time, and resulting from one-sided views of its own decision-making. Indeed, that is why accreditation reviews of groups take into account broad happenings within a medical practice as observed by outsiders. Aside from the all-important medical record, source materials for such reviews include questionnaires on the logical processes of care, educational activities of the staff in all departments, technological support, ethical considerations and overall environment. This article takes a look at quality assurance-in an innovative form--within group practice. The type of program detailed in it was first put to the test in 1975, by the St. Louis Park Medical Center, Minneapolis, in conjunction with a grant from the W. K. Kellogg Foundation to St. Louis Park, and to the Minneapolis-based firm InterStudy.


Technology and group diseases: treatment calls for planning, consultative approach.


Ambulatory care accreditation: an historical overview of AGPA's role.


Foreign medical graduate legislation and its impact on international relations.


The physician's dilemma: when to let go.


"...A very present help in trouble.".

"...A very present help in trouble.".


Dealing with death.

Dealing with death.


Recertification or retreat?

Recertification or retreat?


Why I am leaving a rural practice.

Why I am leaving a rural practice.


GAO challenges planning group's savings claims.


Communication problems on the job.

Communication problems on the job.


Hospitals: a link to alcoholism treatment.


Conducting a successful survey.

Conducting a successful survey.


Compensation for HMO physicians: pay policies for staff retention and motivation.


Snatching capital campaign success from jaws of failure. This article details the steps of one medical center which turned an "almost" $3.1 million capital campaign into a success. Leadership provided the steps to victory for a development director who stepped into a job with the high prospects of failure. In two years, he made his goal.


Nucleus hospitals: blending old into new. A new nucleus hospital at Macclesfield will in three years' time form the keystone of a totally modernised district health service. Meanwhile, 40 miles away at Chester, a similar nucleus scheme is being built using a new type of contract which the DHSS hopes will enable hospitals to be built more quickly, more cheaply. Benjamin Marsh traces the history and the implementation of these schemes.


Health administration: sensible medicine not radical surgery for NHS ills. In Nick Davidson's second article on government expectations for saving 30m pounds by streamlining NHS administration, he looks at non-management costs and asks what kind of savings could be made. He examines Beckenham Hospital's savings committee which is exploring methods of cutting costs without affecting patient services.


On philanthropy today and tomorrow. Interview by James H. Mooney.


Joint care: what the parents want.

Joint care: what the parents want. No-one knows better than the parents of mentally handicapped children what facilities should be available for their short-term care, but they are not often asked. The North Tyneside Planning Group for the Mentally Handicapped did ask. Dave Bromley, senior administrative assistant, North Tyneside AHA and Tim Lister, clinical psychologist, Northumberland AHA explain that the results indicate the need for a flexible service.


Hospital life: a contrast in Cambridge.

Hospital life: a contrast in Cambridge. Dr John Addenbrooke, born 300 years ago, left 4,500 pounds in his will to found a hospital for the poor in Cambridge. Today, Addenbrooke's Hospital occupies two sites which could not be more of a contrast--a fine old building dating from 1766 and a huge new hospital which is a monument to 1960s design. On her visit, Alison Hyde found out about the current problems and possible future developments at 'old' and 'new' Addenbrooke's.


Health insurance: an eye on American welfare. One of the great myths about the United States is that it does not have a welfare state. The myth is largely founded on the fact that America is one of the few remaining western nations with no national health insurance scheme to protect its citizens against the crippling costs of medical and hospital care. However, that does not mean that the United States does not have an extensive welfare system, writes John Draper.


The patient iceberg: some characteristics and variations in consultation behaviour. From the recent interest in the field of illness and consultation behaviour shown by medical sociologists, and from the much larger volume of epidemiological data available, some interesting facts about patients' use of their general practitioner have emerged. Despite increasing interest there remain a number of anomalies or 'grey areas' which merit much more attention from both sociologists and those who administer or practice professional medical care at the primary level.


Open for business as usual.

Open for business as usual. Mount Vernon Hospital's new burns unit, opened in 1974, has been closed--the research programme being run there ended prematurely and the fabric of the building itself mysteriously deteriorated. Until it can be re-opened, work continues as usual back in the old burns unit where, as Alison Hyde found, a friendly atmosphere and a high staff/patient ratio compensate for the cramped, old-fashioned ward.


Courting the idea of national health.

Courting the idea of national health. Compromise is the name of the game as America works towards a system of health insurance. In the run up to the presidential elections, John Draper looks at the current legislative proposals and their chances of survival in a country which has always shied away from 'socialised' health care.


If you have tiers to shed, shed them for the patient. If the NHS has one tier too many, perhaps this is true also of the nursing management structure inherited from Salmon. John Pealing, district nursing officer, SE Staffs, and based at Burton-on-Trent, describes a structure in which nursing officers are accountable to the divisional nursing officer, without an intervening tier of SNOs.


Information at the touch of a button.

Information at the touch of a button. At a time of increasing interest in the development of computerised supplies information systems, N. Evers-Crabtree, K. Haworth and J. Batchelor describe the development and implementation of an on-line stock control and stores accounting system in North Western RHA.


Health administration: good communication is the key to success. Chris Barrett, area pharmaceutical officer, City and East London AHA, starts the Journal's series of articles on the organisation of pharmaceutical services by outlining the administrative structure and considering the role of regional, area and district pharmaceutical officers. He says that it is essential that all three should form good working relationships if there is to be a good service.


Domestic management in the eighties: at the hub of the hospital wheel.


Domestic management: first and foremost--home. Domestic management of mental handicap hospitals presents a challenge to staff who often have to cope with outdated methods of cleaning, difficult areas to clean, and insufficient money to spend on new equipment. Catherine Jones, a domestic services manager, outlines some of the problems of management in this type of hospital.


Domestic management: value for money training. 'Nellie' can still train 'Nellie'--to a point, but in order to obtain value for money in health service domestic management attention must be given to the need for more technical input. Inez Oliver reviews the training facilities available.


Check your telephone bill.

Check your telephone bill. A careful check on the Westminster Hospital's telephone system showed that, among other things, the hospital was being charged for extensions which did not exist. Eventually the Post Office made a rebate of nearly 15,000 pounds. D. V. Hodgson, telephone supervisor, and T. J. Townend, district residences manager, tell how this was achieved and what steps have been taken to see the hospital is not over-charged in the future.


Patients First: in the light of the last six years. Patients First has proposed a reduction in the number of health service administration tiers. Ellie Scrivens, lecturer in social administration and health services research in the department of community medicine at St Thomas's Hospital Medical School, welcomes this but feels there are contradictions and omissions to be rectified before reorganisation begins.


Domestic management: nemesis for pharaoh's ant. Apathy and ignorance about pest infestation and the health risks involved are the subject of an article by Norman Southam, who discusses the use of pesticides and measures to control and eradicate many pests which thrive in many hospitals today.


Pharmacy: training for co-operation.

Pharmacy: training for co-operation. Pharmacists today are called upon to use a wide range of skills but their training, at present, lacks well-defined aims. In the second of the Journal's series on the organisation of pharmaceutical services, Dr E. Fullerton, regional pharmaceutical officer, North West Thames RHA, suggests some guidelines for the development of pre-registration and continuing in-service education.


Materials management plays leadership role.


The new product committee looks at old products.


Are you setting proper priorities for your job?


Materials management in the small hospital.


Pick your targets for price cuts in 1980.


Six components control hazards in hospital environment.


Does your hospital safety program meet JCAH standards?


Suggested procedures for disposing hospital solid waste.


Procedures for the hospital library.

Procedures for the hospital library.


Recruiting and interviewing.

Recruiting and interviewing.


$57,000 in thirty days.

$57,000 in thirty days.


Pitfalls in operational policies.

Pitfalls in operational policies.


Queen's Medical Centre, Nottingham.

Queen's Medical Centre, Nottingham.


The organisation of NHS supplies services 1948-1980.


Large institutions reconsidered: an approach to the management of transition.


A policy group at work--lessons learnt.

A policy group at work--lessons learnt.


Computerised scientific equipment listing for planning and management in the NHS.


Beyond the programme budget: economics and resource planning in the NHS.


Union decertification: three ways to lose the election.


Why nurses join unions.

Why nurses join unions.


Hospital strikes under the health care amendments.


Communicating during a strike threat.

Communicating during a strike threat.


Flying rescue team handles wilderness emergencies.


AWH needs assessment results analyzed.

AWH needs assessment results analyzed.


Excessive hospital costs: guilty or not guilty?


"Death counseling" -- more professionals needed.


Hospital unions: which way for the West?


Hospital records: friends or foes in the courtroom?


Attorneys outline basics of IC malpractice cases.


Quality-of-care index shows board how hospitals rate.


JCAH responds to legal questions raised over QA standard.


Liability, role of trustees affected by QA standard, says administrator.


Patient reps in the ER: an asset to your QA program.


Expert urges expanded functions for patient reps.


Bishop links involuntary sterilization to other ethical-moral issues.


Neighborhood clergy advise, assist hospital in pastoral care program.


State questions tax-exempt bond financing for Catholic hospitals.


Hospital charged as vendor in impure blood transfusion.


ER treatment fails to meet reasonable standard of care.


Canada's NHI needs fiscal realism, hospital autonomy, consumer responsibility. Government-sponsored health care programs must have limits if they are to be effective and cost-cutting. Canada's experience with a national health insurance plan indicates that long-range planning, a measurable definition of health, and consumer responsibility are necessary ingredients.


Sponsoring congregations' answer to McGrath Thesis: corporate control. Fr. Maida refutes McGrath's Thesis and posits that Catholic health care facilities face special corporate, financial, and theological administrative issues. By maintaining corporate control of the institutions they sponsor, religious congregations can determine institutional policies consistent with church teachings.


Rating departmental tasks: a tool for accountability.


GAO's report on hospital purchasing: discrepancies, buried conclusions.


The midwife in Taiwan: an alternative model for maternity care. While more than 99% of all American babies are delivered by obstetricians, the majority of Taiwanese babies are delivered by midwives.  The history of traditional and professional midwives in Taiwan is reviewed.  Taiwanese midwives operate their businesses according to the principles of client-centered health service.  They also serve many social and religious, as well as health, needs of their clients.  This system contrasts with that in operation in the U.S. where pregnant women utilize physician-centered, not client-centered, maternity care.  The role of the Taiwanese midwife in the management of childbirth is described.  Postpartum care provided by the midwife includes nutrition information and initial care of the infant once the mother returns home.  The role of the midwife in relation to abortion, adoption and other obstetric and gynecologic services is explained.  The American system of childbirth might be made more flexible and acceptable if the client-centered features of the Taiwanese system could be incorporated into the modern American health care system.


Judging drugs: patients' conceptions of therapeutic efficacy in the treatment of arthritis.


Ethnomedical beliefs and patient adherence to a treatment regimen: a St. Lucian example.


Body concepts and health care: illustrations from an Egyptian village.


Physician surplus: the specialty of internal medicine.


Physician surplus: allied health professionals.


Physician surplus: the role of specialists.


A coming glut of doctors?

A coming glut of doctors?


Physician surplus: blessing or burden? Keeping up with the competition.


Physician surplus: blessing or burden? How will quantity affect quality?


Physician surplus: blessing or burden? Comparing the financial options.


Thumbing through medical records: easy access? No easy answers.


Thumbing through medical records: from hieroglyphs to computers.


Future directions in national health policy for the United States. Unlike other countries which have established some form of national health insurance, the United States is debating this profound social program in facing all problems of financing and managing personal health services simultaneously: elimination of cost at time of service, sharing this cost equitably through the tax system, distributing the services equitably goegraphically, controlling rapidly rising costs and managing the organizational structure of services. Originally in other countries the primary objectives were to free citizens of the burden of costly illnesses, improve access across income groups, and share the costs more or less equally. Now other countries are expressing the problems found simultaneously by the United States. It is argued that universal and comprehensive national health insurance spreads money and resources so thinly that specific and important problems such as pockets of high infant mortality or curable diseases are obscured and ignored. The United States sould set up a health program which targets specific problems and mitigates high cost episodes rather than indulge itself in a comprehensive and universal national health insurance. This proposal is not politically feasible, however, and predictions are made as to what will happen in the United States within the politically and culturally determined range of debatable options.


Effects of financial incentives on physicians' specialty and location decisions. Available information is reviewed on the effects of financial incentives on physicians' specialty and location decisions. Income of physicians varies by specialty and geographic area, but evidence is limited on the effects of these differences on career decisions. Only two studies have been done on the relationship of oncome to specialty choice. These studies showed that the impact of income on specialty choice, if any, is weak. Studies on the relationship of both reimbursement levels and income to physician location choice generally concluded that there is a small, positive correlation between these financial factors and physician density. Thus, increasing physicians' income appears to be viable public policy for attracting physicians to underserved areas. Though rough estimates are calculated of the cost of attracting additional physicians, based on studies reviewed, conclusions on costs of incentive programs are premature.


The decision-making process: implications for the medical school organization. In this article, the authors make use of some contemporary models of decision-making to show how the process of decision-making can become more self-conscious, and thus both more enlightened and more assured. The approach is an examination of several models examined both from the perspective of the steps in the process itself, as well as general observations about the decision-making process. The practical focus is on the medical school organization with its unique characteristics. This article also examines the decision-making process through a comparison of two types of organizational structure (pyramidal and matrix) found in most medical schools. Certain constants emerge from this article that positively enhance good decision-making. These elements are: (1) the rapidity of change; (2) the critical need for a wide range of alternatives; (3) an understanding of both the organizational structure and human factors involved; and (4) the necessity of involving others in the decision-making process. By analyzing various modes of decision-making and presenting options, this article should be of real assistance to administrators.


Assuring professional competence in medicine: expectations of the public. A trend toward increased public involvement in assuring professional competence in medicine has resulted as an outgrowth of the consumer movement, the public disenchantment with many traditional institutions, including professions, and broad social acceptance of the concept of health care as a basic human right. Expectations of consumers and the public include a broader definition of professional competence which includes caring and ability to communicate as aspects of curing. Knowledgeable consumers are concerned that inadequate safeguards exist to preclude physicians from practicing beyond their scope of competence and to assure continued competence of a physician over time. While assuring competence is the responsibility of the medical profession, it serves a public function and must be held accountable to public and consumer interests. Consumers should be involved more directly in the process. They can bring valuable judgment to the human questions relating to competence. They can bring a more holistic and humanitarian view to the process. Involvement of consumers, particularly in relation to hearing grievances, would serve to increase public confidence in certifying institutions. They can help assure that public, not merely professionals, interests are served: To assure that consumer representation makes a significant contribution, consumer members of certifying bodies should be provided with adequate orientation, continued training and direct staff assistance to aid in understanding technical issues and evaluating a technical recommendations.


Electronic fetal monitoring: is it effective? Is it safe? Office of Technology Assessment.


Electronic fetal monitoring: are federal and state controls effective? Is HSA planning relevant?


What's in it for us? A consumer analysis of the 1979 Health Planning Act amendments.


Health systems agencies and their role in the Hill-Burton program.


Why medicine is failing.

Why medicine is failing.


Whom do providers represent?

Whom do providers represent?


The holistic health movement: challenges to health planning.


Occupational health: a new focus on prevention for HSAs.


Part of the way with HSAs.

Part of the way with HSAs.


New York: HHC kills its own.

New York: HHC kills its own.


Is there a doctor in the shop? The role of the company doctor.


Hospital closings--a national problem.

Hospital closings--a national problem.


Motivation through recognition.

Motivation through recognition.


A miracle cure for meeting misery.

A miracle cure for meeting misery.


What is happening in the struggle to obtain a sensible reimbursement system for nurse-midwives in Pennsylvania?


Effective communications minimize problems.


Planning for community and medical staff changes. The physician's role in planning at both the community and the medical staff level has become increasingly complex in recent years. A recent AMA seminar discussed some of the ways that physicians can participate in HSAs as well as deal with some of the planning problems confronting the medical staff organization.


How to field test and validate a program or product.


Measuring productivity in an ambulatory setting. Planning, budgeting, and effective management depend on some measurement of productivity. Until now, there has not been a concerted effort to look for means of measuring productivity of health care providers in an ambulatory setting. The author presents a simple technique for measuring productivity that can be agreeable to both managers and providers.


Age contrasts in self-discharge from general hospitals.


The expanding role of pharmacy. Interview by Nancy Agresta.


Last gasp for hospital bill.

Last gasp for hospital bill.


Evaluation of a new semi-rigid intravenous container. Mercy Hospital, in cooperation with McGaw Laboratories, conducted a pre-marketing evaluation of a new intravenous solution container made of a polyallomer thermoplastic, polyolefin. Following a four-month evaluation period using the Accumed container in the pharmacy intravenous admixture program and on all nursing units, the container was evaluated by both the pharmacy and nursing staffs and compared with our present system, Viaflex. A questionnaire prepared and supplied by McGaw Laboratories allowed nurses to evaluate the container subjectively. A questionnaire was also prepared for members of the pharmacy staff, both professional and supportive personnel, to use in evaluating the container. In addition, a time and motion study was developed to compare the Viaflex, Travenol glass, and Accumed containers in all areas of the hospital where intravenous solutions were used. Both the subjective and objective evaluations demonstrated acceptance by the Departments of Pharmacy and Nursing, and the Accumed container performed comparably with the Viaflex and glass containers tested in intravenous admixture preparation and in their administration. A list of properties of the "ideal" system is proposed.


Emergencies with reservation: an experience in Indian community programming.


General suggestions for auditing antibiotic usage.


Off to a bad start: the obstetrical experience of the urban poor.


CBC: what's preventing a health politics?


Some abbreviations found in medical records.


Evaluating community awareness of a community mental health center. To assess community awareness of a community mental health center, a telephone survey was conducted, using a random stratified sample. In order to provide comparative analyses, two other mental health agencies were included in the study. Five specific issues were addressed: (a) the percentage of the population that was aware of the agencies, (b) inter-agency comparisons, (c) heterogeneity of awareness levels among geographic areas, (d) the relative merit of different sources of information, and (e) the relationship between awareness and demographic factors. The results indicated relatively high levels of awareness for the three agencies (X = 57%). There were, however, significant differences in awareness levels between agencies and between geographic areas. The source of information cited most often by respondents was the newspaper; in addition, there was an effect for the primary agency's storefront office. Sex, education, and family size had significant but weak correlations with the amount of accurate information a respondent possessed. The results provided substantive answers to the agency's concerns as well as methodological guidelines for future evaluations of community awareness.


Correlates of community mental health center underservice to non-whites. The relationships between relatively low utilization rates for non-whites and catchment area demography and center service characteristics were examined for 142 federally funded community mental health centers. Center characteristics were less strongly related to relative utilization by non-whites than were area demographic characteristics. Several characteristics of the black population were among those most highly associated with relative non-white utilization rates.


Community families: a seven-year program perspective. During the past seven years, Southwest Denver Community Mental Health Services, Inc., has made use of an alternative network of families in lieu of psychiatric hospitalization. This particular article focuses on its key operational aspects and considers recruitment, screening, and support structures which have enabled the project to become a viable community mental health center program. In addition, there is a discussion of the limitations of the system and how it might be integrated with psychiatric hospital services.


From the editors: Washington, D.C. "crystal ball gazers".


Primary presenting problem and mental health service delivery. This study describes the variety of problems reported by clients seeking the services of a large urban community mental health center and explores the extent to which these problems are related to three sets of variables: client demographic characteristics, system entry, and system response. A 10% random sample totaling 273 case files was examined. The most frequently reported problem area was interpersonal followed by drug/alcohol abuse and cognitive disturbance. Clients' presenting problem was significantly related to all three sets of variables. Implications for planning service delivery are discussed with emphasis on identifying both unique and shared center responses to presenting problems, client characteristics, and system entry factors.


Simplified manual systems for clinical management: the internal management report.


A performance-based physician compensation plan.


A management alert--now schools are delivering ambulatory care.


Service, teaching and research in a university ambulatory care facility.


Setting standards for monitoring the performance of primary care personnel--outreach workers. Personnel performance evaluation should be an integral part of the monitoring of a service program's efforts, particularly in those programs utilizing outreach workers, for the effectiveness of the program will initially depend on the success of such a service element.  Variables need to be selected and criteria need to be established in order to operationalize the measurements to be used and to be able to evaluate performance.  The contribution of outreach personnel performance to the effectiveness of a personal health service program is based on conditions stated in the following assumptions:  1) if the working capacity of the outreach workers is maintained at a satisfactory level, the service program will have the capacity to contact and follow-up a sufficient number of consumers, therefore increasing the probabilities that the service program will succeed in achieving its objective of a high degree of "population coverage;" if the outreach worker is sufficiently "convincing," the services offered will be accepted by the consumer; and 3) if the outreach worker complies with the standards, techniques, and procedures set forth by the program, the quality of services is ensured.  Based on these assumptions, it seems reasonable to consider working capacity, and compliance with standards, techniques, and procedures as variables in evaluating and monitoring outreach personnel performance, provided that these variables can be operationalized for measurement.  The opportunity to apply these concepts was provided during the recent efforts to evaluate a primary care program in Cali, Colombia.  PRIMOPS (Spanish acronym for Research Program in Health Delivery Models) is a primary care Maternal and Child Health/Family Planning Program designed to contribute to the reduction of mortality, morbidity, and fertility of the "target" area.  The mainstay of the PRIMOPS design are the 13 health promotoras recruited and selected from the community and trained according to the tasks they will perform.  Using the information gathered through the record system and the supervision report, an effort to measure the performance of PRIMOPS promotoras was conducted.  It was found that the variables of working capacity, convincing capacity, and compliance with standards, techniques, and procedures can be adapted to programs with features similar to those of the PRIMOPS program.  Consequently, they should be taken into consideration as managerial tools in the efforts to assess and monitor personnel performance.


Writing made easy for nursing home administrators.


Determinants of job satisfaction in nursing care units. Considerable attention has been placed on containing health care costs through structural approaches and budgetary means. Often overlooked in this process are costs associated to employee turnover and absenteeism. One of the important contributing factors to this withdrawal behavior is job satisfaction. Unfortunately few studies have explored the factors which influence the job satisfaction of health care workers. This study, using data collected from four hospitals, identifies fifteen factors that make major contributions to predicting the job satisfaction of nursing employees. This research suggests that the job satisfaction of nursing aides is influenced by procedures and practices that are organizational in their impact, by interactions with the work team and supervisor, and the daily activities of the nursing job. By understanding the interactive nature of these factors on job satisfaction, improvements in absenteeism and turnover can be realized with a reduction in personnel costs and improvements in quality of care.


"The professional".

"The professional".


Hammering back at the insurance industry.


Third party letters improve cash flow.

Third party letters improve cash flow.


"AGPAM standards of performance, how necessary are they?".


A fair question?

A fair question?


The effect of a manual follow-up system on days revenue outstanding.


Communication in conflict.

Communication in conflict.


Employee performance evaluation.

Employee performance evaluation.


P.S. problem: how to respond to a patient's letter concerning excessive hospital charges.


P.S. solution: implementing a pre-admission testing program.


Environmental health impact in the hospital laundry. The task of surveying the hospital laundry is often dismissed by public health officials as unnecessary because the laundry cycle is generally considered to be capable of destroying all pathogens. Even though a properly operated laundry can produce a relatively bacteria free product, there are a number of variables that have an impact on the bacterial quality of the linen before it reaches the patient. It is vital that surveillance personnel understand these factors during processing, transporting, or sorting linen so that the final product is aesthetically, chemically, and bacteriologically acceptable for patient use. At the U. S. Public Health Service Hospital laundry in New Orleans, surveillance by the Environmental Health Department has identified potential problem areas. Operational improvements have been instituted at this laundry that would not have been possible without a thorough understanding of the laundry cycle. The authors describe the laundry cycle, including potential problem areas; identify useful microbial and chemical surveillance methods; and discuss process control procedures. This information will help the environmental health worker in discussions with laundry personnel regarding contamination control and operational efficiency.


Slow pay letter 95% effective.

Slow pay letter 95% effective.


Hospital notebook -- OHM: from an information booklet prepared by Osteopathic Hospital of Maine.


Cutting rising medical costs.

Cutting rising medical costs.


Using a collection agency.

Using a collection agency.


Bankruptcy: attractive option under new Bankruptcy Reform Act for debtor.


Preventive medicine: the library prescription.


Good neighbors: California health volunteers in Mexico.


Who says doctors can't live with negotiated fees.


Making a claim form tell enough--but not too much.


Our health planners are fiddling while I'm burning.


FPs: no longer shortchanged on hospital privileges.


Let's pay patients to stay well.

Let's pay patients to stay well.


Which malpractice reforms protect you best.


How states plan to regulate physician supply.


The hiring process.

The hiring process. Anyone who has done any hiring at all can tell something about the difficulty in choosing people from a group of strangers. Hiring the right people is the most important step in managing an organization. Any hiring is important, but making the correct choice in management people is increasingly vital the higher the job being filled is in the organization.


By-pass arrangements for the direct transfer of A4 size general practice records.


Leave and academic allowance policies for physicians.


Person data or event data.

Person data or event data.


The computerised psychiatric case register as an information system.


ACMGA plays leadership role in health administration education.


Some observations on medical records practice and training in the U.S.A.


The effect of the economic recession on the hospital market.


24th annual prescription survey, Albany College of Pharmacy.


'Is there a doctor in the house?' a health planner asks.


Patient advocacy becomes a specialty.

Patient advocacy becomes a specialty.


Child health: some priorities.

Child health: some priorities.


Rewriting Roe v. Wade.

Rewriting Roe v. Wade. Presented in this essay are suggestions for rewriting Roe vs. Wade, the case that resulted in the establishment of a constitutional right to abortion.  Essentially, the argument is 1 of equal protection.  It is suggested that abortion be viewed as presenting a problem that might be termed "the law of samaritanism" -- the law regarding obligations imposed on certain individuals to provide assistance to others.  In American law it is a deeply rooted principle that an individual is ordinarily not required to volunteer assistance to another individual who is in danger or in need of aid.  The argument presented maintains that if a pregnant woman is required to carry the fetus to term and deliver it, then she is being compelled to be a Good Samaritan.  It is argued further that if the generally limited scope of obligations of samaritanism under current law are considered, and the special nature of the burdens imposed on pregnant women by laws forbidding abortion are also considered, the obvious conclusion is that the equal protection clause forbids imposition of these burdens on pregnant women.  The argument is developed in a lengthy form and calls for an extended discussion of the law of samaritanism.  The uniqueness of the abortion case also creates problems as the equal protection argument is approached, and an approach to equal protection questions is sketched.


The juridical status of the fetus: a proposal for legal protection of the unborn. This article investigates the juridical status of the fetus.  It assesses what this status should be in the light of recent developments in case law, legislation, medicine, and technology (particularly in vitro fertilization).  The article is presented in 5 sections: Section 1 deals with the supreme court's landmark decision in Roe vs. Wade, which relied on biological stages of fetal development rather than philosophical determination of when life begins.  Section 2 examines the historical reliance on birth as the point at which legal protection vests in the developing human.  Section 3 compares fetuses with newborn children, identifying relevant similarities and differences.  Section 4 studies whether the fetus at all stages of development should have the same protection (the author concludes they should not).  Section 5 examines the practical implications of choosing viability as a developmental stage of special significance for legal protection.


The abortion-funding cases and population control: an imaginary lawsuit (and some reflections on the uncertain limits of reproductive privacy). An imaginary lawsuit is discussed wherein the issues involved in public abortion-funding and population control are brought out.  Issues raised are: 1) the public hospital's charter which authorizes "medically necessary" abortions; 2) the constitutionality of state action providing free medical treatment for indigent women seeking abortions but not providing free antenatal and childbirth services; and 4) the individual rights of privacy, due process of law, and equal protection under the law.


Roe v. Wade and the lesson of the pre-Roe case law. The attempt is made in this discussion to demonstrate that the Supreme Court in deciding the Roe v. Wade case should not have decided an abortion case when it did and that the opinion was almost destined to be bad in that the Court could find no persuasive rationale in the pre-Roe cases for each of the points in its decision.  In 1973 political forces were actively debating abortion.  Abortions had been prohibited by most states, except to save a woman's life, since the 19th century.  In the 5 years immediately preceding Roe, 13 states had revised their statutes to resemble the Model Penal Code's provisions, which permitted abortions if the pregnancy threatened the woman's life, if it would gravely impair her physical or mental health, if it resulted from rape or incest, or if the child would be born with grave physical or mental defects.  4 states had removed all restrictions on the permissible reasons for seeking an abortion before a pregnancy passed specified lengths.  In short, in many states the political process had yet to decide on abortion, but Roe's rejection of Texas's statute voided almost every other state's statutes as well.  Between 1970 and 1972, a flurry of constitutional challenges hit the courts.  3 years was hardly sufficient time for the judicial system to evolve sound analysis for such an emotionally charged issue as abortion.  The Court could justifiably have allowed the dispute to simmer longer in the lower courts.  There is some indication that a sounder case law might evolved if given time, but that was prevented by Roe.  The Court could not find a rationale in 1973, but it decided anyway, suggesting a legislative rather than a judicial process.


Abortion and the presidential election of 1976: a multivariate analysis of voting behavior. Data collected in the National Election Survey from 2248 respondents before the 1976 U.S. presidential election and from 1909 respondents following the election was used to examine the impact of the abortion issue on the election outcome.  Analysis revealed that despite the wide news coverage given to the issue and the intense effort on the part of the National Council of Catholic Bishops to politicize the abortion issue, voters gave little priority to the abortion issue.  Less than 1/2 of 1% of the votes cast by the respondents could be accounted for by the voter's opinion on abortion.  Although both Carter and Ford opposed a constitutional amendment restricting abortion, Ford's position was closer to the position of the pro-life groups than Carter's position. When other factors were controlled, 47.7% of the respondents who were opposed to abortion for any reason voted for Carter and 54.4% of those who though abortion should never be forbidden voted for Carter.  These findings indicated that there was a relationship between voting behavior and abortion attitudes but that the relationship was very mild.  Abortion was certainly not a major issue in the minds of the voters.  When the respondents were asked to name the 3 major issues in the campaign only 1/10 of 1% mentioned the abortion issue.  The prediction was made that the pro-life groups would attempt to make abortion an issue in subsequent elections but that the major impact of this effort would be felt only at the local level and not at the federal level.


The challenge of the child in India.

The challenge of the child in India.