Joint company/YMCA fitness program benefits employees.


Hospital's wellness program helps employees improve lifestyles.


Controlling high blood pressure at the worksite.


We're making more money than we used to, but we're living worse.


New minimum wage rates for League 1199ers.


New York's League negotiations begin.

New York's League negotiations begin.


Victory at St. Barnabas.

Victory at St. Barnabas.


Equal pay for women workers.

Equal pay for women workers.


Network analysis in evaluation: some words of caution.


Evaluation in the U.S. Department of Health, Education, and Welfare.


Equity for the pharmacist: recognition with responsibility.


Utilizatin of within-hospital services: a study of the effects of two forms of group practice.


Consumer reactions to differing amounts of written drug information. Four prototype patient package inserts (PPIs) for erythromycin were tested in an analog study using 325 individuals drawn from a college community. There was no difference in the total amount of knowledge communicated by the different PPIs, but results for individual test items suggest (1) that more explicit information may be better recalled, and (2) that longer PPIs may aid in information integration, whereas shorter PPIs may aid in pure recall of facts. PPIs containing elaboration on why drug effects occur were rated by the subjects as more "accurate." Subjects tended to rate PPIs that provided behavioral instructions on what to do if certain drug effects occurred as designed to promote better care.


Clinical pharmacy and specialization.

Clinical pharmacy and specialization.


Management development is imperative in small/rural hospitals. Management development is important for all health care institutions, but for small and rural hospitals it could be the pivot point for survival in the 1980s. The program described here concentrates not only on developing managers' skills but also on building a team approach to hospital management.


Public relations and promotion: a few ideas for group practices. Public relations is the attempt to influence another's perception of an event, individual or institution by presenting a specific, directed, outward image. In public relations terms, the very worst thing that can happen is for someone to say something bad about you. The second very worst thing is for them to say anything at all about you! Between this Scylla and Charybdis, what can a group practice do to enhance its public image and increase its visibility within its community while, at the same time conducting itself in an appropriate and seemly manner? Some suggestions follow.


Satellite laboratory services: a blending of form and function. In March, 1980, Holzer Clinic, Ltd., a 45-physician multispecialty group practice located in southeastern Ohio, started its own clinic laboratory operation at a facility some four miles from the clinic building. To the clinic, this significant event signaled a major departure in operations, concept and philosophy.


The high cost of a CON.

The high cost of a CON.


Congressman Gramm favors eventual abolishment of CON to pave way for competition model.


New National Council chairman tells views on major health planning issues.


Administration's bed reduction plan: capital punishment for hospitals.


Health planning costs study indicates significant changes needed in system.


Managed hospitals in 3 towns merge, stop duplication, reduce beds, plan new buildings.


Skill of Sherman Oaks Burn Center team helps Pryor, others win their fight for life.


Employee Stock Option Plan (ESOP) offers investment potential for hospitals.


AMI expanding mobile CT fleet; plans to extend service to all parts of country.


Competition and CON: an incompatible combination?


Burnout in foodservice.

Burnout in foodservice.


AMI sees Hyatt purchase strengthening its management capabilities in domestic contracts.


Problem: how to involve foodservice in family healthcare. Solution: celebrate births with a gourmet meal.


Running a hospital is no different from running a store.


Aspects of member satisfaction under two types of health delivery systems: a comparison of prepaid group practice HMO members and a Blue Cross/Blue Shield matched control group.


Hospitalizations in three competing HMOs during their first two years: a cohort study of the Rochester experience.


Prepaid medical practice: a summary of findings from a recent survey of group practices in the United States. A comparison of fee-for-service and prepaid groups.


United States citizens studying medicine abroad.


It's roundup time for the runaway regulators. Alexander reviews some of the problems caused by governmental regulation of business practices and considers some of the current moves to decrease regulatory intervention. According to the author, this is the first time in 15 years Congress has acknowledged that regulation is a matter of serious concern. The trigger was a 1978 proposal of the Federal Trade Commission (FTC) to extend its control over the voluntary product standards established by industry. Prior to that action, the author states, the FTC was condemned for listless enforcement. Economists blame excessive regulation for low productivity, lack of innovation, inflation, unemployment, and shortages. The author points out that the stringent rules of the Federal Drug Administration (FDA) have brought about a steep decline in the number of new drugs introduced--drugs which presumably could have prevented considerable suffering and quite a few deaths. The author thinks that the gold medal earned by the FDA for its refusal to approve Thalidomide has fostered a siege mentality--"We only get into trouble by approving something." The stringent regulations have caused voter dissatisfaction, as evidenced by the attempt of the FDA to bar the use of saccharine. In an effort to restore political accountability, Congress is considering strengthening the oversight of agencies by elected officials. The House of Representatives favor the wider use of the "legislative veto." This would make any new rule an agency writes subject to nullification by either House of Congress for a 60-day period. The Senate prefers a "sunset" approach, which would require that regulations, spending programs, and even entire agencies undergo periodic reapproval. A study carried out by the American Bar Association (ABA) singles out the congressional sin of needlessly enlarging the burden of regulation by creating a new agency every time it perceives a problem, eventually resulting in sharply increased regulatory compliance costs. The same ABA study recommends that each agency be required to prepare an analysis of the likely costs and benefits of their proposed rulings and of recommended regulations in light of established national priorities. Alexander concludes that the ABA recommendation for increased reliance upon the competitive market is an essential step in encouraging regulatory reform.


The meeting goer's lament.

The meeting goer's lament. Executives spend about 69% of their time in meeting with at least two other people, according to a recent study out of McGill University. In spite of this, participants do not consider this to be time used wisely  and, according to the respondents, the problem seems to be growing worse. Despite the claims of some executives that government regulations or increased corporate complexity underlies the problem, society at large is viewed as the source of the change. Meyer asserts that all institutions have become less authoritarian and the trend away from command has left persuasion and consensus as the basis for corporate level decision-making. Although executives seem to agree that most time is wasted because participants fail to be succinct, the author argues that leaders could improve meetings by choosing the right participants, guiding them briskly through the agenda, and closing the meeting before it degenerates into a shouting match. The article suggests that chief executives are concluding that meeting skills can be learned. Most of the FORTUNE 500 companies have hired outside experts to teach these skills and some companies are building inhouse units for the same purpose. Since meetings have become an integral part of the business day, Meyer concluded that the goal of the executive should be to use the meeting time well.


Information--the key to the future.

Information--the key to the future.


The creation, maintenance and distribution of a computerized drug inter-action file (DIF).


Controlling hospital costs.

Controlling hospital costs.


Federal regulation of medical practice in nursing homes.


Interview: Henry Simmons.

Interview: Henry Simmons.


Plumbing for hospitals.

Plumbing for hospitals.


Medical care in Papua New Guinea.

Medical care in Papua New Guinea.


A partnership for rural healthcare.

A partnership for rural healthcare.


Overcoming resistance to change.

Overcoming resistance to change.


What every nurse manager should know about risk management.


Finding the causes of job stress and learning to control them.


Disposables: saving by throwing away.

Disposables: saving by throwing away. The demand for health care facilities and services will remain insatiable, concludes a report by Frost and Sullivan due to be published shortly. The report on trends in the European clinical soft goods market says growth is guaranteed but that the market penetration of disposables is not.


Supply council: a man of persuasion. Interview by Joyce Galley.


Disposables: one-way trip articles.

Disposables: one-way trip articles. There are many factors to be considered before a decision to introduce disposables can be confidently made. Although the supplies officer signs the order, he must take into account the advice of people from many other disciplines.


Look for the silver lining.

Look for the silver lining. On January 1, 1980, the price of silver on the London Metal Exchange reached an all-time record of pounds 21.55 per troy ounce. The predicted price in 1978 had been pound 3.80. This sudden upturn in the market sent people scurrying to silver merchants with family trophies, and put a glow on the faces of hospital finance officers. Proceeds from the sale of photographic waste from radiography departments are very healthy.


Out of hours social care: planning for peaks and troughs.


Calculators: managing with technology.

Calculators: managing with technology. When the calculators do the calculating, the managers can do the managing. Len Goldstone of the UMIST Department of Management Sciences examines how close we are to that ideal. There are, he says, calculators of three levels of complexity and price, but warns that tomorrow's manager may find even the most sophisticated of today's instruments clumsy compared to the mini-computers now being developed.


Health education: focusing on the video show. In his second article on patient education Dr J. L. Graham, chief administrative medical officer, Forth Valley Health Board, describes how six short videotapes are being produced and evaluated in a research project. The research consists of four main areas: preliminary work, exploratory work, production of the videotape and, lastly, evaluation of its effectiveness. The production steps followed by the Forth Valley Health Board in producing a series of health education videotapes was described.  Each videotape focused on a specific health condition and provided self-care instructions for patients with that particular health problem.  Steps involved in the production process included preparations, videotaping, editing, and evaluation.  Appropriate topics for health education videotapes were selected in reference to needs expressed by the medical profession.  Once a topic was chosen, patients were interviewed to ascertain their current level of knowledge concerning the topic.  After filming and editing the videotapes, an effort was made to evaluate the tapes.  Several evaluation methods were and are currently being used to assess the tapes.  Evaluation procedures included 1) asking medical professionals and patients to assess the value of the films; 2) asking the patients to act out the steps in self-care described in the films; 3) assessing patient knowledge levels before and after they viewed the videotapes; 4) assessing the long term impact of the videotapes by ascertaining the patient's level of knowledge several months after exposure to the film; and 5) comparing the increments in knowledge between a group that viewed the videotape with a group that read a booklet on the same subject.  Effective videotapes can provide doctors with an easy, time-saving method for instructing patients in routine self-care procedures.


Family practitioners: justice for GPs and patients. The Family Practitioner Committee has a broad ombudsman function, writes Judy Allsop, a former medical service committee lay member and senior lecturer in social policy, Polytechnic of the South Bank. She discusses the way PFCs deal with complaints against GPs and highlights some of the problems faced by complainants and the medical service committees.


Safety in hospitals: our Nordic neighbours.


HSSJ guide to managerial salaries and conditions in the NHS: explanation of grading of ex-special grade officers.


IHF study tour: a lesson in Swedish.

IHF study tour: a lesson in Swedish. The International Health Federation paid its first visit to Sweden in June. The study tour, which involved 35 people from 15 countries, spent ten days studying Swedish health care with the particular brief--'Co-ordinating health services within a region". Here David Hands, assistant director, Kings Fund Centre, describes the tour which was organised by the Swedish Hospital Association and the Swedish Planning and Rationalisation Institute in conjunction with the National Board for Health and Welfare, and the Federation of Swedish County Councils.


Recipe for cleaner kitchens.

Recipe for cleaner kitchens. The replacement of much old equipment and improvements in the maintenance of such items as heated trolleys were prominent among the recommendations of two food hygiene surveys carried out in Oxfordshire AHA(T). The surveys and the circumstances that led up to them, are described by Dr Nicholas Black of the AHA(T)'s department of community medicine.


Consensus management: giving up a little of the "I' and thinking of the "we'. According to the Minister of Health, consensus management to some people, is like a red rag to a bull. At least that's what he intimated at a conference earlier this year to an audience of senior nurses. One is tempted to picture the scene with the matador administering the coup de gráce to the applause of a crowded arena. But John Pealing, district nursing officer, South East Staffs HD, asks who is the matador and is the sacred bull really dead?


Health authorities: obsessed by structures. Last January, Brian Watkin suggested (Journal, January 25) that the constitution of health authorities as essentially lay bodies required further consideration. He concluded that it would be far better for an authority to consist of a chairman, a group of executive directors (the area management team or area team of officers) and a group of nonexecutive directors who might be appointed or elected in a variety of different ways. Frank Pethybridge, regional administrator, North Western RHA, begs to differ


Porter training: the key is 'keep it practical'. Just over two years ago, Edward Lewis, personnel officer, Mid Glamorgan HA, described in the Journal how a training programme for head and deputy head porters was received in Wales. At that stage only the first module had been devised. Now with Nigel Bryant, lecturer in the department of management studies, Polytechnic of Wales, and William Brown, Welsh Office advisor, he reports on further progress.


Medical staffing: working out a better balance. The Medical Practitioners' Union is the latest group to call for changes in junior doctors' career structures. These would entail a shift in emphasis away from the consultant's traditional role and reliance on inpatient care. Here, Brian Watkin discusses the MPU's policy document.


Health education for Asians: cultural bridge building. Judith Gray, a specialist in community medicine, and Waltrant Browning, who visited Britain in 1979 to study health education of ethnic minorities, examine a scheme in Blackburn which set out to overcome the language problem. Dr Gray is area specialist in community medicine (social services) Manchester AHA(T)


Dialogue with John Welbourn: managing the hospital's BTUs.


A national survey of opinions toward health promotion among directors of health systems agencies.


Safety in hospitals: philosophy of fire defence. The idea that whole blocks should be warned immediately a fire is discovered, is not generally favoured in Sweden and Denmark. This is one of many fifferences of approach which David White, area education and training officer, Coventry AHA found on his Council of Europe Fellowship study tour. Here he concludes his report begun last week


Liability: hospital vs. contractor.

Liability: hospital vs. contractor.


Purchasing a CT scanner through the quotation process.


Hospitals urged to review mercury disposal procedures.


Quality assurance: who? where? why?

Quality assurance: who? where? why?


Disposables: utopian dream or dissolute dilettantism.


Israel's medical equipment industry: a look ahead.


Kitchen hygiene--Crown immunity.

Kitchen hygiene--Crown immunity.


State of the National Health Service.

State of the National Health Service.


Selling to France.

Selling to France.


An experiment in semi-automatic order production.


Records--the hospital's nervous system. Part 1: functions.


Records management. Part 2: systems.

Records management. Part 2: systems.


The decline of the National Health Service.


General practice and the consumer.

General practice and the consumer.


Time for change in supply organisation.

Time for change in supply organisation.


Records management: Part 3.

Records management: Part 3.


The Cardington experiment.

The Cardington experiment.


Do-it-yourself training in supplies.

Do-it-yourself training in supplies.


Community participation in health care--how it has worked out in practice.


Variation in perinatal mortality by region and area.


An administrator's view of childbirth: a tribute to Bellshill Maternity Hospital and its staff.


The health care market: can hospitals survive? Does it sound familiar? Resources are scarce, competition is tough, and government regulations and a balanced budget are increasingly hard to meet at the same time. This is not the automobile or oil industry but the health care industry, and hospital managers are facing the same problems. And, maintains the author of this article, they must borrow some proven marketing techniques from business to survive in the new health care market. He first describes the features of the new market (the increasing economic power of physicians, new forms of health care delivery, prepaid health plans, and the changing regulatory environment) and then the possible marketing strategies for dealing with them (competing hard for physicians who control the patient flow and diversifying and promoting the mix of services). He also describes various planning solutions that make the most of a community's hospital facilities and affiliations.


Marketing volunteer skills.

Marketing volunteer skills.


Management men and women: closed vs. open doors.


The health economist and NHS planning.

The health economist and NHS planning.


Specialty costs: an aid to planning and control.


How much stress is too much?

How much stress is too much? "There is no question that a certain amount of stress is good," says one of the chief executives quoted in this article. "If I have a particularly easy week, I can feel an ache or pain, but if I get really busy, I feel really much better." But when managers feel themselves under too much stress, the executive adds pessimistically, then "not only will they burn out in time, but they get erratic and their judgment goes all to hell." These insights reflect one of the authors' main themes: medical research finds stress productive up to a point (which of course varies with the manager), but beyond that point it can be disastrous. The trouble in corporate life seems to be that leaders appreciate the first part of the relationship but not the second. As a consequence, both individiuals and organizations suffer--and suffer greatly. This penalty is unnecessary, the authors believe, because a newly tested, proved, and relatively simple approach to managing stress is available to any corporation that wants to use it.


Halt: who goes there? An account of clinical access in Durham.


Who complains? An inconclusive study.

Who complains? An inconclusive study.


Trends in developing effective inservice education for HSOs.


Presidential address 1980.

Presidential address 1980.


Positive discrimination in the health and social services.


NHS planning: an assessment.

NHS planning: an assessment.


Waiting lists: some problems of definition and a relative measure of waiting time.


Closures of hospitals: procedures and problems.


Waiting lists: a step towards representation, clarification and solving of information problems.


Commissioning hospital projects--management or mismanagement.


The million-dollar question: why pay employees' social security taxes?


Study cites needle disposal as risk for hospital employees.


Nosocomial infections found to be major cause of death after trauma.


Handwashing fails to improve with building design changes.


Multiple strategies control staph infections in nursery.


Finding the perfect person for integrated QA program.


Two hospitals cope successfully with Mount St. Helens fallout.


New Jersey hospitals experiment with cost-per-case reimbursement.


An interview with Sr. Mary Lucy Power, RSM.


Contraceptive sterilization: no panacea for human problems.


Restatement on tubal ligation confuses policy with normative ethics.


Bishops' statement reaffirms Church's reverence for spousal love.


Court's guidelines on incompetent patients compromise their rights. All patients have the right to request or to forego extraordinary means. Who shall make this decision for incompetent patients? A Massachusetts court, ruling that only a court is competent to decide such requests, contradicts theologians' recommendations. These decisions should be left to the patients' closest relatives with the help of the physician.


Terminating treatment: asking the right questions. The sole question to ask in considering curtailing treatment of incompetent, terminally ill patients is not, Who shall decide? Other philosophical and ethical considerations should be addressed before requesting a judicial ruling which might set dangerous precedents.


The inability to judge: the malaise of our time. A certain Alice in Wonderland mentality pervades the current times as society cautions us not to be judgmental. But when virtue and vice are indistinguishable, Christian living and growth are precluded.


Health care services for homebound aged maintain independence, limit costs. Aged, homebound people suffer from a complex of problems too diverse for one health worker to handle successfully. Comprehensive programs using hospital-based health care teams to provide services for these people in their own homes can forestall enforced transfer to a long-term care facility or unattended death.


Mercy Center for Health Care Services, Aurora, IL. Healthful living program focuses on wellness.


Forecast for health service executives: rapidly rising compensation. Total cash compensation for health service executives should increase at an annual rate of 9 to 10 percent in the next few years. Retirement income, life insurance, long-term disability coverage, and general perquisites will likewise improve. Health service executives receive proportionately lower cash compensation (salary plus bonuses), judged by their institutions' operating budgets, than executives in the for-profit sector.


NLRB ignores congressional mandate, allows bargaining units to multiply. The NLRB has studiously ignored a congressional mandate that large numbers of bargaining units should not be allowed in hospitals. Health care institutions may force negotiations with eight or nine unions unless the courts take a hard look at bargaining unit determinations.


Patient files malpractice suit five years after hip surgery.


Patient suffers stroke after physicians perform angiogram.


Three hospitals consolidate services to regionalize burn treatment.


Community Corp: a partnership in mental health.


Getting to the core of the problem.

Getting to the core of the problem.


Emergency services: a model in cooperation.


Community support program update--1980.

Community support program update--1980.


Creative approaches to chronic crisis.

Creative approaches to chronic crisis.


HCFA redefines special care units; AHA maintains objection to undue stringency and inadequate reimbursement.


California Courts lay groundwork for new areas of liability.


Six to eight hospitals may benefit from aid to financially distressed hospitals; AHA urges long-term solution for all.


Report confirms AHA recommendations to hospitals on chemical waste; EPA-AHA discussions on infectious waste held.


National Health Service Corps/AHA develop private practice option program for corps MDs; interested hospitals must apply immediately.


Natural gas curtailment proposed regulations would apply to hospitals that purchase interstate natural gas.


Home health care and national health policy.


Restrained in Canada--free in Britain.

Restrained in Canada--free in Britain.


A systems approach to planning hospital-based patient education programs.


Biocommunications in developing nations: roles and problems for specialists from developed countries.


On health care and users: patients as users of health care.


A university information center as a potential unit of a network.


Communication for research in biomedicine in Canada.


BioSciences Information Service: information resources for biomedicine.


Information service activities of Japan Information Center of Science and Technology in the fields of biological science, medical science and agriculture.


CANCERNET: a European network for cancer literature data bank.


Colorful recoveries: Baptist Memorial Hospital-East.


It's operation germfree: Schoitz Memorial Hospital O.R. suite.


Good planning pays off: Cleveland Metropolitan General Hospital and Mercy South Hospital.


Equal access to health care: health planning agencies' obligations.


March articles should have mentioned error rate in medical records.


Borrowing for capital: will it empty our pockets?


Ten issues to consider when evaluating case-mix reimbursement.


Improving inventory records now becoming more important.


Condensed control reporting for better departmental management.


The ODIS project: a home-grown data information system.


Inside HFMA: Secretary notes Board responsibility.


Conditions: a tool for effective certificate-of-need regulation.


The Pennsylvania Health Department's proposed changes in the patient's bill of rights--and in other hospital regulations.


Payment patterns: management of receivables.


The pink slip blues.

The pink slip blues.


Managing the underperformer.

Managing the underperformer.


Sampling: how to fix the odds--Part 2.

Sampling: how to fix the odds--Part 2.


The San Francisco Health Care Coalition.


Sampling: how to fix the odds--Part 3.

Sampling: how to fix the odds--Part 3.


Traditional insurance package may not credit good RM.


Why mandate malpractice insurance for medical staff?


Community health in a Chicago slum.

Community health in a Chicago slum.


JCAH reviews ambulatory care standards.

JCAH reviews ambulatory care standards.


Physician concerns aired at hospital medical staff forum. When physicians and administrators at Sinai Hospital of Detroit convened at a medical staff forum, the physicians became more familiar with administrators, operational problems were identified, and a monthly newletter on health care issues for physicians was born.


Maximizing reimbursement for physician services. Both hospital and physician can benefit from the increased reimbursement revenue that can be derived by carefully structuring the hospital-physician relationship.


Products liability and the health care provider.


Care for the elderly in rural areas.

Care for the elderly in rural areas.


Planning for nursing home construction.

Planning for nursing home construction.


Night of terror.

Night of terror.


A week of celebrations: National Nursing Home Week, May 11-18, 1980.


Visiting: a positive approach.

Visiting: a positive approach.


Successful aging: the possible dream--successful nursing homes: the not impossible dream. "Telling it like it is" has never been a problem for Dr. Pfeiffer, which accounts partly for his wide acceptance by people in both the mental health and long term care fields. As a result of personal impressions and professional observations of the author, the reader sees the aged in a different light.


What is quality care in a nursing home?

What is quality care in a nursing home?


Health planning law--background: from 1954 to 1980.


Decertification of a union: to what extent can employers assist in this process?


Fear of the invisible.

Fear of the invisible.


Spotlight on staff development.

Spotlight on staff development.


Thoughts on our health care system.

Thoughts on our health care system.


Sexual practices and administrative policies in long term care institutions. Long an activist in the long term care field, Dulcy Miller again provides us with well grounded advice: "Sexual behavior of the intact aged," Miller states, "presents significant administrative problems. Sexual behavior of the impaired and the resulting sequelae present moral dilemmas worthy of microscopic analysis."


The geriatric crisis in Canada: real or imagined? Reviewing Canadian policy and planning for old people, Dr. Cope Schwenger reminds us of our own "geriatric crisis" and governmental intervention, and its effect in the provision of services. Several issues are examined demonstrating mutual problems in each of our countries, and the considerations given to planning for access and distribution of services in long term care are germane in the United States.


Social rehearsal for death and dying.

Social rehearsal for death and dying. Dr. Koff, an articulate spokesman of the care system in nursing homes, answers an oft repeated question: "What are sensible and sensitive steps to be dealt with on the subject of death and dying in the institutional setting?" He argues for a "system"in the home which transcends a piecemeal approach to policy making on an important event--death--for the nursing home resident.


Conversations with a gerontologist.

Conversations with a gerontologist. Simon Bergman's observations combine his deep personal experiences with a sharp-edged insight into the practitioner's role in the provision of health care services to the aging. While he projects needs into the future, he also has strong feelings for both what has been achieved and what is missing now in care systems the world over.


State-funded mental health research: 3. Building support for state mental health research.


State-funded mental health research: 4. Organization and funding of state mental health research and development.


Budgeting and the management power equation.


The marketing of mental health services.


Due process and the institutionalization of mentally disabled persons.


A computerized data management system.

A computerized data management system. A low-cost, computerized data management system has been developed on a Digital Equipment Corporation PDP11V03 computer system with dual floppy discs using BASIC in a time-shared configuration. The system collects, updates, and stores patient information on floppy discs for later retrieval and statistical analysis. All application software is written in BASIC to simplify changes or expansion, and to reduce the software labor costs for transferring the system to other low-cost microprocessor systems currently on the market. This system has been used by several hospital departments for data management and has proven to be a useful tool.


Medicalization and social control in the workplace: prospects for the 1980s.


Clinical engineering services at the VA Medical Center, Los Angeles. A large, modern Medical Center requires clinical engineering services to account for all medical equipment utilized in the treatment of the short-visit clinic patient, as well as the critically ill, who require extensive hospital, surgical or medical health care. The clinics act as multiphasic screening systems, providing simple treatment and referral for more extensive medical treatment. The hospital provides the necessary medical systems to accommodate the extensive daily patient flow. Few of the clinics can provide the facilities or machines to handle the expense of newer diagnostic and therapy requirements. Manpower and funding for maintenance today is concentrated in the fast-growing Radiology, Radiation Therapy/Nuclear Medicine, and Laboratory areas of the Medical Center. These departments require service specialists, and large amounts of dedicated funding to balance and insure reasonable maintenance of the newer, high-technology equipment. Growth of such technology in the hospital must be matched by the growth of service professionals in biomedical engineering departments.


The BMET and the need for esteem.

The BMET and the need for esteem. In the hospital organization, the status and esteem accorded an individual is based primarily on his profession and position. As a relatively new specialization, the professional status of the BMET has not been established, and those individual BMEts who seek increased esteem must work toward improving the status and professionalism of BMETs as a group. To achieve this goal, the BMET should present an image of professionalism; support and participate in activities of local and national BMET societies; involve himself in continuing education; establish supportive relationships with hospital equipment users; and become an effective member of multi-disciplinary hospital committees.


The symbiosis between engineering and medicine. This paper discusses the contribution of engineering to medicine, and the relationships that exist between the two disciplines. Engineers have followed a rational approach to analyse the physician's needs and have begun to bridge the gap between engineering and medicine. As a result, there has been a proliferation of life-saving products made by the industrial sector of society. The author offers suggestions for engineers and doctors to help them improve communications and better understand each other's problems.


Contract versus shared services.

Contract versus shared services. Contract service and shared service organizations are the two primary alternatives to in-house maintenance of medical equipment. The emphasis on manufacturer-based service has been decreasing lately for all but the most specialized equipment. This development is due to a variety of influences, chiefly related to the economy, and the need of the hospital to access broad-based technologists to service the equipment, and provide rapid technical support. The factors which must be weighed by the hospital in considering these two approaches are examined.


Mechanical hazards in clinical equipment. A wide variety of mechanical hazards are associated with clinical instrumentation containing mechanical components. Therefore, safety considerations for clinical equipment must be extended to include mechanical safety standards, maintenance programs, and operating procedures. Mechanical risk classes have been developed from the study of mechanical-mode failures of medical devices. To facilitate the development of priorities for clinical engineering involvement in mechanical safety programs, most mechanical devices which are commonly used in clinical practice have been assigned an appropriate risk classification. General recommendations for the development of such programs are also presented.


An improved image display for early E.M.I. scanners. First generation EMI head scanners have a poor image display and photography system. This paper describes how an image converter is interfaced to the EMI viewer console to produce a standard television image. The design also incorporates a multi-image photography unit to allow photographing of up to nine images on one standard X-ray film. The converted system's advantages are: a bright and stable display, reduced operator time, and significant material savings.


State-funded mental health research: 1. The state's unique contribution to mental health research.


State-funded mental health research: 2. Coordinating state research programs: accountability, information exchange, and duplication.


Professionals, administrators, and hospitals: moral conflicts.


Unionism in the health care industry: an overview. Block profiles the two unions that are the most active in organizing non-nurse health care employees: the National Hospital Union (NHU) and the Service Employees International Union (SEIU). The two international unions present a contrast in structure and ideology. The SEIU is a truly international, decentralized union, whereas NHU is a far more centralized affiliate.  As an international union, SEIU characterizes, taxes, and disciplines locals. Its decentralized strategy has been to permit locals to do the bulk of the organizing and collective bargaining, while the national union merely coordinates and offers financial and technical support. Conversely, NHU is an affiliate of the retail, wholesale, and department store union, deriving authority from, paying tax to, and subject to discipline by the parent organization. Its centralized approach has been for national officers to determine when a district will be created and what its jurisdiction will be. The structural differences of the two unions can be traced to their respective histories. As an old-line AFL union, SEIU had an existing structure of independent local unions that operated in health care as they did in other industries. NHU, however, originated as a union of drug store employees and its structure evolved over time. Membership growth and geographic expansion elevated it beyond the status of a local into a division with its own districts. The unions also diverge in their ideology; SEIU takes a more traditional business union approach to collective bargaining and unionism, while NHU is oriented to social welfare, involving itself in more than the work aspect of members' lives. These differences again can be attributed to contrasting histories of the old-line SEIU and the more radical NHU. The authors emphasize that unions are not homogeneous entities but organizations that respond to a similar environment as a result of their respective structures and histories.


The nurse practitioner: development of a new role in medical care.


A hospital cost model for policy analysis.


Liberalism, politics, and health planning.


Alternative federal revenue sources: human resource possibilities.


Two courts deny tax-exempt status to hospital owned laundry services.


Scrupulous housekeeping is crucial to infection control, says consultant.


Nurse says basics are essential for infection control in laundry.


Linen control yields big savings says material management director.


Laundry manager plays key role in infection control, nurse says.


Multiple objective planning for regional blood centers.


Patient representatives: sometimes they even help doctors.


The prescription decline: sense or nonsense?


The fallacy of job enrichment.

The fallacy of job enrichment.


The untapped segment of the pharmaceutical marketplace.


Florida Hospital runs central laundry on former commercial laundry site.


Physicians' competitors: upstaging the star.


Speculation equals expert testimony.

Speculation equals expert testimony.


Getting those monkeys off your back.

Getting those monkeys off your back.


'Friesen' hospitals discover highly automated systems aren't fail-safe.


Administrators find technological forecasts critical financial tools.


New technology forces hospitals to recognize need for radiology nurse.


Did Cleveland hospitals fix prices?

Did Cleveland hospitals fix prices?


Shared services and purchasing groups rapidly expand programs.


Senate eyes widespread problems in purchasing by federal hospitals.


Expect Congress to ignore hospital construction limits pushed by OMB.


Regs aren't as burdensome as hospitals claim.


City, county contracts lead to hospital sales.


Hospitals urge BCA to revise cost reviews.


Fierce competition for building funds.

Fierce competition for building funds.


Unions rush hospital defense; tackle nurses.


Schizophrenia makes ANA prime target for other unions' attacks.


Union busters, out-of-touch organizers slow healthcare unionization.


Computer system will combine all radiology modalities in five years.


CTs replace more costly techniques.

CTs replace more costly techniques.


Digital radiography will replace current modes.


Real-time scanners will take over hospital ultrasound departments.


Nuclear medicine departments will add data processing capacity.


Hospitals can improve productivity in their CT scanning departments.


Use of mobile scanner, ultrasound, nuclear medicine accelerates in '80s.


Voluntary sector's evaluations will outlive government assessment fad.


Why employees want unions.

Why employees want unions.


Human relations effects on safety.

Human relations effects on safety.


Health cover loss ratios: meaning and uses.


It pays to stay healthy under new plan.

It pays to stay healthy under new plan.


Group dental plans in the 1980s.

Group dental plans in the 1980s.


Energy master planning.

Energy master planning.


Parking garage opens at KU Medical Center.


Holistic health care: its promise, its problems.


Holistic health...scientific principles.


Critical decisions in the clinical laboratory. Described here is a system for dealing with unexpected or exceptional results which, like other laboratory data, must be transmitted appropriately to the primary physician, but which require a departure from the ordinary communication channels. To illustrate the principles under discussion, the author offers three case examples.


The solution to the challenge--CAP clinical standard solutions program. Quality assurance is a major concern and goal of clinical laboratories, the scope of which extends to all phases of clinical laboratory operation. The CAP Clinical Standard Solutions are an integral component of the quality assurance system. These primary volumetric working standards assist the laboratory in assuring the reliability of individual clinical laboratory results. This article reviews the rationale, content, and application of the CAP Clinical Standard Solutions Program.


The current status of laboratory data processing. The CAP Laboratory Computer Applications and Data Processing Committee surveyed recently a random sample of participants in the CAP Survey Program to determine the current status of data processing in clinical laboratories. The results of the study, which confirm that laboratory computerization is a still new but growing movement, are presented in the following pages.


An economist assesses physician supply and demand.


Patients in the dark about pathologist functions. Pathologists are little known to the public. In a day when each dollar for health care is so closely scrutinized, such a lack of understanding may lead to lack of support for our profession. Early this year, outpatients at the Milwaukee County Medical Complex in Wisconsin answered questions concerning laboratory tests, medical laboratories, and pathologists. The results revealed a severe lack of knowledge about pathologist functions, and, according to the authors, illustrates well the need for patient and public education about medical laboratory services. The results of the survey presented here were used in creating an educational videofilm, prepared within the Department of Pathology of the Medical College of Wisconsin, which was shown during the recent National Medical Laboratory Week in the same outpatient laboratory where the polling occurred.


Rhode Island bids for fewer doctors.

Rhode Island bids for fewer doctors.


The military way.

The military way.


Why performance appraisals fail.

Why performance appraisals fail. Our faith in the effectiveness of performance appraisal derives in part from its planned redundancy, in the interplay of employee, appraiser and reviewer. But this very safeguard, as Dr. McGuire points out, means that each party is trying too hard to satisfy the others' needs and expectations, both real and imagined.


Taking action to contain health care costs---Part II. Last month, Mr. Larson explained some large corporations' methods of saving health care dollars within existing corporate roles. This month, he outlines what companies are capable of doing, once certain organizational barriers are removed.


How accurate are performance appraisals?


Absenteeism--there's no absenteeism in a love affair.


A study of the interviewing skills of trainee assistants in general pactice. The effect of specific teaching of interviewing techniques, measured by a rating scale, was compared in experimental and control groups of trainee general practitioners. The subjects were given the opportunity to observe their own consultations on audio-visual recordings. No significant overall effect was demonstrated, but more detailed analysis revealed trends that suggested that the effect of the teaching only occurred in the latter half of the training year and was accompanied by an increase in the time of the consultation. It is our conclusion that the study should be repeated with larger numbers. It is possible that the absence of any effect of teaching interviewing techniques in the early part of the training period could be due to the traumatic experience of moving from hospital practice to primary care.


Promoting the management of weight reduction. Many people try to lose weight. Health providers who try to help these people often feel frustrated, as do the patients, because long-term success is rarely experienced, especially for those patients whose weight is a serious medical problem. A new approach is offered in which the client assumes responsibility for weight loss, and the role of the health provider is to help the client become an increasingly independent manager of his or her own weight reduction. An instrument is offered that guides the clients through the planning, conducting, and assessing of their own actions.


Effects of an information booklet on well-being of hospital patients. Although informational booklets are being used increasingly in Dutch hospitals, little is known of their effects and the conditions for optimal use. Various aspects of the use and effects of a specially developed information booklet were investigated in two surgical wards of a general hospital. The booklet gave information about ward procedures, operative routines, narcosis, and psychosocial care possibilities. Both before and after introduction of the booklet we gathered data on the satisfaction, knowledge, and emotional state of patients on the two wards and their perception of the care climate. Patients on the control ward received just the booklet. On the experimental ward staff nurses were trained in nondirective therapeutic skills, and measurements were repeated on both wards after this intervention. In a third manipulation on the experimental ward, some of the patients had a supportive and informative talk with a trained nurse. Although patients appreciated and read the booklet better than a general hospital leaflet, the results show that the booklet and other supporting measures had no effect on the patients' perception of their well-being.


Counselling for vasectomy.

Counselling for vasectomy. In the United Kingdom the provision of vasectomy service differs according to the geographical locations within the country.  Regarding the interview that occurs prior to the vasectomy operation, 3 areas of concern must be covered: information regarding the nature of the operation and its effects must be conveyed to the client; the doctor must feel confident that he/she can recommend the couple to the surgeon performing the operation; and helping the couple to explore personel feelings and experiences about birth control and providing information on all possible choices.  Although the latter aspect -- counseling -- is probably the most important, it is usually the least explored.  The reason for this is inherent to the procedure through which a vasectomy is currently obtained.  The couple regard the interview as a situation where the doctor will either allow or refuse the operation.  Conflicts may arise if the family planning doctor simultaneously tries to play both medical and counseling roles.  Further confusion arises between the screening and counseling aspects of the prevasectomy interview.  Vasectomy clinics have less rigid criteria than individual surgeons.  A step that must be taken if vasectomy counseling is to be improved is to increase general awareness and acknowledgment of the combined goals of the preoperative interview.


How to audit the personnel function.

How to audit the personnel function.


Selection interviewing and the new uniform federal guidelines.


Managers' perceptions of personnel: a case study. This ASPA Student Research Award winner explores the reasons managers find personnel a roadblock to progress.


How the terminal patient accepts dying.

How the terminal patient accepts dying. This article identifies six parallel but related problem-solving tasks on which the dying patient must work in order to master the terminal crisis. While engaged in these tasks the patient experiences many emotions. Once an individual has accepted death, feelings of preparedness, peace, and achievement accompany the fulfillment of the problem-solving task, and the crisis is over. The patient is then ready to die with dignity.


Teaching parents with high-risk infants in the home. Forty families evaluated the effectiveness of the newborn intensive care coordinator's teaching in helping them to adjust to caring for their high-risk infants after discharge from a newborn intensive care center. The families described the coordinator as an effective teacher and a trusted person who was available, gave emotional support, and made them feel competent as parents. The families recommended that the newborn intensive care coordinator work with other families with similar problems.


Teaching children self-care for chronic disease prevention: obesity reduction and smoking prevention. A general health education program was developed for 1,252 students in six New York city area school districts. The purpose of the three-year project was to reduce the prevalence of risk factors associated with increased cardiovascular and cancer risk in adults. The curriculum included nutrition, antitobacco, and hypertension-control materials. A smaller, experimental intensive health behavior program was also developed for obese children (weight greater than or equal to 120% ideal for height, age, and sex). A smoking prevention program was offered to children with the aim of discouraging new smokers. Findings show that: 1) such a school-based primary disease prevention program is feasible and highly acceptable; and 2) reduction of obesity and new cigarette smoking occurred with intensive intervention involving small groups of students. On the other hand, a general health education itself had little effect in the total population in reducing the incidence of extreme clinical values (such as physical inactivity, high blood pressure, as well as smoking and obesity) for their age and sex. It is recommended that future programs for higher risk children concentrate on behavioral change rather than on general education.


Do positive reinforcement programs reduce employee absenteeism? This second of two articles explores various incentive programs aimed at reducing work absence--with the authors urging caution when employing these programs.


How proper planning helped us greatly in moving our pharmacy twice.


Counselling in a hospital-based newborn screening service. The newborn screening and parent counselling service at Howard University Hospital is an integral component of services to newborn infants. The organization of this service presents a model that appears appropriately suited to the general organization of health-care delivery in the United States. Significant features of this service are: hospital-based planning and management of the service; integration of multiscreening components into a unified service; tight integration between screening, education, and counselling; a hospital-based team that provides coherent and in-depth counselling for all screening-related needs; a forum for orienting parents to the benefits of preventive health care; and a context in which to teach students the applied aspects of preventive health care based on early detection of disorders. If we are to have high quality newborn services in this area it may be incumbent on hospital-based health professionals to designate this as a required component of adequate hospital-based services for newborn infants rather than relinquishing the initiative to centralized health planners and legislators.


Teaching people to change: two experts offer their advice.


Doctors who "go bare" without malpractice insurance.


UCLA center studying why, how people change health behavior.


Patients' assaults on staff more frequent than thought.


Emergency psychiatry is growing as subspeciality.


Hispanic maternity care: a study of deficiencies and recommended policies.


"New' Legionnaires' disease? It may predate us on earth.


Health care facility planning: some developmental considerations.


Government intervention and innovation in industry: a policy framework. The authors build on recent studies to derive a framework for analyzing the effects of basic forms of government intervention on technological innovation. Relying on a recent Rand Corporation study of federally funded demonstration projects, the authors classify 10 projects on the basis of types of government intervention. The authors explain that the government can try to induce change in two basic ways--directly or indirectly. The direct method includes support for the development of new technology and the creation of market mechanisms to provide incentives for change. The indirect approach can range from persuasion to regulating product standards or direct government purchases. The authors set up four categories to encompass the joint effects of direct and indirect intervention, and offer tentative generalizations about the application of intervention. Direct intervention, such as R&D programs, is not likely to produce products of technological significance unless it is complemented by regulatory action. This type of joint action yields a high payoff when successful; many major post-World War II innovations such as the computer, the jet engine, and advanced semiconductor devices resulted from this mix of interventions. Conversely, regulatory measures alone entrench existing technologies and limit the payoff to incremental intervention. The emphasis in this category is on perfecting and redefining established technologies rather than innovating new ones. The findings of this study reinforce the notion that regulatory interventions play a vital role in shaping technological progress, although the process is seen as one that defies simple generalizations.


Central air conditioning.

Central air conditioning.


Help seeking among addicted and nonaddicted women of low socioeconomic status. Concern with the provision of health and welfare services to underserved or inappropriately served groups has led to numerous studies of patterns of service utilization. This article focuses on the help-seeking patterns of heroin-addicted and nonaddicted women of lower socioeconomic status. The results suggest addicts generally experience more problems than nonaddicts; those with few problems are less likely to use formal support systems; and black respondents, both addicts and nonaddicts, are less likely to use formal support systems. The evidence indicates that while addicts tend to use natural support systems less frequently than nonaddicts, addiction per se does not explain help seeking when race and number of problems are taken into account. The heavy reliance of both addicts and nonaddicts on informal helpers supports the value of professional efforts designed to facilitate or enhance these networks.


Management education in the future: perspectives.


After 41 years, for the second time, a name change for HEW.


Health management needs: the global perspective.


Using computer time-sharing programs for pulmonary care.


Louisiana hospital selling EDP services to defray costs of on-line charge system.


Washington Hospital Center selects computer system.


Model system resulted from close cooperation. How to get the best possible comprehensive information system for your particular needs? Try working with an enterprising supplier who would welcome the opportunity to use your facility as a development site. That's what Roanoke (VA) Memorial Hospital did, and the supplier, also based in Roanoke, continues to manage the system.


Hermann Hospital computerizes medical information system.


Eight fires in two months: Touro's encounter with arson. Eight fires in two months at this major New Orleans hospital attracted the attention of the news media and arson investigators. The author provides an interesting look into the way this awkward situation can be handled by a hospital that has been stricken by an arsonist.


Hospital data center delivers computing services via network of printers. A group of 23 Virginia health care organizations has pooled their resources with a not-for-profit, shared-service organization that provides them with an extensive series of business and clinical data processing systems. This article is followed by a series of brief reports on other installations.


Selecting a hospital information system. The need for a hospital information system is relatively easy to establish. The process of selecting the system that is right for a particular hospital is another matter entirely. The author takes you through the selection process that led Fairfax Hospital Association to a choice that satisfied the Association's needs.


The marketing audit.

The marketing audit.


Good news in court cases.

Good news in court cases.


Hospitals, consumers and advertising.

Hospitals, consumers and advertising.


Selection of a planning consultant.

Selection of a planning consultant.


They're playing games in education.

They're playing games in education.


A penny saved: hard water can be one of our costly enemies.


Conference on Health Planning and Development.


Federal regulations of labor-management relations.


The role of UR coordinators in risk management.


Quality assurance anecdotes: quality accountability at Flow Memorial Hospital.


Stress management for hospital employees.


Advancing health employment in the 80s.

Advancing health employment in the 80s.


A penny saved: cross-training of personnel.


Effective communication: 10 steps to a happier, more productive staff.


Stress in the health-care industry.

Stress in the health-care industry.


E.A.R.S.--a counseling service that does more than just listen.


Energy conservation in new hospital construction--Part I.


An alternative to social security: one hospital's answer to government's fiasco.


Computers help provide better care.

Computers help provide better care.


Application blanks: employers' score cards.


As I see it: the shortage of personnel needed to carry out our primary responsibility of nursing.


What makes a board innovative?

What makes a board innovative? A study of 20 community hospital boards suggests that boards of trustees whose members represent a wide variety of occupational backgrounds are more likely to be innovative and to initiate new programs and services than are more homogeneous boards. The innovative hospital boards also had more women and minority group members, more members under 50, and moe members who lived in their hospital's primary service area.


New data on hospital governing boards.

New data on hospital governing boards. This article, the first of three, presents data from the 1979 AHA Survey of Hospital Governing Boards, the AHA's first comprehensive collection of data on hospital governing board structures, procedures, and composition. Data are presented on size of boards, number of trustees, frequency of meetings, length of service and other aspects of terms of service, committees, title of top board officer, quorum, and age, education, and sex of board members.


Trustee development program: issues in nursing.


Purchasing group attracts large following in Michigan.


Behind worries over a glut of doctors.

Behind worries over a glut of doctors.


Is modern medicine worth its price?

Is modern medicine worth its price?


Minnesota's new mascots.

Minnesota's new mascots.


Army medical mission in Canal Zone 'unique'.


Women and volunteering: perceptions, motivations and effects.


Issues in the creation of organizations: initiation, innovation, and institutionalization. Kimberly presents a case study of the birth and early development of an innovative medical school. When the school opened in 1971, the existing 86 medical schools all offered similar programs: two years of basic science training in lecture halls and laboratories, followed by two years of direct contact with patients in clinical settings. In the new school, students were taught didactically only during the first year. During the second year, each student was assigned to a community physician who acted as an advisor and who discussed with students those patients afflicted with the diseases the student was currently studying. Available evidence indicated that the school's innovative curriculum was favorably received by the students and that they performed as well as their peers on standardized year-end exams. The author found the case of this medical school to be of particular interest from an organizational viewpoint in that: (1) the early development of the school was shaped by the first dean's entrepreneurial activity, ambitions, visions, strengths, and weaknesses; (2) the uncertainty resulting from the school's novelty forced individuals to assume new roles and face unclear performance criteria; and (3) the transition of an innovative school to an institutionalized one was problematic because it modified the decision-making process. The author suggests that those things which lead to an organization's success during its early years are not the same as those that lead to longer-run success. He says that a new organization creates new norms, values, and procedures whereas the elements of an existing organization interact within an established culture. He concludes that organizational birth is a phenomenon about which relatively little is known, but which may be an important constraint on later development. A comparative analysis of the birth, life, and death of organization is advocated.


The effects of environmental characteristics on the structure of hospital clusters. The population ecology view that variation in sets or clusters of organizations should be isomorphic with variation in cluster environment was used here to explain structural variation among hospital clusters. The structural characteristics studied were range of services offered within the cluster, average size of hospitals in the cluster, and cluster differentiation. In the causal model that was developed and evaluated, variation in the patient environment and variation in the supplier environment were compared. Four lagged panels of data on a national sample of fifteen hospital clusters demonstrated the relative superiority of supplier variables over patient variables. Supplier group preferences were more powerful than patient needs in determining the range of services offered by the cluster. Furthermore, increasing the range of services in the cluster had a positive, significant effect on average hospital size, whereas size apparently exerted no effect on range of cluster facilities. Cluster differentiation seems to be causally affected by range of services, average hospital size, and by the periodic closing of hospitals over time.


Health rights of the elderly fizzle as management fiddles.


The effects of group decision-making process and problem-situation complexity on implementation attempts. The effects of group problem-solving method and problem-situation complexity on attempts at implementing group solutions were investigated in a laboratory-field setting. Group members were supervisory nurses from various organizations, who were randomly assigned to three groups in a balanced research design which included three group decision-making processes and three levels of problem-situation complexity in implementation. The dependent variable was the number of attempts at implementing group-derived solutions in home organizations. The results showed that structure in group decision-making processes led to increased rates of implementation attempts at all levels of problem-situation complexity. There was a significant complexity-by-process interaction effect among the decision-making processes, which supports the conclusion that the type of group decision-making process and the problem-situation complexity should be considered in order to optimize the number of implementation attempts.g


Triage: a central source for a variety of services.


Hospice concept tested at Texas nursing home.


Nutrition: responding to the needs of the geriatric patient.


Strategies for safe home visits.

Strategies for safe home visits.


Mass. facility cares for both young and old.


Five-meals-a-day plan benefits residents, facility.


Council of Elders promotes 'regenerative community'.


Connecticut survey says residents need facilities to survive.


Drug destruction.

Drug destruction.


Primary nursing at Rush-Presbyterian-St. Luke's Hospital.


The unlimited potential of nursing in the eighties.


Financing a nursing home through tax-exempt bonds.


Rehabilitation through education: educational therapy used in a neuropsychiatric setting.


Community support system program--comprehensive rehabilitation for chronic mentally disabled.


Analysis of licensure examination performance in relation to prior internship experience.


Senior volunteers bring experience and expertise to ACTION.


Working with the elderly ex-mental patient.


Lack of good managers called biggest problem facing HMO industry.


Company helps hospitals recover 'lost charges'.


In Maryland, physicians fight state commission ruling.


HMO for senior citizens draws fire from MDs.


Chicago physicians are invited to advertise in 'yellow pages'.


Proposed VA hospital generates planning controversy in Baltimore.


Community action stirs senior potential.


Controversy simmers over new OSHA rule.

Controversy simmers over new OSHA rule.


Widowhood peer counseling.

Widowhood peer counseling.


The older "indigenous" worker: assets and problems.


Tele-care: a telephone reassurance success story.


HMO study assesses cost, quality, access to care.


Services for families of the institutionalized aged.


Preparing chaplains to meet the needs of older adults.


Getting to the roots of linen loss problems.


Laundries taking smaller share of total hospital expenses.


Working four days a week works.

Working four days a week works.


Sound textile management needed to reduce costs.


Delegates reaffirm NHI policy.

Delegates reaffirm NHI policy.


Sound catering management a necessity.

Sound catering management a necessity.


Health promotion--an idea whose time has come. The sharpening focus on positive lifestyle habits is one signal of the growing emphasis on health promotion. Lately the priority of communities, businesses, government agencies and lung associations has been to nurture the concept that disease prevention is as vital as effective treatment.


Russia: health care integral part of the system.


How to reduce turnover by creating a positive work climate. Despite company attempts to reduce employee turnover by offering attractive salaries and benefits, Kushell notes that attrition continues at an alarming rate. He states that more than one of every three employees will change jobs over the next five years, a transition that will take its toll on company morale and productivity. The underlying factor, according to the author, is the quality of the working environment. A 1969 University of Michigan survey of 1,533 workers, at every occupation level, reported that all respondents ranked interesting work and authority to get the job done far ahead of good pay and job security. Sources of employee frustration include a stifling bureaucracy, excessive job expectations, and unsuitable jobs. The author suggests that top managers ask themselves whether they are missing out on or losing talented employees. If this is the case, there are several guidelines management should follow: improve communication between employees and top management; define expectations of the employee; and promote candor in the job interview. Kushell concludes that top executives can have an impact on turnover by paying attention to what employees really want rather than what management thinks they want.


Physicians and administrators can work together. This article describes the working relationship between the administration and medical staff of the Mid-Maine Medical Center which is comprised of two separate modern hospitals. The authors advocate the philosophy that "a hospital which harnesses the medical staff's considerable talent and expertise through sound organizational input will be a stronger institution." They explain that patient care is becoming increasingly complex and that management decisions impact heavily on the care provided. In 1973, the Medical Center changed from its traditional organizational form of having a full-time medical director and an administrator report to the board of directors, to a modified corporate model designed to increase physician involvement. In the new organization, the vice president of finance and a part-time chief of staff (acting as vice president for medical affairs) report to the president (former medical director) who, in turn, is responsible to the board of trustees. The authors attribute the success of the reorganization to the CEO's willingness to delegate and share authority, not to the CEO's physician background. Planning at the institution involves a committee of six physicians, four administrators, and one full-time planner. A budgeting committee of three physicians and three administrators is responsible for the review of the budget as well as for making recommendations for the executive board for the expected volume of services. It is concluded that there is no perfect way to run a hospital, but the involvement of doctors in hospital decisions is necessary.


Sizing free-standing ambulatory care facilities. This guide, written by an administrator and an industrial engineer, identifies and discusses the factors that should be considered when planning space requirements for ambulatory care facilities. The authors view sizing the ambulatory care facility as a complicated sequential task where trade-offs are made with regard to several factors: philosophy of patient care; cost; expansion requirements; patient comfort and waiting time; patient privacy; staff preferences; utilization patterns; and scurity of the faculty. It is suggested that the weight assigned to each factor when making trade-offs will be largely affected by the philosophy of patient care. The authors divide ambulatory care facilities into five functional groups: (1) basic medical services; (2) supporting medical services; (3) administrations; (4) support and service facilities; and (5) community and secondary support facilities. There are tables summarizing recommended space requirements for each of the functional groups based on mathematical models of the number and type of people using them (i.e., a typical physician is expected to see 24 patients per day). Space requirements for the whole clinic can be determined by adding together those required for each functional component. Provisions for growth and technological advances are discussed. An extensive bibliography is included.


CME standoff: no new legislation in sight.


Exposing a lady killer: the American Cancer Society launches a media blitz on breast cancer.


We've come a long way, baby, in improving trauma care.


Comments on verfication program.

Comments on verfication program.


Verification program for hospitals developed by the American College of Surgeons Committee on Trauma.


The Gallup survey on surgeons and surgical care.


Cancer: guidelines for the eighties. Patterns-of-care studies: results and consequences.


The hospital cancer program: its benefit to patients.


Cancer: guidelines for the eighties. Is the approvals program relevant to the university center?


Tasks for the community cancer center.

Tasks for the community cancer center.


Cancer: guidelines for the eighties. The role of the field liaison program.


Challenges for the medical oncologist.

Challenges for the medical oncologist.


The Commission on Cancer.

The Commission on Cancer.


Cancer: guidelines for the eighties. Goals for a new decade.


Hospital pharmacy's objectives show visually on magnetic board.


How a Texas hospital copes with dictation processing.


Food and Drug Administration--Prescription drug products; patient package inserts requirements. Final rule. The Food and Drug Administration [FDA] adopts final regulations establishing requirements and procedures for the preparation and distribution of patient package inserts for prescription drugs for human use. The package inserts will inform the patient about the drug product. This action is intended to promote the safe and effective use of prescription drug products by patients and to ensure that patients have the opportunity to be informed of the benefits and risks involved in the use of prescription drug products. The agency intends to apply the regulations to 10 drugs or drug classes during an initial implementation program. Further evaluation of the costs and benefits of the program will guide the agency in deciding whether to extend, revise, or defer these requirements.


Too many Caesareans?

Too many Caesareans?


Cancer: guidelines for the eighties. Update on the American Joint Committee.


Public Health Service--Grants for training in emergency medical services. Final regulations. These regulations set forth requirements for grants for training programs in emergency medical services, under section 789 of the Public Health Service Act. These grants would go to schools of medicine, dentistry, osteopathy, and nursing; training centers for allied health professions; hospitals; and other appropriate educational and public entities.


Society has no right to modify behavior without consent.


Cost monitoring helps restore bankrupt HMO.


For doctors, Washington has become one of the burdens of doing business.


Survey shows budgeting art improved in hospitals.


The art of medical illustration.

The art of medical illustration.


The sealed bid--a matter of confidence.

The sealed bid--a matter of confidence.


Small hospitals move to private telephone systems.


Purchasing and the antitrust laws.

Purchasing and the antitrust laws.


Product evaluation-standardization-value analysis.


Co-op laundries not tax-exempt.

Co-op laundries not tax-exempt.


Controlling rental equipment.

Controlling rental equipment.


CS' commitment to continuity.

CS' commitment to continuity.


Captive supply house charting new courses.


Organization: move over, Obi-Wan Kenobi.


VA examines disposables use; switch to reusables unlikely.


Linen loss prevention: ring around the pocketbook.


The pharmacy service of Memorial Hospital Medical Center. This article identifies the scope of activities, needs and subjects of a clinical pharmacy service program in a progressive community hospital. Even after ten years of constant effort, a comprehensive hospital clinical pharmacy program still requires continual review, changes, and improvements.


Freedom of speech and freedom of the press in medical and pharmacy practice.


Evolution and trends in major medical plan design.


Connecticut Health Plan looks to successful future under financial and management reorganization.


Radiographic education at the crossroads.


Selection of screen-film combination.

Selection of screen-film combination.


The structure of competence in health professions. The past decade has seen widespread research on systematic evaluation of the competence of health professionals. Such activity usually has been carried out in accordance with the prevailing psychological paradigms, in which competence is represented as a trait, or as an intrapsychic factor. However, even when competence has been delimited as problem-solving, the research generally identified a strong situational influence on performance. In this article are assembled a set of diverse but complementary arguments for dispensing with the conventional representations of professional competence. In their place is proposed a relational model in which competence in health professions is seen as the aggregated adaptations of practitioners to the set of special social circumstances that obtain within the situational boundaries of their profession. It is argued that a thorough understanding of the content of professional situations is a necessary prerequisite for successful evaluation of professional competence, since competent behavior is lodged in a network of probabilistic relationships with the surroundings. Also discussed are selected procedural implications of this new model for the conduct of investigations of professional situations.


Standard-setting in written and interactive (oral) specialty certification examinations: issues, models, methods, challenges. This article addresses standard-setting for written and interactive (oral) examinations in the health professions. The currently used methods are explained and classified, and their strengths and weaknesses are discussed. We argue that standard-setting must be understood as an interactive system involving decision maker(s), subject area, and methods. Thus, standard-setting is a psychological/social psychological process as well as a psychometric one. It rests upon a foundation of judgment. For written examinations, normative and content-referenced (absolute) methods are discussed. In interactive examinations, judges' standards are inherently absolute; design considerations are presented to systematize the context for these judgments.


The medical confidentiality sham.

The medical confidentiality sham.


Building organization effectiveness through retreats: Kaiser Permanente works its plan system-wide.


Group practice management: eight challenges for the eighties.


Licensure by specialty.

Licensure by specialty.


ECFMG announces program of grants-in-aid.


The child visitor: a hospital hazard?

The child visitor: a hospital hazard?


The patient comes first.

The patient comes first.


Twenty-ninth annual Welch Memorial Lecture.


Visions of the future.

Visions of the future.


The physician-patient relationship--a shift in understanding.


The fresh air of ethics on Molokai.

The fresh air of ethics on Molokai.


Computerizing patients' histories cuts costs plus improves quality of care.


A proven approach to in-house technical training.


Medical costs contained through computerized appointment scheduling.


Hospital-HMO relations: the health alliance experience.


In-house versus service bureau: an economic analysis.


Computer-based collection effort increases income by 9 percent.


Hospital radio: advertisements get an airing. As a DHSS circular opens the door to advertising on hospital radio, someone who describes himself mysteriously as a "senior health service administrator in North London with a special interest in radio communication and allied subjects' reports how one station has risen to the challenge.


Cottage hospitals: a place in the country that is not entirely countrified. They built a monument to the venerable Dr William Irvine, and they called it Irvine Memorial Hospital. Eighty years on, it lives up to his good name. There is no call to rusticate at this haven of healing in Scotland's tourist belt. Life is not all a summer idyll, as Nick Davidson discovered.


Flying squad to the rescue.

Flying squad to the rescue. Set up following a serious train crash at Sutton Coldfield in January 1955, the accident and emergency department at the Derbyshire Royal Infirmary was the first such department to organise and operate an accident flying squad. On its 25th anniversary Tim Brett, deputy administrator at the hospital, looks at its development and the role it plays today.


Public property--let the seller beware.

Public property--let the seller beware. The greatest lesson to be learnt from the sale of Robroyston Hospital, Glasgow is the growing need to develop commercial awareness in the public sector. Stephen Halpern reports on how costly failure to apply this lesson may be.


Organisation of nursing services 2: strength in integration. 'The concept of the nursing officer has much to command it and we commend it and we recommend that her clinical role should be developed...'declared the Royal commission on the NHS. L.C. Howell, area nurse (information service planning), Cambridgeshire AHA (T), in the second of three articles, suggests how this development might take place.


Trauma--the way to cope?

Trauma--the way to cope? A 140-year-old accident hospital in the South Birmingham Health District offers a much praised service to the injured patient. Yet conditions are cramped. Old operating theatres are under repair, and operations are carried out in a tent. Why then are there some objections to the planned resiting of the hospital? Pauline Drummond reports.


Forum for the future.

Forum for the future.


The hospital engineer's role in health care delivery.


Accident and emergency: Raynet--the helping hams. Without an efficient communication system through which to co-ordinate and control, even the most comprehensive accident and emergency procedure is useless. Here, George Forfai sings the praises of those generally unsung heroes, the radio amateurs who, working with the professionals, ensure that the message gets through...


Accident and emergency: testing the prototypes. The Dorset ambulance service is currently carrying out trials on modular prototype ambulances. Joyce Galley joined a high speed test run over a rough course and reports on a ride which was made quite tolerable.


Accident and emergency: patients don't--staff do. Who is responsible for the misuse of the ambulance service and what can be done about it? This question is raised by Terry Ball, planning officer for West Yorkshire Metropolitan Ambulance Service, who believes that the guilty parties are the ambulance service itself, doctors, nurses administrators and support service staff. Here he explores ways in which the misuse can be rectified.


Staff influence on design and purchase of technical equipment.


Defending illusions: the institution's struggle for survival. Based on participant observation and other qualitative data collected at 15 institutions for the mentally retarded, this study is directed to determining how institutional officials deal with outside criticism of their facilities. Over the past decade and a half, the legitimacy of institutions for the retarded has been challenged by professionals, courts, parent groups, and the media. Officials have reacted to outside criticism by developing new legitimating myths, increasingly sophisticated impression-management techniques, and detailed rationales for the all-too-visible discrepancy between goals and practices. Thus, this paper is concerned with the symbolic nature of the institution's struggle for survival.


Hospital maintenance: consequences of cost and safety aspects.


AHA continues to oppose HCFA malpractice regulation but offered constructive criticism to proposed manual revision; advises hospitals to file protective cost reports.


Alternate roles for the elderly: an example from a Midwestern retirement community. Increasing numbers of individuals are surviving to retirement age in relatively good health. With the loss of the work role and other roles typically associated with middle age, they are faced with the dilemma of the "roleless role," an absence of well-articulated, age-appropriate expectations and standards of behavior by which to structure everyday life. Recent anthropological, sociological, and psychological studies indicate the possibility of the development of alternate roles and age-appropriate normative systems in age-homogeneous environments. An example of one such alternate behavioral system is provided from data collected on a small retirement community in the Midwest. A normative system seems to have developed in which personal qualities such as trust, friendliness, and concern for others are more highly valued than former achievements or occupational status. Residents most frequently cited as having made a good adjustment to aging were not necessarily those who were most active, but rather those individuals who showed a determination to "keep going," lacked self-pity, kept mentally alert and aware, were willing to help others, and showed a sense of responsibility to the community. Various roles were developed and were expected to be assumed by incoming residents: alternate "work roles," represented by committee memberships and volunteer activity; "family roles," represented by the supportive or helping relations adopted toward other residents; and leisure-type roles. These behavioral standards and expectations helped to structure the relationships and everyday life of residents within the community.


GAO report explores impact of hospital prospective rate-setting programs; AHA states report neglects increased hospital costs due to excessive regulations.


Religious discrimination guidelines to be published by EEOC.


HHS publishes priorities for investigating Hill-Burton complaints.


AHA submits group purchasing position paper to HHS, seeks endorsement of operating principles.


Organisation of nursing services 1: fine tuning is called for--not a new instrument. These are critical times for the nursing profession. Morale is sagging in the wake of changes and attacks. In the first of three articles L.C. Howell, area nurse (information service planning), Cambridgeshire AHA (T), looks at management structure.


HCFA proposes dialysis reimbursement regulations with separate hospital-based rate: comments due Nov. 25.


Delaware rules on termination of treatment for comatose patient.


How to improve meals while cutting costs.


Paramedical team assures recovery.

Paramedical team assures recovery.


Labour arbitration: when somebody lies on the application.


Make politics work for you.

Make politics work for you.


Physicians can treat cost control ills.

Physicians can treat cost control ills.


Professional formation as a tool for change: rethinking the education of health workers.


Health laboratory manpower and services: a proposed model for developing areas.


The epidemiology of malignant disease: a basis for public policy.


An approach to regulating cephalosporin use and costs.


Implementation and operation of a hospital pediatric satellite pharmacy. The planning, implementation, operation, and evaluation of a hospital pediatric satellite pharmacy are described. An initial three-month project involving establishment of a pediatric satellite pharmacy that provided unit dose drug distribution, intravenous admixtures, and a few clinical services was completed and evaluated. Positive evaluations by the medical and nursing staffs resulted in continuation of the satellite as a permanent program. Clinical services initially provided by the pediatric pharmacist were expanded to include acquisition of admission drug histories, instruction on discharge medication, participation on pediatric medical rounds and on the pediatric cardiopulmonary arrest team, operation of the poison control center, distribution of pediatric drug information, preparation of chemotherapy and monitoring of investigational protocols, and provision of pediatric nursing inservice education and community education. A five-year evaluation of the services provided by the pediatric satellite pharmacy was completed by 71 pediatric nurses and 27 Mayo Clinic physicians, all of whom had worked with the system regularly. The tabulated results are presented. Responses to overall services of the pediatric pharmacy were designated good to excellent by 100% of the physicians and by 98.6% of the nurses, indicating that the pediatric satellite pharmacy is a successful and beneficial program at this institution.


Oral syringe use survey.

Oral syringe use survey. Use of oral syringes at children's and ASHP-accredited residency hospitals in the United States was surveyed. Questionnaires were mailed to 131 hospitals; 117 (89.3%) were returned. Of the responding hospitals, 54.5% of children's hospitals and 67.1% of residency hospitals used oral syringes. There was no definite preference for a particular brand or type (glass vs. plastic) of syringe. Patients who often required liquid dosage forms, including pediatric and geriatric patients and patients with nasogastric tubes, were most frequently included in oral syringe distribution systems. Twenty-six of the 73 hospitals utilizing oral syringes used them for most unit dose liquids in all drug distribution systems. The remainder reported use for specific medications or circumstances. Expiration dating policies varied from 24 hours to one year to the manufacturer's expiration dating. The survey indicates widespread use of oral syringes and identifies a need for evaluation of medication stability in these devices.


Turning complaints into cash.

Turning complaints into cash.


Time to work.

Time to work.


Problem: how to involve the employer in collection problems with insurance companies which are slow to pay.


The group practice management game 2. Lessons and strategies of medical group management.


The unqualified profession: a problem oriented study.


The most effective "form letter".

The most effective "form letter".


Collection forms, an analysis: what is illegal, objectionable under P.L. 95-109?


Painting with numbers.

Painting with numbers.


Patient attitudes to PPIs: a pilot survey of three demographically distinct areas.


Maslow, motivation and the manager.

Maslow, motivation and the manager.


Flextime: flexible work schedules may improve employee relations.


Management peer review.

Management peer review. By implementing a management audit program, you can not only improve your clinic's operation, but also demonstrate a forward-thinking management style and strengthen your public image.


Legislative efforts to reform medical malpractice: unconstitutional in practice?


Management in a trilingual setting: accommodating the non-English-speaking patient.


Regulations: it's a jungle out there.

Regulations: it's a jungle out there.


The pregnant minor: contraception and abortion under Canadian law.


Physicians proud of physical plant.

Physicians proud of physical plant.


The case of Brother Fox: immunity procedures in the treatment of terminally ill incompetent patients.


Patient well-being is designers' first concern.


Management systems engineering.

Management systems engineering.


Form must follow function.

Form must follow function.


The future of the healthcare system and the new realities of today.


The concept of self-insurance.

The concept of self-insurance.


Hospitals split between praise, distrust of DRGs.


Seaway influences design.

Seaway influences design.


Questions physicians should ask about HMOs and IPAs.


Administrators take command, leading hospitals into new DP growth stage.


Complex systems manage energy as costs rise and resources dwindle.


AHA position on standards awaited.

AHA position on standards awaited.


The Little Rock Orthopedic Clinic.

The Little Rock Orthopedic Clinic.


Where is group practice headed?

Where is group practice headed? A CRAHCA educational program was held recently to determine the changes in the health service environment that are most likely to occur in the near future, and how these changes will affect medical group practice.


Blues have right to trim payments.

Blues have right to trim payments.


Hospitals play into the hands of vendors who try to break group contracts.


New tax-exempt bond program cuts interest cost for hospital equipment.


Hospitals mobilize as volcano chokes Pacific Northwest, riots rock Miami.


The buying and selling of group assets.

The buying and selling of group assets.


Employers wary, but hospitals welcome bill.


Collective bargaining given funding, priority boost by ANA delegates.


ANA rebukes opposition, reaffirms support of entry-into-practice stand.


Bond tax threat spooks hospitals.

Bond tax threat spooks hospitals.


Few materials managers are given responsibilities matching their titles.


Syark urges HSAs to concentrate on top priorities; HHS wants results.


Summary of pending healthcare regulations.


Abuse, poor image causes shortage.

Abuse, poor image causes shortage.


CHA strategy: aid Catholic systems to compete with management chains.


Solve nurse shortage with dual attack.

Solve nurse shortage with dual attack.


Inflation and devices, 1979.

Inflation and devices, 1979.


Disposable insulin syringe makers wary of "safe' multiple use claims.


CT scanners prove worth the cost.

CT scanners prove worth the cost.


"Branching out' in Denver.

"Branching out' in Denver.


How we specialize in serving long-term care facilities.


Our pharmacy department offers 8 services in a lithium clinic for manic-depressives.


When a woman wants to deliver outside the hospital.


Competition, catastrophic insurance, financing will spur convention debate.


Legal aspects of cardiac pacemakers.

Legal aspects of cardiac pacemakers.


New medical malpractice crisis: pricing, politics, problems.


Advocacy and the mentally ill.

Advocacy and the mentally ill.


Performance appraisal: match the tool to the task. Performance appraisals can be vital tools in administering an effective human resources program if they're used properly, although they're particularly useful in salary administration, incentive award determination, and promotability assessment, selecting the method or methods that best meet your needs may not be easy. John D. McMillan, director of compensation services, and Hout W. Doyel, consultant, of A.S. Hansen, Inc., explain the key features, advantages, and disadvantages of four major types of performance appraisal methods: the trait checklist, the management by objectives approach, the free-form approach, and the responsibility rating system. The authors note, for instance, that the most frequently used method, the trait checklist, has these major disadvantages: Traits that are rated tend to be general and don't relate specifically to job performance. The tendency of raters is to focus on personal characteristics rather than job performance results. And the method makes no sense where different levels in a job family are rated on the same form.


Screening for high social risk: principles and problems. Sound use of hospital social work services is not achieved when workers rely on other health personnel for referrals. The authors propose a screening mechanism to identify patients at what they term high levels of social risk and to restore the initiative to social work staff. Relevant principles and problems are also discussed.


Stage three in personnel administration: strategic human resources management. The traditional view of the personnel manager-a glorified record keeper who processes forms, monitors the suggestion box, and administers employee benefits-is fast fading. Top management's notion that the personnel department is merely a cost center-overly concerned with humanistic ideals and with little impact on the bottom line-is giving way under the impact of several changes. Beginning in the late 1970s, a series of major upheavals in the world of work-increasing government regulation, declining productivity, rising concern with the quality of worklife, and the entrance of the post-World War II baby boom population into an already highly competitive job market-have changed the personnel department's status from that of organizational stepchild to a potentially premier force in the organization's ability to survive and grow. Stella A. Nkomo, human resource research associate at the University of Massachusetts at Amherst, traces the evolution of the personnel function and discusses how personnel executives can meet the challenge of strategic human resources planning.


A goal programming model for the siting of multilevel EMS systems.


Fixed proportion production models for hospitals.


Credentialed in college: NBRT's entry-level examination proposal.


Standards for humidifiers and nebulizers; an important first step.


Facility report : Lynn hospital, Lynn, Massachusetts.


Hospital management industry update.

Hospital management industry update.


Watching Washington. Interview by David Cassak.


The new PACs.

The new PACs.


The harbinger of home healthcare.

The harbinger of home healthcare.


Rural health: policies, progress and challenges.


Tuskegee area program attempts to link 'Black Belt' health services.


Folk medicine or physicians? What happens when Appalachia goes urban?


Hypertension in rural America.

Hypertension in rural America.


Practitioners find health problems 'no different from other places' at Oregon Indian reservation.


'Involvement' and 'unhurried pace' caused doctor's decision to stay in small town.


The ambulance was an old panel truck.

The ambulance was an old panel truck.


Who cares for the Indians?

Who cares for the Indians?


Turnaround at Valley View.

Turnaround at Valley View.


Trouble at Eagle Butte.

Trouble at Eagle Butte.


Reviving an ancient healing art.

Reviving an ancient healing art.


Patient power: complex issues need complex answers.


Big changes in store as HMO industry enters 'adolescence'.