A guide to knowledge and skills necessary for employment within a mental health service. This document "A Guide to Knowledge and Skills Necessary for Employment Within a Mental Health Service" was developed over the course of a number of meetings by the Provincial and Territorial Directors of Mental Health Divisions. It arose from a concern expressed from all parts of the country that the graduates of some professional schools were not necessarily equipped by their training to assume roles in mental health services. The document has no mandatory aspect and is intended only as an advisory guideline, to be helpful to employers and to those planning to work in direct mental health services.


Radio, social support, and mental health. The author discusses the rise of "interactive radio" and its potential as a form of social support. Ranging from music request shows to on-air counselling, interactive radio reduces isolation, allows listeners to participate in various kinds of networking and dialogue, and conveys information and advice that may be helpful in promoting mental health. Based in part on his own experience with a weekly program, the author identifies characteristics of interactive radio that will be to interest or professionals who want to use the medium for community mental health promotion.


Planning your niche in the "high tech" home care market. Proponents of high tech home care cite its significant cost savings compared to similar therapies provided in an inpatient setting. Further proof of its cost effectiveness may, indeed, provide support for more attractive reimbursement coverage in the future and greater use of such therapies. However, at the present time, existing and prospective providers should proceed cautiously given the potential reimbursement pitfalls and increased competition. Hospitals, in particular, are increasingly interested in participating in this market, either through providing all aspects of the program or only parts. As such, agencies may find them either to be competitors or affiliated partners in providing high tech home care. Agencies have a variety of choices to make regarding high tech home care: provide specialized nursing care, provide equipment/supplies, handle billing, or handle it all. Whatever the approach, it is critical to understand the reimbursement aspects and target marketing efforts to hospitals, high tech product companies. HMOs, and perhaps most important, physicians.


The role of the social worker in provincial psychiatric hospitals: an Ontario study. Confusion still exists about the roles and functions of social workers in the mental health care system. The authors discuss this role ambiguity and its effects. They then present and discuss the findings of a study that explored the current role of the social worker in Ontario psychiatric hospitals with the following objectives: to document social workers' major roles and activities; to assess role satisfaction; to assess involvement in decision making; and to identify major types of therapy used.


Visiting Nurse and Home Care, Inc.: high tech home care in a VNA.


Creating a safe environment for high tech home care.


Caring for ventilator dependent patients.


Assuring quality and confidence in new home care technologies. In summation, a quality assurance program must prepare itself to succeed. The groundwork is often tedious and the orchestration of "hi-tech" programs no easy task. But by spending the time required in the development and educational phases, you will effectively avoid the common pitfalls in implementation of "hi-tech" programs. Patient care will run smoothly from beginning to end. All people involved will receive satisfaction in knowing that no compromise in quality is necessary in the transition from the hospital to the home setting.


The danger of making serious problems worse.


The Visiting Nurse Association of New Haven, Inc.: profile high-tech program development.


HMOs in transition: what the future holds.


Vertical integration in home care--part I.


Assessing staffing needs in home care.

Assessing staffing needs in home care.


Geriatric alcohol program: participation in a demonstration project.


U. S. Senators raise money for hospice and home care.


The compelling issue of access to capital.


Legislators speak on home care.

Legislators speak on home care.


Home care challenge: care of the vulnerable elderly.


An alliance for economic revitalization.


For-profit hospitals: a cost problem or solution?


Meeting community needs is a major concern raised by for-profit health care.


Forming an ethical response to for-profit health care.


The rise of proprietary health care.

The rise of proprietary health care.


The organization review: health care management.


Illinois looks to data gathering council to spur competitive cost reform.


Purchasers should share in solving the mutual problem of indigent care.


Hospital care for the poor: who will bear the burden?


ProHealth: curing hospital ailments.

ProHealth: curing hospital ailments.


Meeting the competitors.

Meeting the competitors.


Bar coding--where are we? Part 2.

Bar coding--where are we? Part 2.


Hospitals selling computers.

Hospitals selling computers.


An interview with Leo I. Mirowitz, President, McDonnell Douglas Health Systems Company.


Doctors and hospitals: an antitrust perspective on traditional relationships. Under new pressures for cost containment, hospitals are increasingly asserting interests that conflict with those of physicians. Professor Havighurst argues that legal rules under which practitioners have challenged denials of hospital admitting privileges should be clarified in order that hospitals can more effectively carry out their new cost-containment and other responsibilities. He invokes antitrust law's "essential-facilities" doctrine to protect those abused by their competitors on a hospital staff, but he contends that, if a hospital participates in decisionmaking as an independent actor--even though it acts in concert with its physicians--, antitrust courts should lower the level of scrutiny to a point at which most challenges can be dismissed summarily. He analogizes restraints imposed by hospitals on competition between health professionals to vertical restraints of other kinds, and draws conclusions critical of doctrine traditionally applicable to the latter.


Attitudes of the emergency physician toward and diagnostic evaluation of suicide attempters. The negative attitudes of emergency medical personnel toward suicide attempters are well documented in recent studies. Part of the reason for such negative attitudes may involve the emergency medical professional's lack of knowledge about the variety of psychiatric conditions present in the patient who attempts suicide. Information about such conditions and the emotional reactions certain personalities generate might alter these attitudes. Questioning the patient about the feelings and thoughts experienced during the attempt often provides some of the most helpful data about the patient's psychiatric condition, treatment needs, and prognosis. Proper guidelines and education for the emergency physician should help improve the early management of the suicide attempters.


Appropriate bargaining units in health-care institutions: the disparity of interests test.


Retiree health and welfare benefits: controversy over their duration. As the cost of providing health-care benefits skyrockets, employers have begun to reduce or even to terminate health-care and life insurance benefits for retirees, often with little awareness of the possible repercussions. Retiree groups and unions have countered these actions with claims based on such theories as the "status benefits" argument--that retirement benefits should be viewed as earned compensation for years of service--or the "vested rights" view--that retirement rights may not be altered without the pensioner's consent. Crucial to these conflicts are the terms of the collective bargaining agreement. Case law indicates that employers can never feel themselves fully protected even if the agreement contains provisions explicitly stating the benefits' scope and duration. The authors demonstrate this point in their review of recent retiree benefits cases. They then explore in detail the problem of contract and document ambiguity, and offer guidelines for ascertaining intent. They conclude with a discussion of strategies for litigating retiree benefits cases.


Recruiting trustees who care: a key for effective boards.


Defining health and health care--a practical perspective.


The effectiveness of alcohol control policies in Europe. This paper examines the relationship between alcohol control measures, alcohol consumption and selected indicators of alcohol related harm in fifteen countries of Europe and in Israel. A public health perspective on alcohol problems is developed in which alcohol related consequences, both positive and negative, are seen as emerging from the interaction of alcohol itself, the individuals who consume it and the physical and social environment. Consequently, a range of alcohol control and prevention measures is examined, some aimed at the availability of alcohol, other at those who drink alcohol and yet other at the environments in which drinking takes place and problems emerge. A rudimentary scale of alcohol control policy is presented, from which a classification of European countries in terms of alcohol control status is possible. Per capita alcohol consumption and liver cirrhosis mortality data in these countries are examined cross-sectionally and over time. These indicate that cross-sectionally there is, in general, a clear relationship between the alcohol control status of European countries and both per capita alcohol consumption and liver cirrhosis mortality. However, from a time series view there are some interesting exceptions to this general observation. Nonetheless, there is sufficient evidence to suggest that alcohol control and prevention measures are effective at controlling alcohol consumption and preventing the adverse consequences of drinking. Some considerations about alcohol control policy in Europe other than the control of availability are presented.


Volunteers: unleashing their potential.

Volunteers: unleashing their potential.


Parking headaches? Trenton Memorial has viable solutions.


Social inequalities and perceived health. The association between morbidity and mortality indicators and low socio-economic status has been observed for many centuries. In 1980 the publication of the Black Report in Britain drew attention to the failure of the National Health Service to close the gap between rich and poor in relation to health status. The gradients of morbidity and mortality which are linked to social class have been observed throughout Europe, in the U.S.A. and Australia. However, information on how people feel, as opposed to how they become ill, and the cause of their death, is scarce. Measures of perceived need can provide important additions to routinely collected data because they give access to the experiential status of respondents and thus provide vital data on which to base planning, provision and evaluation of health services. A standard reliable and valid measure of perceived health, the Nottingham Health Profile, was used to conduct a postal survey of differential status in subjective health between social classes in England. The results showed statistically significant differences between social classes in the age group 20-44 years only. For both men and women these were in their experience of sleep problems, emotional problems and lack of energy. In all cases the lower the social class the greater the amount and severity of perceived distress. After the age of 45 these differences, although still present, were not so marked, perhaps because of the excess mortality rates in lower socio-economic groups and the lowering of expectations with age. It is suggested that younger people from unskilled and semi-skilled occupations and, of course, the unemployed, are more vulnerable than their better off compatriots because of a kind of psychic susceptibility which is a consequence of social circumstances and the inability to cushion the effects of ill health. A type of Marxian "immiseration' may occur whereby in contemporary society health status is undermined by spiritual and social impoverishment rather than by the gross poverty and grinding labour of the past. The results of this study indicate that changes in the allocation of health care resources may have only a minor influence on inequalities in health. Remedial action would, rather, need to take the more radical form of providing fulfillment for aspirations and enhancing well-being by introducing fundamental social, economic and environmental reforms.


Failures of the hospital financing system of the Federal Republic of Germany and reform proposals. This paper deals with an economic analysis of the present hospital financing system of the Federal Republic of Germany. In the first section normative criteria for the evaluation of hospital systems are established. The most important objectives are: a medically appropriate hospital care, an efficient production of services and adequate hospital care for everyone. The imminent conflicts between individual and social value systems on the one hand and between allocative and distributive objectives on the other hand are pointed out. The second section contains a short description of the most important elements of a hospital financing system: first the method of coordination of supply and demand. Since pure market systems are rejected as the only mechanism for the coordination of hospital care, other coordination systems must be applied. There are in principle two alternative systems at one's disposal: regulation of the hospital care by public authorities or negotiations between hospitals and financiers. Second, it is analysed how the financial burden can be shared amongst the patient and the various third party financing institutions such as statutory health funds, private insurance companies and public budgets. Third, the modes of reimbursement are discussed. It is pointed out, that besides the problem of how the hospital performance should be measured and how the level of prices of the services should be determined, the distribution of the production risks is the central matter in hospital reimbursement. The more hospitals have to undetake financial risks, the greater the incentives are for an efficient production of services. The third section contains a description of the main failures of the German hospital financing system. It is argued that the central public planning of capacities, which is dominated by political interests, causes excess capacities and structural disequilibria in particular sectors of hospital care. The next important failure is the division of the financial burden amongst public households and statutory health funds in spite of exclusive public planning authority. In the area of reimbursement the total cost reimbursement is criticized. The cost based public investment grants and cost based lump sum per-diem rates per patient in the area of operating cost imply incentives for an inefficient (and ineffective) production of services. The last section deals with some reform proposals which at present are being discussed. All proposals claim a regionalization of the hospital planning and a stronger participation of the hospitals and health funds concerned in the planning process.(ABSTRACT TRUNCATED AT 400 WORDS)


Evaluating trustees: "Who cares"?

Evaluating trustees: "Who cares"?


Public image: the number one PR problem.


The appropriate use of diagnostic services. (1) Introduction to the series.


Earthquake planning and preparedness.

Earthquake planning and preparedness.


General practice facilitator--a personal view.


Psychiatrists who passed MRCPsych 1975-77.


Occupational therapy in a health district--an overview.


A system for assessing use of patients' time. Education and patient education literature provide evidence that time spent in instruction, particularly when the student or patient is actively involved, is positively related to understanding. Time spent on other tasks is not positively related to outcomes. The way in which health professionals and patients spend their time together, however, has not been adequately researched. A system is described for assessing how patients spend their time in environments where health care is delivered. When the system was employed in a multidisciplinary diabetes clinic, it was found that almost two-thirds of patient nonwaiting time was spent in assessment. Only 20% or 12 to 15 minutes, was spent in instruction; in only four of these minutes wee patients actively involved. Although it may be common sense that people learn better when actively participating in an instructional session, these data suggest that common sense may not be common patient education practice.


Health Agreements between the United Kingdom (UK) and other governments for the development of co-operation in the field of medicine and public health. The UK has a number of Agreements with other countries covering co-operation in different aspects of health care. The provisions in some relate only to the treatment of the nationals of either side when visiting the other; others are more widely based and cover broader co-operation in the health care field. This article outlines what the Agreements contain, how they have developed and what opportunities they present to senior health professionals for exchanges with the countries concerned. Any reader who wishes to learn more about the scope of existing Agreements or who would like to put forward suggestions on topics for exchanges of information and experience in future Agreements should contact the Department of Health and Social Security at the address given at the end of this article.


Terminally ill patients' and families' responses to participation in a research study. Evaluations of the effect of interventions on the terminally ill focus on outcomes such as patient satisfaction and quality of life. Due to the theoretical nature of these measures, researchers must rely on patients and family members as primary data sources. Family members of terminally ill patients wee queried concerning their motives for participation in the National Hospice Study and their reactions to an intensive interview schedule. Of those contacted, 94% agreed to the interview. The most frequently cited reasons for participating in the study were the desire to help other families facing a serious illness and the desire to help the hospice movement. Responses indicated a real enthusiasm for study participation in spite of the stressful nature of the terminally ill patient's situation.


Mass casualty incident preparedness: can you plan for disasters?


Moulage: making disaster drills realistic.


Psychiatric emergencies, Part 1.

Psychiatric emergencies, Part 1.


Bloomington Hospital: kitchen & employee/visitor cafeteria.


Promoting a positive image.

Promoting a positive image.


How to cut dietary costs & improve patient care.


A new climate for management & labor.

A new climate for management & labor.


Medevacs of Alaska.

Medevacs of Alaska.


The market for dietetic services.

The market for dietetic services.


Relationship between the American Medical Association and the Federation of State Medical Boards.


Foreign medical graduates: credentials and licensure--I.


A modest proposal for controlling the influx of United States citizen foreign medical graduates in the United States.


The health of the industry.

The health of the industry.


New York and New Haven: labor walks the line.


EMS and nuclear war.

EMS and nuclear war.


New American Healthcare sees a key role for members in restructuring health care system.


VHA president says hospital group is a viable force in systemization.


Hospital's bottom line aided by effective management of equipment.


Polybutylene piping for automatic sprinkler systems.


Preventing pitfalls in fire protection systems.


Rethinking computer room design.

Rethinking computer room design.


National trends in union contract settlements.


State rate setting resoundingly beaten by Arizona voters.


The performance appraisal interview: putting it all together.


The supervisor's central role in organizational communication.


The team approach to patient management: a supervisor's responsibility.


Hospitals restructure for new markets in move to establish health systems.


Investor-owned companies develop innovative services in bid to build health care systems.


Freestanding hospital at Houston plans for future by developing health care system.


Image program gives AMI hospital workers a new look.


Self-insurance for employee health care benefits: an overview.


Act to impact taxable and non-taxable groups' joint ventures.


Bar coding: getting at the truth.

Bar coding: getting at the truth.


Trends in ambulatory care center automation.


Rose Medical Center's management team. Interview by Bill W. Childs.


Implementing order management.

Implementing order management.


The hospital materials management operations appraisal. Materials management is responsible for approximately 25% of the operating expense of the typical hospital. With the emphasis today on cost containment due to the various TEFRA, DRG and prospective payment regulations, many health care institutions are demanding increased economics and efficiencies from the various materials functions. However, numerous members of administration are uncertain how to obtain the desired materials improvements.


A look at hospital supply and equipment trends.


Measuring productivity in health care security. Activity logs of security officers can provide a statistical basis from which security productivity can be measured with validity. Here is a step-by-step description of one such approach.


Productivity--what is it and why.

Productivity--what is it and why.


Quality indicators of hospital security productivity. Indicators that measure the quality of an officer's performance are equally as important as those which measure the number of things he or she does. Here is a description of the quality indicators used at one hospital to increase program effectiveness--from newly hired officers through supervisory personnel.


The AAR report--how to record and disseminate afterhours entry activity, insecure areas and unsafe conditions. A reporting sub-system currently used by the safety/security department of Richmond Memorial Hospital provides a means to record and disseminate security and safety related activity. This system may easily be adapted to a micro-computer to provide a wide variety of incident analysis and productivity data.


Developing and applying computerized productivity standards for a hospital security department. One of the most successful computerized productivity programs in hospital security is being conducted at North Carolina Memorial Hospital, Chapel Hill, NC. In this article, the program is explained in detail. Besides Brexler, Dave Donaldson, security coordinator at the hospital, and Richard L. Brandon and Willy G. Yamamoto of the hospital's management engineering department, were instrumental in the program's development and implementation.


Humana Care Plus plan enables hospital company to compete in insurance business.


Increased productivity through employee participation. Applying theory Y and other management approaches that win employee support, rather than dictating productivity, has doubled individual officer performance in one hospital's security department.


Justifying your budget--a persuasive and flexible approach. The pressures have never been greater on security directors to demonstrate the cost-effectiveness of their expenditures. Here's one approach to budgeting that can be instrumental in getting manpower requests approved.


When your staff is cut: how one hospital coped with a one-third reduction in security officers. With many hospitals struggling with DRG's and growing competition for patients, budget reduction in security and elsewhere is becoming more and more prevalent. Forced to deal with a severe cut in its security officers' staff in 1980, New England Memorial Hospital's security department has survived for four years by taking a number of steps that have achieved more with less. Here are some of the lessons learned.


Using the computer to increase productivity in a shared services operations. Understanding the computer and developing programs for it that increase productivity in security is not as difficult as you might think. Here is an account of how one organization's experience with computers is working out.


How to develop and win support for a properly equipped security operations center. A Security Operations Center (SOC) offers security directors an opportunity to modernize, maintain efficiency, provide expanded services, and reduce future staff costs. Here is a step-by-step description on how to successfully set up an SOC, based on the system in place at William Beaumont Hospital.


Improving productivity through more effective supervision: motivational keys that work. "It is our belief that once security management has recognized the key roles played by their supervisory personnel, much can be done to improve the work, morale, and effectiveness of the security force. To this end, it is the responsibility of management to see that their supervisory staff is properly equipped and trained to assist their subordinates to use, as it were, the right tools".


The personal computer: getting the information you need for the least cost. By acquiring a relatively low cost personal computer and certain software, you can reduce the time now spent on costly manual operations in security, safety, and telecommunications management. At the same time, you can improve both your department's performance and its value as a resource for other departments.


Employing a dispatch-record card system for better performance. A simple 71/2" x 31/4" card, used to to record calls for service can be the basis for computer reports that enable management to better analyze the performance of a hospital security department. Here is a detailed account of how the card is used.


Making productive use of your creative resources--a "spatio-temporal" approach to loss prevention. Despite the overwhelming number of events that complicate successful and cost effective loss prevention programs, the fact remains that each event involves a "simple" act by a "simple" person. Perhaps we can come up with "simple" solutions, if we call on our creative resources.


Some basic approaches to productivity that work. Improvements in productivity or reductions in cost do not necessarily have to be tied to complex systems involving computers. Opportunities exist in all organizations to utilize more effectively equipment or systems on hand. In this article, three such "simple" approaches are described.


Nosocomial infections: an overview.

Nosocomial infections: an overview.


What is marketing?

What is marketing?


Maintenance data analysis for ambulances.


Cost containment pressures.

Cost containment pressures.


The acquisition agreement--its format.

The acquisition agreement--its format.


Strategies for adapting to high rates of employee turnover. For many organizations facing high rates of employee turnover, strategies for increasing employee retention may not be practical because employees leave for reasons beyond the control of management or the costs of reducing turnover exceed the benefits to be derived. In this situation managers need to consider strategies that can minimize or buffer the organization from the negative consequences that often follow from turnover. Strategies organizations can use to adapt to uncontrollably high employee turnover rates are presented in this article. In addition, suggestions are made for how managers should make choices among the alternative strategies.


Supreme Court decision could affect publicly owned hospitals.


HHS provides instructions for Hill-Burton uncompensated care amount.


After St. Francis II: rigid standards imposed on small bargaining units.


Children, families, and mental health service organizations: cultures in conflict. This paper applies the concepts of culture, organizational culture, and culture conflict to a study of relationships between children, their families and a number of mental health and other social service organizations. The culture of a specific children's mental hospital ward is examined and a sample of 12 patients is followed on their course through the service system (pre- and post-hospitalization). A cultural interpretation of current mental health service delivery problems is suggested.


Hospital joint ventures, diversification, and the antitrust price discrimination laws.


More than 400-member hospitals join in asbestos suit.


Public Health Service proposes amended Hill-Burton recovery rules.


Supreme Court declines review of staff privileges, other health cases.


Hospitals/providers should review new GM plan.


Federal Court rejects nurses' assn. comparable worth claim.


Legal considerations of medical staff-hospital joint ventures.


Infection control: is it quality assurance?


Medical records--friend or foe?

Medical records--friend or foe?


NLRB revokes association's certification.


Executive message: clinical data management.


Health for all by the year 2000: what role for the medical record practitioner?


Burning out.

Burning out.


Hospitalization from a patient's point of view.


Where will all the garbage go?

Where will all the garbage go?


The politics of health care.

The politics of health care.


Fighting fire with compassion.

Fighting fire with compassion.


The information manager and his environment.


An introduction to health futurism.

An introduction to health futurism.


Rural hospitals and community health.

Rural hospitals and community health.


A peer-reviewed journal?

A peer-reviewed journal?


English community health services.

English community health services.


Registered nurses in BC: 1979-83.

Registered nurses in BC: 1979-83.


Medical consents and minors.

Medical consents and minors.


Learning from teaching hospitals.

Learning from teaching hospitals.


Quality assurance in 90 days.

Quality assurance in 90 days.


Hospital integration: theory and practice.


CEO perspectives on mission, healthcare systems, and the environment. Nowhere in the United States' economy has the role and function of management changed so dramatically as in the hospital industry. And no functionary has felt it as keenly as the chief executive officer (CEO) of the multihospital system. The enlargement of the CEO's responsibility--from governance of the hospital to the development of the multihospital system to the evolution of the healthcare corporation--has mainly taken place in the last two decades. The purpose of this study is to look at the changing mission, environmental demands, and organizational structures of healthcare corporations from the vantage point of top management. With a grant from the Hermann Hospital in the Texas Medical Center, interviews were conducted with a select group of CEOs of major hospital systems. A study overview is presented here.


Factors influencing hospital employee motivation: a diagnostic instrument. This article presents a diagnostic instrument which identifies the most salient elements of employee motivation in hospitals. Application of this instrument in medium-sized U.S. hospitals indicates that recognition is the primary motivating factor. The results are greatly different in other countries.


What's cooking in hospital gift shops?

What's cooking in hospital gift shops?


The fine art of fixturing.

The fine art of fixturing.


All dressed up and no place to go.

All dressed up and no place to go.


"Oh, no! Not another meeting"!

"Oh, no! Not another meeting"!


Service, smiles and profits: the Johns Hopkins Hospital Gift Shop.


Creating customer comfort.

Creating customer comfort.


One for the books.

One for the books.


Putting slow movers on the fast track.

Putting slow movers on the fast track.


Are you an effective leader? Part II.

Are you an effective leader? Part II.


Adjusting the builder's basic shop.

Adjusting the builder's basic shop.


Markdowns: when and why to take them.

Markdowns: when and why to take them.


Drug usage guidelines, Part 3: assessment of acceptance of the program. The Drug Usage Guidelines (DUG) program, as perceived by the members of the P & T Committee and by physicians who had prepared and submitted DUGs, was demonstrated to be an effective method for evaluating drugs for formulary inclusion. The majority of P & T members felt that the DUG program had strengthened the drug review process without being too tedious or preventing the addition of valuable drugs to the formulary. Sixty-eight percent of physicians who had submitted a DUG expressed the opinion that it served as a vehicle for providing educational information on rational therapeutics. A majority of respondents stated that they would recommend the DUG program to other hospitals.


Conflict resolution strategies in the pharmacy. Conflict occurs in the pharmacy as employees seek limited resources, prestige, power, and position. An organization such as the pharmacy has a diversity of employees, including professional, semiprofessional, skilled, and technical, which makes the pharmacy susceptible to constant confrontation. Various strategies exist for the pharmacist to use in resolving conflict situations in the workplace. These include win-lose, lose-lose, and win-win strategies. To achieve a win-win situation, the pharmacy manager must have good communication skills that help employees clarify the meaning of words and avoid misunderstandings.


Methodological issues and policy implications of physician manpower forecasting. Future physician supply is a matter of concern in most industrialized countries due to its impact on cost and quality of health care. Consequently, forecasting the number of physicians becomes an important research issue from both methodological and policy perspectives. This article presents a simple forecast model developed for the State of Wisconsin (U.S.A.), using the complex federal model of the U.S. Graduate Medical Education National Advisory Committee as a backdrop. In this context, the article discusses the main determinants of physician supply, such as mobility, retention, ageing and productivity. The methodological issues in the simple modelling of such phenomena are examined using the Wisconsin case as an empirical example. Finally, policy implications of planning physician supply with respect to projected demand for services, changes in reimbursement patterns and productivity are discussed along with some of the recommendations actually made to the Wisconsin Legislature.


Person-to-person communication in an applied research/service delivery setting. Data from a national survey (n = 1666) of researchers, practitioners, and policymakers in the field of rural mental health services were used to conduct a sociometric analysis of person-to-person communication in the field. This article describes the structure of the person-to-person communication network in terms of its connectedness, centrality, homogeneity, and differentiation. Despite the diversity of survey respondents, and apparently meager interorganizational communication, communication in he field is similar, in many respects, to that observed in "invisible colleges." While the probability of two randomly chosen individuals being in contact is low (0.0008), over 70% were connected indirectly. The person-to-person communication network is also highly centralized and exhibits higher than expected communication among respondents in the same professional role, type of work organization, and geographical region. It does not appear to be highly differentiated with respect to topic, since the majority of information providers are contacted with respect to a number of topics.


Warfarin: a quality assurance model for concurrent drug monitoring. Until recently, the mechanism to gain the attention of hospital decision makers on the potential implication of pharmacists' involvement in the drug use review process was missing. However, integrating clinical pharmacy services with quality assurance activities appears to provide a mechanism to reduce patient risk and cost while maintaining the quality of patient care services provided. The department of pharmacy at The Mercy Hospital of Pittsburgh, through the hospital-wide quality assurance committee (QAC) and pharmacy evaluation committee (PEC), has developed concurrent drug the reviews. The concurrent warfarin review conducted by the department of pharmacy is described in detail to illustrate the process that is followed in the development and implementation of a concurrent drug use review. The concurrent review of warfarin was initiated and, in general, criteria were met and few variations occurred. Interventions by staff pharmacists were effective in further improving compliance with certain criteria. Although it was not proven that the incidence of hemorrhage was actually decreased, the QAC felt that such an approach would serve to decrease the likelihood of hemorrhage as warfarin therapy is initiated in the hospital. Similar drug use reviews have been developed for aminoglycosides, third-generation cephalosporins, piperacillin, cefoxitin, cefazolin, vancomycin, phenytoin, and the digoxin-quinidine interaction. The objective of these reviews is also to reduce patient risk and costs associated with drug use. Therefore, in today's hospital environment, a mechanism to improve the visibility of the pharmacist's involvement in the health care process is to integrate clinical pharmacy services with quality assurance activities.


The role of the schools of public health in the development of primary health care. Starting with the assumption that the schools of public health can and should be major promoters of primary health care but that they have not fully utilized their potential, the paper reviews the different interpretations of primary health care and their implications for the recruitment policies, educational objectives, teaching methods and research orientation of the schools. Four interpretations (primary health care as a set of activities; as a level of care; as a strategy of organizing health services; and as a philosophy permeating the entire health care system) are identified. It is suggested that most industrialized countries already have a primary medical care system which has to be transformed into primary health care. A blueprint for this transformation is outlined. Many of the changes included in the blueprint are related to the concept of primary health care as a strategy. Schools of public health can play a major role in implementing the necessary strategic changes and in training their implementers. The training of actual primary care providers for leadership; increased emphasis on management in the curricula; and reorientation of research towards primary health care are underlined as particularly important elements in the new role of the schools of public health.


Information-seeking behavior in an applied research/service delivery setting. The area of rural mental health services was used as a testbed to study information-seeking behavior in a field that includes researchers, policymakers, and practitioners. Findings from a nationwide survey (n = 1666) describe the sources that were used to obtain information about various topics and the use and value of these sources by or to individuals in various work roles and settings. The findings demonstrate the importance of person-to-person communication; differences in the sources used, and the value placed on these sources, by individuals in different work roles and settings; and that information-seeking episodes generally involve using multiple sources (5.0) to obtain information about several topics (3.2).


Demand forecasting for magnetic resonance imaging services. Healthcare providers interested in acquiring MRI technology are finding it difficult to assess demand and, therefore, financial feasibility. This article presents a quantitative technique for MRI demand forecasting that interrelates the known applications of MRI to the specific clinical setting in which it is to be employed. The first step in this technique is to identify the number of patients with diagnoses for which MRI is known to be applicable. Next, each of these diagnoses is weighted according to the percent of patients who are expected to receive MRI scans versus other diagnostic modalities. Finally, the number of patients in each diagnosis is multiplied by the weighting to estimate the number of patients for whom MRI scans can be expected. This technique was used by a consortium of three major community hospitals in Omaha, Nebraska, as the basis of their demand forecasting and was used in successfully obtaining a Certificate of Need.


Healthcare management: a letter to the president. This imaginary letter to a hospital president examines current literature on management and outlines those traits that are applicable to the healthcare field. According to the findings, effective managers have a flair for communication; are persistent, reliable, and coherent; have positive self-regard; focus their energy and attention only on the task at hand; and neither fear nor avoid failure. In addition, creativity through personal commitment should be stressed. Managers must learn that it is not only acceptable to care about others, but that it is a necessary prerequisite for effective management.


Multiple rater performance appraisals: solutions for hospital personnel. Widely used single rater personnel appraisal systems are not as effective as they should be. Moreover, rater training does not improve ratings based on one person's judgment about an employee. Multiple rater appraisal systems improve accuracy by using the judgments of several knowledgeable people in arriving at a decision. Multiple rater performance appraisals are better than single rater systems because they increase participation; improve accuracy and perceived fairness; provide higher quality management information for selection decisions; supply better Equal Employee Opportunity documentation; give quantitative feedback for employees, appraisers and management; take less management time to complete the performance measurement process and, consequently, improve cost effectiveness.


The legal mandate of drug registration authorities in theory and practice. In the course of this century all industrial nations witnessed a growth in the influence of the state over the individual. Usually, state intervention in private life is justified by the state's mandate to protect the health and security of its constituents, either through general, uniform precepts such as laws or decrees, or through individual arrangements such as licences or subsidies. The principle of state protection has also long been established in the pharmaceutical sector, and entails that regulatory agencies should only approve those drugs for market use, which--according to scientific knowledge--have benefits which outweigh their potential harmful effects. Although 'the state of scientific knowledge' seems to imply that safety decisions concerning drugs are predominantly based on medical, scientific criteria, it is argued in this paper, that regulatory agencies nevertheless have wide discretionary margins, which allow for a political dimension to such decisions. For this reason it is briefly examined how drug authorities react under political pressure, i.e. when a drug has become a public problem. Additionally, the issue is considered why especially so-called non-steroidal anti-inflammatory drugs (NSAID's) have recently been the focus of controversy in the media. This attention has led to a situation in which it seems that regulatory agencies only accept drugs for market use with zero risk. The paper concludes by recommending that safety decisions of health authorities should involve two expert levels: in order to make precise risk assessments on the scientific level all relevant information about risks and benefits of drugs should be collated, whereas safety decisions should be taken by experts knowledgeable in the field of societal proportions.


Regulation and selection of patients.

Regulation and selection of patients. During the past decades health legislation and regulation have been on the increase in most industrialized countries. The growing role of government in the provision and financing of health care, the need to correct given aspects of health care and the mandate to protect the underprivileged have been some of the many reasons for increased regulation. Different regulatory approaches and their respective advantages and disadvantages are reviewed in this paper. Particular attention is given to the crucial issue of how to regulate the access to scarce resources and how to cope within a legislative approach with the resulting patient selection.


Alternative modes of care threaten single-tier goal.


Two views of the human person. Ethical decisions: why "exceptionless norms"? Theoretical differences between the teachings of the U.S. bishops and many moral theologians have left Catholic medical professionals puzzled about whose advice to follow. Although three concepts have influenced the development of medical ethics--physicalism, ecclesiastical positivism, and personalism--the real source of disagreement is two different approaches to understanding the person: the objective and the subjective. Objectivists see persons as living organisms subject to natural laws and unique among animals because they can develop cultures, control the environment, and exercise critical thought. According to the subjective approach, persons are free subjects who transform the objective world into one of meaning. They find reality only in the culture and its social forms, arts, history, and theories. The objective approach identifies basic human needs that transcend cultures and it defends exceptionless moral norms; the subjective demands that the person be free to decide each situation's morality. Objectivity is preferable because it is supported by Catholic tradition, which trusts human reason to arrive at universal ethical truths, and leads to an ethics grounded in an understanding that is transcultural and objectively verifiable. In the future the Church's moral teachings on abortion, euthanasia, and other life issues will not change. They will, however incorporate subjective insights that emphasize the person's uniqueness, sociological conditioning, conscientious responsibility, and moral evolution.


Survey advises CEOs to reexamine traditional goals.


A reaction to: "Demand Forecasting for MRI Services". In this short piece, the author outlines the efforts the American Hospital Association (AHA) has made to uncover the issues associated with MRI. In March of 1983, as part of its Hospital Technology Series, the AHA published a 60-page report on MRI. In January 1985, it published a 240-page report entitled, "NMR Issues for 1985 and Beyond," that probes the questions of utilization, magnetic field strength, and the future of MRI in spectroscopy.


Medical humanism: pragmatic or personalist? Those in health care practice and research must depend on humanism for guidance in making difficult judgments and decisions that involve the individual patient's dignity and value. But what kind of humanism will inform those choices? Pragmatic humanism tends to view dignity in terms of human functioning: One is human because he or she acts, produces, thinks, achieves. The comatose, the insane, the hopelessly senile, fetuses and the newborn may be accorded human dignity as well, but only because society grants it to them. Thus such dignity can be manipulated or diminished in the name of overall human progress or the common welfare. By contrast, personalist humanism holds that human dignity is rooted in "being human" rather than in "doing human things." An individual has full human value simply by being a living person. This humanism suggests that health care providers must use their capabilities even for nonproductive patients. This may be difficult in the face of today's cost-benefit analyses. But if the individual's basic value is not defended, human dignity will vary in direct ratio to a person's social usefulness. And that would be obscene.


Sister Mary K. Samson v. The United States. Religious institutes and the IRS: the Samson Case's impact. A federal appeals court recently ruled that a member of a Catholic religious institute assigned by her superiors to serve with a county hospital was subject to Social Security withholding on earnings from that service. Consequently, Catholic institute members will have Social Security taxes withheld whenever they serve with an entity not associated with the Church, that is, any entity not listed in the Official Catholic Directory. The ruling hinges on the contention that the sister could not have been "required" by her superiors to serve with the county hospital, since the hospital had final authority to determine who its employees would be, and that she thereby failed to qualify for the exception to Social Security withholding in Internal Revenue Code section 3121(b)(8)(A) for members of religious institutes performing service "'required" by their superiors. Because virtually all employers have this final authority, however, the appeals court's ruling leaves in doubt the perimeters of the exception to Social Security withholding in section 3121(b)(8)(A).


New Testament story presents model for health care ministry. Those who minister to the sick and the aged can learn several lessons from the experience of two disciples who met Jesus on the road to Emmaus. Though the men, who were leaving Jerusalem to escape the confusion caused by Jesus' crucifixion, did not initially recognize him, Jesus walked alongside them and drew them into conversation about the preceding days' events. His attentive listening and perceptive questioning, which allowed them to vent their feelings, helped the men to deal with the reality of their suffering. When they asked Christ to remain, he accepted their invitation, knowing that they needed additional support. As they broke bread together that evening, the disciples recognized Jesus, "whereupon he vanished from their sight." Care givers, too, at times need to walk away from their work, not only to allow time for reflection but also to enable patients to experience God's presence. They must be alert to everything a patient says so that words meant to comfort do not cause suffering, and they must learn to recognize the subtle ways in which patients ask them to stay with them. Helping patients face the truth requires courage and the ability to help another appreciate his or her self-worth. Just as the disciples recognized Jesus' presence in those they encountered, so, too, must care givers allow themselves to be transformed at the eucharistic table and to see in others--even the unlovely-an existential, holistic love.


Workshop involves hospital staff in assisting area's poor.


Anesthesiologists face conflict as technologies develop.


Fitness programs benefit mothers-to-be, heart patients.


A case for democratic capitalism.

A case for democratic capitalism.


Who picks the hospital: practitioner or patient? This article presents the findings of a survey on consumer versus physician selection of a hospital. Forty-one percent of respondents reported that they or the affected household member selected the hospital. In addition, the perception of who chose the hospital was related to: 1) demographic (age and marital status); sociocultural (number of times moved in the past five years), and psychological (willingness to change physicians) factors which predispose hospital selection; 2) differences in individual resources (type of insurance coverage) which influence decision making; and 3) medical conditions (inpatient vs. outpatient status and the reason for the hospital utilization) which imply specific needs. Knowledge of these factors permits the correct classification of 70.2% of the cases, as opposed to 59.5% without such knowledge. The implications of these findings for healthcare marketing are discussed.


Resuscitating the terminally ill.

Resuscitating the terminally ill.


Train your trainers. Part 2: Instructional objectives.


Refusal of care. Caught between a rock and a hard place.


Organ procurement.

Organ procurement.


Negligence in EMS. Case studies.

Negligence in EMS. Case studies.


Alternative health care for the elderly: a description of three models.


Getting your certificate of need approved.


Health care allocation: who gets left out?


Update: the removal of life supports in long-term care facilities.


Reformulating the development theory of welfare. Industrialization, technological change and overall economic development are often cited as important factors in the development of welfare states. This article examines the importance of cycles in economic activity and cycles in technological innovation to enhancing our understanding of welfare. The history of technological change in health-care services is used to illustrate the argument.


A nursing home/university exchange program: an alternative model for teaching nursing homes. The nursing home/university exchange program is a long way from the ideal teaching nursing home model, but it can meet many of the same objectives of providing high-quality care for the elderly. The utilization of an interdisciplinary exchange can encourage cohesiveness throughout the nursing home and provide for increased opportunities for university affiliation. The nursing home can serve as an educational bridge for educators. Likewise, the university can provide practitioners an environment in which to grow and keep current in the field. This model can be adapted by any nursing home and university committed to improving the quality of life of older persons, regardless of whether they have the resources to develop the ideal teaching nursing home. This type of exchange program will benefit academicians, administrators, students, service providers, and, ultimately, the older individual.


Are worker participation plans "labor organizations" within the meaning of Section 2(5)?: a proposed framework of analysis.


Is seniors' housing really health care?

Is seniors' housing really health care?


Extended meal plan spices up food service.


Seniors push hospital resources to the limit.


The Illinois state legislature will change rule on wash temperature.


Managing the elderly alcoholic resident.


Look for hidden costs.

Look for hidden costs.


Humana laundry expects increase in volume due to heart publicity.


New laundry at Brooklyn Hospital may eliminate need for disposables.


Facing up to layoffs.

Facing up to layoffs.


Laundries above criticism, State finds mental hospitals otherwise dilapidated.


Establishing a successful autologous transfusion program.


Is this a Waterloo in the privileges war?


Medical Electronics Buyers Guide 1984, Part 6. CAT scanners, electrical safety & test equipment, financial management, neonatal & pediatric equipment, pulmonary/respiratory equipment, simulators, stress test systems/ergometers.


Limiting infarct size: the race against time.


A strategic plan for staff development.

A strategic plan for staff development.


How to make certain you get your merit increase.


How 1995's instrumentation will impact the lab.


Flexible budgeting: a tool for better forecasting.


The care and feeding of your staff.

The care and feeding of your staff.


A data base management program for lab inventory.


Instrument checklist for a group practice lab.


What does your staff think about you?

What does your staff think about you?


FDA advises blood centers on phase-in of AIDS test.


Are you acting or just pretending?

Are you acting or just pretending?


"Sorry, John, we have to let you go".

"Sorry, John, we have to let you go".


A closer look at fatal transfusion reactions.


Our lab week lasted a month.

Our lab week lasted a month.


A cost containment checklist.

A cost containment checklist.


A broker for better nursing-laboratory relations.


Working effectively with natural adversaries.


Law, medicine, and the time differential.


Michigan's cancer reporting system.

Michigan's cancer reporting system.


Office computers: managing the human impact. With all the attention placed on the mechanical and technological aspects of office automation equipment, the human element can be overlooked. Office automation is not just equipment, but the process of integration of people, information, functions and procedures. This article explores attitudes ranging from dread to fascination, personnel issues, ergonomics and other "human" aspects of the automation process.


MRI technology: a valuable tool of the future.


Volunteers make a difference at Shiawassee hospice.


Community cancer care of the future: a scenario.


Ambulatory care centers may find public offerings will be hard to sell.


Infection control could save millions.

Infection control could save millions.


An organized system for cancer care in the hospital.


To survive, not-for-profits must learn to act like investor-owned hospitals.


Doctor-hospital cooperation needed for healthcare corporation success.


Incentive plan can add doctors to savings team.


Hospitals' joint ventures, incentive plans may violate fraud, abuse laws.


Humana's game plan for expansion includes exploiting its 'brand name'.


Fiscally fit teaching hospitals eye sellouts to for-profit chains.


Humana money, name may cure financial woes of Doctors Officenters.


Strategic planning and marketing will be administrators' top concerns.


Alternative services. Development company plans to use joint ventures to build surgicenters.


Acquisition plans, vertical integration fueling growth for Summit Health.


Tax reform ideas means municipals will remain volatile.


Hospitals' cost-cutting efforts spur union activity, expert says.


Shrinking market for hospital supplies to limit price hikes.


Design and construction. Bethesda, MD, hospital turns old wing into 13-bed luxury unit.


States' rate-setting plans may be buffer for census declines.


Proposed 'Baby Doe' regulations draw 20,000 comments from public.


Hospital board sells top of building to pave way for expansion project.


Liability looms large when patients sue because of anesthesia accidents.


Two hospitals use new bond deals to refinance, save on debt service.


AMI bids $178 million to buy assets of Denver's Presbyterian-St. Luke's.


Educated consumers could force inefficient hospitals out of market.


Whittaker plans Pittsburgh HMO, first in possible national HMO chain.


Competition heats up in wellness market.


Proposed budget cuts would limit veterans' access to free healthcare.


Hospital chains entering insurance business to attract patients, fill beds.


Design and construction. Healthcare construction boom continued to show vigor in 1984.


Design and construction. VHA's design for surgicenter cuts costs, can be built quickly.


Design and construction. Architects should consider clients' operating methods.


HCA, American agree to form $8.5 billion giant.


A can of worms? Trustee scandal worries hospitals.


Consumers want hospitals to include price of services in advertisements.


Ambulatory care industry has financial growth pains.


Freestanding centers seeking accreditation.


Providers consider focusing on cancer.

Providers consider focusing on cancer.


"Doctor-hospital stress top concern".

"Doctor-hospital stress top concern".


VHA partnership's tax-exempt bonds supply funds for capital financing pool.


Gearing up for insurance. Major systems display varying degrees of risk adversity.


Purchasing decisions affected by economics.


Alliances reveal strategies.

Alliances reveal strategies.


The tale of a consortium.

The tale of a consortium.


Summit plans regional centers.

Summit plans regional centers.


Multis forecast psychiatric growth.

Multis forecast psychiatric growth.


Report sees strong product growth for '85.


Suppliers making ready for sales behind bars.


Hospital materials manager finds many bar code uses.


Fringe benefits yield tax benefits.

Fringe benefits yield tax benefits.


Developing a collection policy that works.


How not to select a computer system.

How not to select a computer system. Deciding whether you should computerize the laboratory is a decision of the past. Today the question is which system to select. Here is a simple, practical approach to choosing a computer system.


Mergers--the personnel squeeze.

Mergers--the personnel squeeze.


Computers and the personnel department.

Computers and the personnel department.


Slash health care costs with claims automation.


Medical cost control.

Medical cost control.


The unturned stone. Chiropractic as cost saver for employers.


How our request form helps us to admit drugs to the formulary.


FastAid in an ER walk-in.

FastAid in an ER walk-in.


Securing maternity market share through portraits in print.


Opening a new hospital.

Opening a new hospital.


Physician referral service. The billboard blitz.


Un-boring employee recognition.

Un-boring employee recognition.


Silver spoon baby. Care and feeding of an OB service.


Evaluating clinical competence of physical therapy students. Part 1: the development of an instrument. The study of clinical competence in physical therapy (PT) to date has focused primarily on a definition of the knowledge, skills, judgements, and attitudes that must be acquired by PT students for a satisfactory performance on entry into professional practice. Concomitant with this emphasis on defining clinical competence is the need for an accurate evaluation of the students' clinical competence during clinical practice. This study was designed to develop a tool for the evaluation of the clinical competence of PT students and to contribute to the definition of a construct of clinical competence. Three steps were involved in developing the evaluation tool. First, the clinical competencies required for PT practice were identified from a survey of the PT literature and professional documents. The identified clinical competencies were then validated through the analysis of a questionnaire completed by 121 physical therapists working in Edmonton, Alberta. The questionnaire results also provided a basis for determining the standards of performance by which to assess these competencies. Subsequently, an Evaluation of Clinical Competence (ECC) was designed as a behaviourally-anchored rating scale to determine, according to four standards of performance, whether a PT student could adequately perform the clinical competencies necessary to practise the profession.


Diversifying volunteers for work and gain.


Priority one. Hospital and industry prioritize each other.


Benefits fair for fun and information.

Benefits fair for fun and information.


One minute housecall. TV health tips.

One minute housecall. TV health tips.


Ad gallery. Successful ads support strong programs.


Donor recognition. Personal, personable and profitable.


Evaluating clinical competence of physical therapy students. Part 2: assessing the reliability, validity and usability of a new instrument. This study was conducted to establish the reliablity and validity of an instrument designed to evaluate the clinical competence of physical therapy (PT) students. A criterion-referenced evaluation instrument--the Evaluation of Clinical Competence (ECC)--was developed by the investigator according to the procedures recommended in the measurement literature. This behaviourally-anchored, four-point rating scale was tested on two groups of PT students from the University of Alberta, Edmonton, Canada. In order to obtain data by which to analyze and revise the ECC, the ECC was administered to fourth-year PT students (n = 29) during their clinical placement in November 1982, according to specified instructions. The revised ECC was administered to third-year (n = 23) and fourth-year PT students (n = 25) during their clinical placements in February and March of 1983. The same instructions were followed in order to collect the necessary data to establish inter-rater reliability, concurrent validity, and construct validity of the ECC. The results of the study suggest that the ECC is a fairly reliable, valid, and practical instrument with which to assess the clinical competence of PT students.


The feeding of body and soul. A trio of brochures teaches nutrition.


Opening a satellite medical center.

Opening a satellite medical center.


Tenth anniversary with trucks. Hospital and kids on parade.


Setting goals in the race against rising medical costs.


Managing the risks involved with saving lives.


A multidisciplinary approach to treating child neglect. Although the multidisciplinary team approach is useful in treating child abuse and neglect, it is underutilized in the first instance and rarely employed in the second. The authors discuss the rationale, process, function, and effectiveness of such a team in dealing with child neglect.


Mapping practice: problem solving in clinical social work. This working guide to solving problems uses diagrams to illustrate a five-phase process that social workers can employ to structure and monitor their practice. It specifies the stages and tasks of the process yet allows for flexibility in choosing interventions.


Social work intervention with geriatric cancer patients and their children.


Participation in the medical consultation: the co-ordination of verbal and nonverbal behavior between the doctor and patient. The following paper is concerned with the coordination of verbal and nonverbal behaviour by the doctor and patient in the medical consultation. It explores the relationship between the talk of the patient and the nonverbal behaviour of the doctor and demonstrates how the gaze direction of the doctor plays a crucial part in the articulation of an utterance by the patient. In examining a series of examples drawn from primary health care consultations, the analysis reveals how patients, or more generally speakers, use gestural activity to realign the gaze of their recipient(s) and encourage their participation in talk. In this fashion the paper addresses the problem of how the participants maintain a state of mutual involvement and sustain their integration within social interaction.


Viewpoint: the academic encirclement of medicine?


Research note: proxy responses in health surveys: a methodological issue. The practice of using proxy respondents in health surveys has been identified as a possible cause of confusion in the literature concerning sex differences in morbidity. Specifically, it has been suggested that proxy respondents (usually female) tend to under-report illnesses of absent persons (usually male) and hence the observation that women suffer from more illness than men may simply be an artifact of this method of data collection. In order to investigate proxy effects, 50 married couples were asked to report symptoms recently experienced by their spouses as well as themselves. A high level of agreement was found between husbands and wives regarding the number and severity of symptoms experienced by each individual, despite considerable differences in health status between sub-groups. Where there was a discrepancy, it was in the direction of the proxy respondent (of either sex) over-reporting symptoms. It follows from this that, if anything, the over-use of female interviewees would tend to minimise observed sex differences in illness. Thus, the excess female morbidity found in health surveys is not attributable to proxy effects but is more likely to result from differences in the way in which men and women experience symptoms.


Provider-sponsored ADSs: reducing antitrust liability after Maricopa.


Electrical design. Transmission media: options for engineers.


Collaborative research with a mutual help organization.


Radiation exposure.

Radiation exposure.


Hospitals--a sick industry.

Hospitals--a sick industry.


The role of hospitals in primary health care.


Hospitals and primary health care: some problems.


Low cost spectacle production for rural hospital and health care facilities.


Research in surgery: the role of the surgical technologist.


Planning health care facilities at a regional level.


New challenges for hospitals in the 1980's and beyond.


Health care in Mexico: a nursing view.

Health care in Mexico: a nursing view.


An introduction to indicators.

An introduction to indicators.


A significant step forward in geriatric nursing.


Quality assurance and hospital organisation.


The public hospital sector in Puerto Rico.


Economics and financing of health services in Puerto Rico.


Causes of death in an urban public hospital. For the study reported here, we examined the charts and autopsy reports of every death in the Department of Medicine at Cook County Hospital for the year 1983. In that period, there were 11,677 admissions to the Department and 476 deaths, yielding a mortality of 4.1 percent. There were 50 percent more deaths in the intensive care unit than on the general wards. Malignancies accounted for greater than one-third of all deaths. Lung cancer, which occurred in one of every six deaths in the department, was the single most-common diagnosis. The other leading causes of death were cirrhosis, gastrointestinal malignancies and cerebrovascular accidents. Cardiovascular mortality was somewhat less than expected. These figures reflect some of the serious diseases of the urban indigent population, which are, in turn, associated with cigarette smoking, alcoholism and hypertension. Decreases in morbidity and mortality are likely to be influenced by preventive medical measures and early detection campaigns. Department of medicine curricula and outpatient clinic programs should devote attention and resources to these areas.


Rationale, practice and problems of holistic medicine.


Consumer opinions of emergency room medical care. If hospital management is to adapt successfully to an increasingly competitive environment, and to retain a viable emergency department, it well be necessary to objectively and accurately assess the hospital's image in the community served. Knowledge of the consumers' views is an essential input into the formulation of strategic plans. This article reports on a study in which consumer opinions on 15 dimensions of emergency room health care were obtained from 723 respondents using a mail questionnaire. Findings reveal that consumers view the emergency room as being more expensive than other health care providers. Except for being available or convenient, little or no advantage is perceived for the emergency room over the personal physician. Even though the emergency room has specialized staff and equipment, consumers do not believe patients receive better or faster treatment in an emergency room than would be obtained in a physician's office. Unless changed, these perceptions will diminish the role of the emergency room in the delivery of health care services.


Risk reduction is Carter Center target for health project.


"Everybody into the pool' ... and other mysteries solved by corporate-culture detectives.


A catastrophe model of employee withdrawal leading to low job performance, high absenteeism, and job turnover during the first year of employment. A catastrophe model of employee withdrawal indicates that declining job performance, absenteeism, and turnover are discontinuous behavioral outcomes of the same withdrawal phenomenon arising from varying levels of job tension and group cohesion. The advantages of using catastrophe models to describe the temporal changes in employee withdrawal over a relatively short time period are discussed.


In-house contract service.

In-house contract service.


The transition from GOGO to GOCO.

The transition from GOGO to GOCO.


Managing change in health care institutions. Introduction.


Assessment of need for alcoholism treatment services: planning procedures.


Managing change in health care institutions. The Austin experience 1973-1983. This article is written by Ian Price who was engaged as a consultant by the Austin Hospital in 1973 to conduct an organisation study. The result of his work was to establish a divisional organisation which integrated the University of Melbourne into the hospital management structure. His work set in train an extensive organisational development program which has become widely known and regarded in the hospital field. After an absence of nine years Ian Price has taken up an appointment with the Austin an Executive Assistant to the General Manager. This article summarises the process which he adopted and the rationale for the changes which were implemented. The article also presents a brief resume of these changes ten years on.


Cost and utilization of alcoholism treatment under health insurance. A review of three studies.


Use of behavioral science concepts and processes to facilitate change: a team building program for nursing supervisors. This paper describes a team development program conducted for Nursing Supervisors and Nursing Executives in a Melbourne teaching hospital. It provides a detailed account of (i) the concepts which guided the formulation and conduct of the program and (ii) the processes which were used to maximise the possibilities for change and foster a joint commitment to dealing with problems in the Nursing Department. The program achieved greater understanding and clarity regarding work roles, improved cohesion and teamwork at the supervisory and executive level and a shift towards a more participative style of management within the department.


A system to convert ICD diagnostic codes for alcohol research.


Managing patient care on the ward.

Managing patient care on the ward.


Change through continuing education: an unproven strategy. Continuing education is the strategy most favoured to ensure professional competence and maintain standards of patient care. This paper questions the effectiveness of current continuing education programs with their emphasis on the structure and process of professional practice. Problems with assessment using course participants' views and the educational content of programs are examined. The assumptions that knowledge is translated into improved performance and that continuing education improves outcomes, notably patient care, are questioned. It is essential that continuing education be evaluated in terms of outcomes. Without a demonstrable improvement in the practical application of skills such programs cannot be viewed as cost effective.


Changing health care organisations for increased effectiveness.


Waiting for Fairy Godmother--intellectual disability in Australia. Since 1977 there have been at least 10 significant government reports on intellectual disability in Australia. Seven of the reports recommended major changes in the structure and organisation of service planning and delivery involving separation of services from health or mental health administrations. None of these recommendations has been implemented yet. This paper describes the process of the development of those reports, with particular attention to Victoria, and provides some suggestions why implementation has been so problematical.


Interview with Dr. Ian Brand, A.O., Executive Director, Preston Community Hospital, Northcote, Melbourne. Interview by Jonathan Tribe.


Report on hospital activity data survey.


Implantable infusion devices: gadgets for the future.


RTI report: economic costs of alcohol abuse and alcoholism.


The National Organ Transplantation Act.

The National Organ Transplantation Act.


A guide to design of radiation therapy facilities. The design technique outline provides the information needed to develop a layout for a new or renovated radiation therapy department. The department described is a medium-sized facility with two megavoltage linear accelerators and a single simulator. The plans for an expansion to include another linear accelerator and a neutron generator also are presented.


Improving x-ray report turnaround.

Improving x-ray report turnaround. Transcription inadequacies within the radiology department can provoke much criticism and can adversely affect a radiology department's relationship with referring physicians. New governmental regulations give added impetus to finding ways to speed x-ray report delivery and improve accuracy. Astute managers are well advised to identify and correct stenographic deficiencies.


Implant manufacturer and physician: must both warn the patient of a product's risks?


The surgeon and intensive care. Pre- and Postoperative Care Committee of the American College of Surgeons.


Unified agenda of regulation--DHHS. Publication of unified agenda of regulations. The President's February 17, 1981, Executive Order (12291) and the Regulatory Flexibility Act of 1980 require the Department to publish an agenda of significant regulations being developed and an indication of those regulatory actions that are being analyzed for their effect on small businesses. The Department published its last agenda on October 22, 1984.


Broad coalition prepares to do battle on taxing employee fringe benefits.


Ringing up savings. NYNEX hoping to cut costs with flexible plan.


The how and why of ethics committees ... in an ethics consultation service--Calgary.


The how and why of ethics committees ... in a research unit--Montreal.


The how and why of ethics committees ... in a general hospital--Toronto.


Caring toward cure.

Caring toward cure. Care determines cure and, therefore, the mode of care dictates the outcome. The medical needs do not determine care, but rather define the reality within which the child has to live. Where that care is given to the child should be a haven, just as home ought to be a secure place to be oneself. The child participates in the therapeutic community as much as the child participates in the family. Therefore, the treatment environment of the child should be designed to foster caring toward cure. The care that is given will determine the truly cured child. The children must be allowed to be themselves so that they can be cared for and thereby their cure assured. To accomplish that, medical care must be incorporated into a normalizing, structured, therapeutic community wherein the child can exercise autonomy and the care givers, compassion.


Child abuse in Winnipeg: hospital and community together. The Winnipeg Children's Hospital Child Protection Centre program for helping physically, sexually and emotionally abused children and their families is presented. The Protection Centre strongly advocates and works within a multidisciplinary approach which includes the hospital, child welfare agencies, the police and the justice system in case management and in carrying out intervention strategies and treatment plans. This approach is considered a most effective means of ensuring the care and protection of children.


Community mental health for children: a shift in emphasis. Children's mental health services are facing a number of issues that prompt reexamination of some key assumptions underlying traditional ways of delivering services. On close examination, there is little support for assumptions that the worst cases are referred for help; untreated "sick" children become "sick" adults; and treatment effects generalize. A shift in paradigm to a "community mental health" model is explored. The factors determining the acceptance of this model are discussed.


From supermarket to hospital: bar coding to streamline hospital functions.


Drug manufacturing in hospitals.

Drug manufacturing in hospitals.


Variations in plan size and type, increased use of self funding highlight medical plan cost study.


Anyone can start a preferred provider group and some already have reported cutting costs.


Misericordia Hospital's volunteers: union of two organizations.


Caring for the care givers.

Caring for the care givers.


Board size: small is beautiful.

Board size: small is beautiful.


No smoking--please.

No smoking--please.


Cost management case study: state of Arizona.


Worksite health promotion programs.

Worksite health promotion programs.


The wellness alternative: a change in attitude.


Is your health benefits cost containment program really working? A prototype methodology.


Primary health care: a training experience with the community. In 1982-83 we organized training schemes for various people involved in primary health care at local authority level. These schemes were part of the pattern of similar activity carried out with trained professional staff of the mother-and-child care and school health services. What was new was the participation of non-professional users (or their representatives) of health services, i.e. local politicians, representatives of associations, etc. The training sessions brought together 20-25 participants for two or three days and there were occasionally follow-up meetings of one or two days. The participants, divided into small groups of five or six, played an active part in the meetings, which were based on known information about the local authority area and the participants' own contributions. The initial task was the identification of health problems. For this to be a relevant exercise, the many political, cultural and personal factors which influence people's lives had to be considered. The fact is that the usual epidemiological data are inadequate if they are based solely on a review of symptoms and their distribution among the population as a whole. The procedure begins with the group concerned, and priority in selecting problems is decided with and within the group itself. The solutions that are required will thus be based on the experience and reasoning of the people themselves. A procedure of this type ought to show the factors which affect the community (working conditions, environment, habitat, cultural background, etc.) and which influence health. If we understand the structures of the community and the resources at its disposal, we can adapt our response accordingly. In assessing our experiment, we found that the training sessions produced a local awareness and a mutual recognition of the various participants, both professional and non-professional. Each person began to understand his limits since his role was constantly being reviewed. At the same time the requirements voiced by health care users became more apparent to the professionals with their preconceived ideas about people's needs and requirements.


Progress through automation.

Progress through automation.


Fundraising in Canada: what's new?

Fundraising in Canada: what's new?


BScN by 2000: one nurse's perspective.

BScN by 2000: one nurse's perspective.


Proposals for a prevention policy: an analysis of the French report. We present here and criticize the "Proposals for a Prevention Policy" drawn up by a multidisciplinary commission in France during 1982. The Report provides original elements at three conceptual levels: (i) a socio-economic model of causality of disease with a temporal, a probabilistic and a polyfactorial dimension; (ii) a social point of view brought to the concepts of health, prevention and health promotion; (iii) general principles for preventive intervention at a population level, including a breaking with the "victim-blaming" ideology. In this Report, work is always at the very center of the analysis developed by the commission. Practically, proposals are concerning work and environment on the one hand and structures and functional of public health services on the other hand. They may appear somewhat unrealistic or not clearly detailed. But one should understand that the commission essentially proposes an attitude of active involvement on the part of social actors rather than a list of concrete proposals. Undoubtedly, this French Report poses and discusses questions which are of interest even outside of the French context.


Video vignettes--a dramatic approach to teaching medicine.


St. Joseph's studies computerized patient systems.


Evaluation of the U.S. Air Force Family Support Center Program. This article provides an overview of the implementation and evaluation of Family Support Centers (FSC) in the U.S. Air Force. After describing the FSC model, the quantitative aspect of the evaluation is discussed, including the evaluation design, implementation methods, survey response rates, and procedures for data analysis. A summary of evaluation results also are presented as well as a discussion of administrative and methodological issues encountered in performing the evaluation. The results of the evaluation suggest that the FSC has become an integral part of the base human service delivery system, especially for married members and civilian spouses.


Guidelines for the appointment of medical staff. Part 1.


On considering the unintended impact of evaluation: reactive distortions in program goals and activities. The relationship between program planning and evaluation can be viewed as bidirectional; that is, evaluation methods, procedures, instruments, and criteria not only are determined by, but also influence, program goals and activities. Within the human services context, several factors or sources of reactivity between evaluation and program planning can be identified. These involve (a) quantification of goals and activities, (b) preferences by different audiences for various kinds of evaluation data, (c) values and evaluation criteria, and (d) evaluation requirements and resource availability. Effects of these reactive features are discussed and illustrated with examples drawn from mental health evaluation and accountability practices. It is argued that for evaluation to be a credible and useful practice, evaluators should plan their efforts and assess their own effectiveness within the larger context of human service systems.


Accounting and the celebration of rationality in human service delivery organizations. Emerging perspectives of control in human service delivery organizations are facilitated by rational accountability formulations whose tenets and assumptions remain basically unquestioned in organizational and accounting literature. This paper critiques the underpinnings of rational accountability formulations and their appropriateness for human service delivery organizations. In turn, a non-rational metaphor of the role of management accounting information is proposed which recognizes uncertainty for what it is rather than assuming the very certainties that cannot be found in the delivery of human services.


Meet Silver Plate winner healthcare: Robert Underwood.


Analyzing mental health evaluation: moral and ethical dimensions. Now that evaluators have been sensitized to the importance of moral and ethical issues in their work, it is time to move beyond generalities and examine the moral and ethical implications of specific evaluation models in specific settings. This paper proposes a framework that can be used to examine moral and ethical dimensions of evaluation and illustrates it by analyzing a selected model of mental health evaluation. Such a systematic identification of moral issues can improve evaluation practice both proactively, by shaping the training of evaluators, and retrospectively, by contributing to meta-evaluation.


The donor profile survey--a way to determine priorities. Community size, educational background, reading habits, church membership, civic clubs and marital status are just as much a part of why and how much a donor contributes as are his annuity or stock and bond holdings. Learning to profile donors can help set priorities.


Marketplace only real way to get true response results.


Accurate, thorough research nets bigger prospect dollars. Effective research is a key to more effective fund raising. Developing your own research skills can be as close as your community reference librarian and net you increased successful solicitations.


Analysis and testing of acquisition mailings.


The politics of planned giving: alligators in the swimming pool.


Cultivating major donors as greatest untapped source.


Expect the unexpected: consequences of the use of productivity indices.


Increasing productivity through on-site smoking control. Smoking in the workplace is becoming an increasingly sensitive issue. For health care providers, the reasons for implementing a proscriptive smoking policy are particularly relevant. This article outlines the reasons for banning workplace smoking and provides examples of companies who have successfully implemented no smoking policies.


Laboratory costs and utilization: guidelines for efficient use of laboratory technology. The practice of laboratory medicine now plays a major role in the delivery of health care. Under PPS, however, the laboratory has come under close scrutiny as one place where costs can be reduced. This article examines the use of continuous-flow and discrete analyzers in the chemistry laboratory and provides guidelines for determining which analyzer is most appropriate for a given organization.


NHS 1985. A year of opportunity?

NHS 1985. A year of opportunity?


Management. Realities of leadership.

Management. Realities of leadership.


Private homes. Homing in on problems of care for the elderly.


Finding common grounds for equal pay among the sexes.


Measuring quality and quantity.

Measuring quality and quantity.


Medical social workers. Ladies left out in the cold.


Resource allocation. How to identify the needy.


Looking at standards through rosy spectacles?


Staff accommodation. A year of living dangerously?


Management development. Dawn of the age of accountability.


All training boards follow this lead!

All training boards follow this lead!


Radiography. A good deal from silver.

Radiography. A good deal from silver.


Putting the home computer to work.

Putting the home computer to work.


A useful crib for good homes. The inspection of nursing homes.


Health promotion. An exercise in sponsorship.


Staff recruitment. Looking for God.

Staff recruitment. Looking for God.


Contract tendering. Catering for workers from outside.


Health education. Health care for the over-fifties.


Putting on the style. Participative management.


Hospital catering--an issue that blows hot and cold.


Centres of conflicting interests.

Centres of conflicting interests.


Boundary changes. Riverside district twice revisited.


The undisclosed dossier on professional ill health.


Computer policy. Good practices and bad packages.


Computers. Getting Körner off the ground.


Management training. Marketing the NHS.

Management training. Marketing the NHS.


Population trends. Making the most of your postcode.


Preventive health care. Tracking down the elderly at risk.


Management. How should the Centre be spread?


Caring in the community ... myths, messages and money.


The patient's right to know.

The patient's right to know.


Reorganisation. Liverpool's strategy ... "faith, hope and charity".


Social policies. Send the alcoholics home.


Hospital accounting. Breaking the book keeper mould.


Copyright issues. Hospital video plagued by controls.


What future for community care?

What future for community care?


Hospital beds. Standing by for a service for London's emergencies.


Unit management. Griffiths: a spoke in the cogwheel.


NHS management. Don't settle down just yet ... this is the age of change.


Staff training. Teaching care of the elderly.


Joint planning. Working well together for Wirral.


Health promotion. Campaign for hearts and minds in Wales.


Smoking: policy. Taking action against the industry.


Smoking: prevention. A breath of fresh air.


HAs ill prepared to make life and death judgements.


Nursing homes. At home with the law.

Nursing homes. At home with the law.


Occupational therapy. Spanning the great divide.


FPC management. Ripples first--followed by a tidal wave.


Hospital closures. Sinking the Dreadnought.


General management. Griffiths across the water.


Waiting lists. New post for an old problem.


Joint management. Health and social needs: bridging the false divide.


Bilingual policy. Clash of two tongues.

Bilingual policy. Clash of two tongues.


Day care for the elderly.

Day care for the elderly.


Unit management. Costing on-call administration.


Who should run specialist units?

Who should run specialist units?


Moves in general management.

Moves in general management.


Finance: the clinical budget.

Finance: the clinical budget.


Key circulars: 1984 round-up.

Key circulars: 1984 round-up.


Towards a rational plan for manpower needs.


Community care. Failure to identify opportunities.


Contracting out. Calling in the experts.


Who can dial their doctor?

Who can dial their doctor?


Predicting hospital failure with the financial flexibility index. In an environment of increasing financial risk, hospital managers are looking for ways to predict financial difficulties before they occur. One response is the financial flexibility index. This index, which uses 10 financial ratios, measures the inflow and outflow of funds to determine the financial flexibility of the institution and identify problem areas before financial failure occurs.


Shared service alternatives offer flexibility and tax benefits. Because the performance of shared service and tax-exempt status under Section 501(c)(3) of the Internal Revenue Code can be incompatible, hospitals planning to provide services to each other or to other organizations on a fee-for-service basis may wish to do so through a separate corporate entity. Using either a Section 501(e) shared service organization, a Sub-chapter T cooperative, or a taxable business corporation, a compromise can be reached between operational flexibility and tax benefits.


Accounting issues: should the merger be treated as purchase or pooling? Under accounting rules, a merger or consolidation can be treated as either a purchase or pooling. A purchase causes an adjustment in the selling hospital's asset basis to fair market value with goodwill often resulting. Such an adjustment is usually favorable for a taxable acquisition but not a tax-free reorganization. A pooling, on the other hand, results in the assets of the two organizations being merged together with no adjustment in asset values or increase in goodwill. The requirements for pooling are strict but the result is the carryover of assets at historical cost, usually favorable for reporting EPS.


Better communications for materials management.


The sale of drugs under HMO plans.

The sale of drugs under HMO plans.


Syringe and needle prices holding steady.


Why are group members paying higher prices for syringe/needle sets?


Protecting yourself from legal pitfalls.


The prescription to grieve.

The prescription to grieve. This clinical note presents a method of bereavement counseling. It describes a technique for structuring a time-limited grief experience for the bereaved client as a way to provide encouragement and direction for an emotional catharsis. Three specific activities: journaling, the life review, and dialoguing with the deceased, are each briefly discussed as suggested tasks for the client's grief work.


The image of the hospice chaplain.

The image of the hospice chaplain. In the author's twenty-five years of supervising Clinical Pastoral Education students, a strong emphasis on how to facilitate grief work and how to minister to the dying has been an important element in the students' effective work as parish clergy, institutional chaplains and pastoral counselors. An analysis of more subjective aspects of their CPE experiences indicates that equally important are images that the chaplain represents to the patient, family or staff. Three excerpts from verbatim patient interviews are used to illustrate the place that transferred meanings of the Church, of God, and of the source for dealing with ultimate questions, play in the role of chaplain.


Characteristics of hospice patients, primary caregivers and nursing care problems: foundation for future research. This descriptive survey identified the characteristics of hospice patients, their primary caregivers and major nursing care problems. Data from 350 patients in 41 states were collected by the hospice nurses who cared for the patients. Patient records served as a source for the data. Pain, physical decline, family emotional difficulties, respiratory distress and constipation were identified as the most frequent major nursing care problems. This study is intended to provide the basis for more definitive investigations of nursing care measures. Questions for further analysis of one of the nursing problems, physical decline, are suggested.


Co-optation and cooperation between home health agencies and hospices. This study explores the emerging conflict and cooperation between two types of organizations providing home health care to chronically ill and terminal patients--the hospice and the home health agency. Exploratory results suggest that the variables of size (terminal patient load), and competition (the number of other home health agencies in an area) influence relationships between home health agencies and hospices. It is also suggested that recent Medicare regulations may encourage mergers between agencies and hospices in addition to the existing modes of cooperation and referrals.


Hospice volunteer programs: a proposed agenda. With the expansion of hospice services, volunteers are being increasingly used to provide emotional, spiritual, and tangible support to the terminally ill and their significant others. Unfortunately, little has been published about the experiences of hospice volunteers. In this paper, we (1) propose a timely agenda for the development and refinement of hospice volunteer programs; (2) outline basic program criteria about which there is emerging consensus; (3) delineate pertinent issues in the screening, training, and job performance of hospice volunteers; and (4) indicate how the implementation of formal program regulations and operations and program evaluation may benefit service recipients and institutional providers.


An interview with: Richard Hollinger.

An interview with: Richard Hollinger.


Security for long-term care patients.

Security for long-term care patients.


Support service management--a third choice from America?


When do American health care administrators use contractors?


Medical innovations: need for evaluation.


Members in the brave new NHS management world.


"The way we do things round here"--organizational change in a psychiatric hospital.