Transfer and terminations as staffing options.


Delusions of reformism--dissent or madness?


Health systems agencies: a civil rights forum.


Public hospitals--there are no alternatives.


The self-concept, personal values, and motivational orientations of black and white managers.


Member and leader satisfaction with a professional association: an exchange perspective. The theories of exchange and of collective action were used to guide a study of the sources of satisfaction of the participants in a medical specialty society. This survey of two groups of participants, leaders and members, showed that the leaders of this nationally recognized professional association were more satisfied than were the regular members; that even though leaders and members have similar professional interests, the two groups evaluated the association differently; and that the involvement of leaders in the activities of other professional associations affected their satisfaction with this association. These results indicate empirical support for exchange theory and for the distinction among kinds of rewards made by the theory of collective action. Structural sources of satisfaction and dissatisfaction are identified for future research.


New programs for elderly citizens: opportunities and options.


Some dos and don'ts in metric.

Some dos and don'ts in metric.


"Because we care.".

"Because we care.".


Going metric.

Going metric.


The inevitable metric advance.

The inevitable metric advance.


Ladders to the work world.

Ladders to the work world.


In the Northwest, it's WAMI.

In the Northwest, it's WAMI.


Your library: neighborhood ombudsman.

Your library: neighborhood ombudsman.


MDs wary of patient rights law.

MDs wary of patient rights law.


Despite 'unspeakable' conditions in camps, refugees' health is 'remarkable,' officials say.


Oregon educator emphasizes ethics as basis for cost-related medical decisions.


Who's telling the doctor what to do?

Who's telling the doctor what to do?


Putting the squeeze on hospitals.

Putting the squeeze on hospitals.


Goodbye, community hospital!

Goodbye, community hospital!


The AoA Advocacy Assistance Program: origins and directions.


Can we be reasonable about regulation?

Can we be reasonable about regulation?


Bureaucracy 'stifles the spirit'.

Bureaucracy 'stifles the spirit'.


How to fight back--and win!

How to fight back--and win!


Flight from regulation: Canadian physicians 'opt out'.


FTC's rulemaking authority under fire in courts. Congress.


Eight fires since July: arson probe under way at Touro Infirmary.


Conservation plan yields substantial savings on linen costs.


Hurricane causes major damage to hospitals on Gulf Coast.


Automated laundry keeps labor costs low.


Prevention now--lower health costs later. Most of the attempts to control health care costs are focused on direct costs of diagnosis and therapy. However, what is needed is a more fundamental approach to cost containment. The key lies in the prevention and delay of onset of the chronic degenerative diseases.


Association retirement programs: how does yours compare?


Standards are required for the regulation of consumer groups.


Post-occupancy study leads to insights on elderly housing.


The hospital: how will it survive?

The hospital: how will it survive? The federal government is under pressure to implement and enforce a program to provide economic and social relief from the rapidly escalating health care costs which now consume 8.5% of the Gross National Product. Glick predicts that within the next twenty years, the character of health care institutions will be reshaped and only the most adaptable hospitals, health maintenance organizations and health-related governmental organizations will survive. He urges hospitals to develop appropriate strategies to deal with the problems of cost-containment, state-operated cost review and control agencies, and the competition for limited health care resources. The author warns the health care industry that if it does not adjust to these changes, it runs the risk of becoming heavily rgulated. It is suggested that health care institutions be integrated into comprehensive health care systems and the article includes a model for assigning patients to medical care facilities on a regional basis. Glick forecasts that hospitals will enter into a competition for survival, resulting in mergers of some and the closing of others. He believes that as the number of health care institutions decreases, the remaining ones will become more specialized and geographically dispersed.


Education as a hidden cost in ambulatory care. Since nearly a quarter of this nation's hospitals' outpatient and emergency rooms engage in medical education, it is of critical importance for administrators to determine the extent to which medical training influences the operational costs and efficiency of patient care for those services in their facilities. A computer simulation model has been developed at a midwest adult medical clinic to study the effects of ambulatory medical training on clinic operations. The model is capable of showing changes in the facility without disrupting the work flow and thus reduces the problems associated with long-term data collection. Various staffing patterns, both with and without medical training, were compared for the operational effects, patient convenience, and costs. The article offers probability distributions based on actual clinic experience. The research identifies and evaluates the trade-offs that must be considered when medical education is incorporated in an ambulatory program. Since both the faculty and students must take time away from direct patient care for consultation, more clinic time is required, causing staff costs to increase and patient care efficiency to decrease. The model demonstrates that when teaching loads increase, the faculty become less available to residents which results in resident inefficiency and longer patient waiting time. These operational consequences demonstrate the basic management problems of the need for balance between the demand for clinical teaching time and the demand for efficient service delivery in a solid ambulatory care/teaching program.


The financial manager's role in the Voluntary Effort. "Voluntary Effort" hopes to duplicate its first year success by further reducing the annual rate of increase of hospital costs by another two percent. The financial manager will play a key role in the achievement of this goal. Mr. Shelton views the financial manager as part of the hospital management team with the responsibility to review the operating goals and management effectiveness of the institution. The Hospital Financial Management Association has developed a Code of Action to assist the financial manager in dealing with his/her assignments and goals. Ultimately, "Voluntary Effort" is striving to establish a cost-effective health care financing and delivery system. The financial manager is encouraged to initiate in-service training programs for support staff to develop a management team capable of creating such a system. The success of the "Voluntary Effort" is dependent upon the effectiveness of hospital managers in dealing with the 1979 minimum wage and social security tax increases, cost containment and inflation. The financial manager can help by determining the financial feasibility of institutional decisions, interpreting government regulations and supplying written facts and figures to the rest of the hospital management team and community.


Clear federal strategy is emerging for cost control. The author states that the purpose of governmental cost containment initiatives is to gain control over hospital capital expenditures, utilization, payment and quality assurance. He suggests that the costs of hospital operation should be completely re-examined stating that the reform of the hospital payment system is emerging as the energizing factor which will stimulate proper allocation of capital resources and effective utilization and quality assurance. O'Hare outlines the potential of the federal strategy. Recent legislation (PL 93-641 and PL 95-142) has mandated that hospital financial and statistical data be made available to federal agencies. He concludes that a dominant federal role in cost containment strategy threatens to abolish individual differences between institutions and their ability to be responsive to local needs. The author urges hospital leadership to take a more active position in implementing a cost containment strategy.


What can Canada teach us about health care financing? Canada now spends proportionally more on health care than any other country except the U.S., Sweden and the Netherlands - about 7.2% of its GNP or about $500 per capita. Almost all Canadians (99%) are insured against the cost of all hospital and physician expenses through government health insurance programs administered by the provinces. Hospitals are reimbursed by the government 26 times per year and must work within annual budgets formulated by the Ministry of Health. The fiscal restraints imposed upon hospitals have caused them to look at expansion of shared services, regionalization and a slowed rate of growth. As in the U.S., hospital administrators complain about government regulation on the grounds that individual physicians have a much greater influence over utilization than do hospital administrators. Further hospital cutbacks will have the effect of reducing services and therefore, costs. However, there is concern that these kinds of modifications will result in services among communities which would affect the very principle of universal health insurance for Canadians.


Hospital-based versus free-standing primary care costs. A survey of the literature supports the broad generalization that primary care delivered in this hospital outpatient department will be more expensive than care provided in a free-standing setting. Among the reasons discussed by the author are: (1) reimbursement policies of third party insurors which mask and inflate the distribution of the true costs of care within the hospital; (2) lack of control by outpatient department directors over their own costs; (3) the degree to which the availability of sophisticated and expensive technology within the hospital setting encourages its utilization; and (4) the differences in case mix: "sicker" patients are seen in outpatient departments. Gold recognizes that most studies to date contain serious limitations in their generalizability; she concludes that additional studies are necessary to explain why the costs vary to the extent they do. She also suggests studying other issues such as access, consumer preferences, provider preferences and training requirements, and quality of care before reaching any decisions about the future of hospital-based primary care.


Reorganizing ambulatory care: an administrator's view. Citing a continuing increase in the utilization of hospital outpatient services, the authors discuss the reorganization of the ambulatory care delivery system at a 300-bed community hospital serving the Cambridge, Massachusetts area. Due to the attrition of community-based physicians, the Mount Auburn Hospital had an overburdened emergency services and an underutilized outpatient department. To improve this situation, full-time physicians and a non-physician administrator were hired for the outpatient area. In the four years following the reorganization, patient volume has increased and utilization has shifted from emergency to primary care which has required the hospital to adjust staffing in several ancillary departments. The hospital has now reached the point where growth must be carefully planned and controlled in order to preserve cost-effective, high quality care. The authors conclude that planning for hospital-based ambulatory care units should include: (1) defining the needs of the target communities; (2) marketing programs; and (3) anticipating legislation which will influence the demand for outpatient services.


How one hospital broke its inflation fever. The Johns Hopkins Hospital has demonstrated that hospital costs can be decreased without governmental intervention (controls). From 1975 to 1978, the hospital inflation rate was cut by half. One key factor, according to Solomon, was a move to decentralize management which was accompanied by a detailed system for monitoring costs. Also instrumental were administration's consistent reminders to physicians and managers about keeping costs down. The hospital was reorganized from a system of clinical departments that behaved, says Solomon, like "fiefdoms" into 14 autonomous departments that function under their own budgets. Each department controls about 85% of its costs (up from 30%), and is set up to function "like a small business." A breakdown of where cost reductions took place shows a savings of $5 million in overhead and $1.5 million in malpractice claims (Hopkins self-insured). Individual departments have also achieved some dramatic reductions: the Department of Medicine decreased the number of laboratory tests ordered; and the Department of Gynecology and Obstetrics built a new facility with fewer beds than the old one.


What you should know about the SHUR cost study. This article critically examines a study funded by the Health Care Financing Administration (HCFA) to estimate the cost of implementing the proposed System for Hospital Uniform Reporting (SHUR). Data for the study were gathered by Morris, Davis & Company who used field teams working with personnel in 50 test hospitals. The author states that the study findings do not reflect the real cost of implementing SHUR for the nation's hospitals. Rummer argues that the study sample included a greater percentage of hospitals in states which already had uniform reporting systems than is actually the case nationally, and that the study was done under tremendous time pressure which did not allow staff from participating hospitals to review and comment on the field teams' findings. On the basis of the SHUR Cost Study, HCFA has extrapolated the cost of reclassifying accounting and statistical information for all hospitals to be $65,648.011; the author estimates the true figure at over $100 million. She concludes that a new approach to meeting the government's information requirements will have to be designed.


Continuing education controversy: cutback in Colorado.


Charting the course: how to avoid hassles and produce perfect charts and graphs.


A Minnesota hospital management information system proves itself.


How the noted Carle Clinic converted its medical records.


Triumph of the odd couple: they share a Nobel prize for pioneering the CAT scanner.


Dump slump: it hurts nuclear medicine.

Dump slump: it hurts nuclear medicine.


Food and Drug Administration--classification of hematology and pathology devices; development of general provisions: proposed rule.


The year of the CAT.

The year of the CAT.


Immigration and Naturalization Service: voluntary departure for out-of-status nonimmigrant H-1 nurses.


Equal Employment Opportunity Commission: proposed guidelines on discrimination because of religion.


Hitting the bottle--is it any of the federal government's business?


Employers suffer sickly effects from government's HMO treatment.


A policy agenda on aging for the 1980s.

A policy agenda on aging for the 1980s.


Health plans to stress prevention: study.


EtO hazard judged low in California hospital survey.


EtO guidelines not reaching central supply, says ASHCSP.


What to do with obsolete equipment?

What to do with obsolete equipment?


Incinerator at Maryland General lights way to energy independence.


Operational auditing -- GAO project.

Operational auditing -- GAO project.


Ethylene oxide: monitoring for operator exposure.


Maintenance of equipment.

Maintenance of equipment.


Preventive maintenance procedure for pacemakers.


Clinical engineering at Case Western Reserve.


St. Mary's employees save hospital $48,000.


Bridging the management-employee gap.

Bridging the management-employee gap. The chief executive willing to experiment with new ways to reach employees should consider four programs used to good effect in a west coast hospital. The benefits match the efforts expended.


Energy-saving ideas.

Energy-saving ideas.


Trimming dietary budgets. Is computerized food purchasing in your hospital's future?


Hospitals, consumers and advertising.

Hospitals, consumers and advertising.


The doctor dilemma. Can medical staffs face up to controlling costs?


Innovative programs help hospitals fight high cost of servicing bio-med equipment.


Increasing philanthropic giving. Fund raising: there's still plenty of money around for hospitals.


Anatomy of a development program.

Anatomy of a development program.


Board chairman speaks on national issues.


Health--a world concern.

Health--a world concern.


Self-insurance contract with Blue Cross cuts hospital's employee health plan costs.


Data processing department is programmed for savings at New Jersey hospital.


Refinancing capital debt. Tax-exempt bonds: tool for containing costs.


Health care marketing management.

Health care marketing management. Health Care Marketing Management is the process of understanding the needs and the wats of a target market. Its purpose is to provide a viewpoint from which to integrate the analysis, planning, implementation (or organization) and control of the health care delivery system.


Applying marketing theories to your hospital.


Provincial trustee education: a guide for trustees.


All-out voluntary effort. Texas hospital program becomes model for the nation.


Standby hospital staff at Sidney A. Sumby Memorial, River Rouge, MI.


Shared services. Joint buying becomes the top cost-containment strategy.


Doctors: key to cost control?

Doctors: key to cost control?


Survey looks at non-profit boards.

Survey looks at non-profit boards.


Holzer Medical Center's incentive plan in action.


Employee incentive plans. The newest idea: give employees a share of what they save.


No-frills unit has patients helping themselves at Wisconsin University Hospital.


Management systems. The need is for an overall approach.


Mandatory controls. Fiscal life in the nine highly regulated states becomes a constant cost squeeze.


Hospitals find buck-a-day savings isn't a bad idea.


The administrative process of a disaster exercise.


Smooth hospital evacuation in New Brunswick.


Effectiveness of continuing medical education: a review of the evidence.


Rehabilitation medicine educational experiences: a retrospective study of exposure to RM.


Professionals and unionization: a study of two cohorts of physician housestaff.


Dependency of elderly people in homes on staffing ratios. A survey of all local authority residential homes for the elderly was carried out in one non-metropolitan county to determine the dependency of residents and staffing ratios. It was found that staffing ratios, while appearing generous, did not reflect the true ratios or the staff workload relevant to the very high levels of dependency which existed. Compared with other, similar counties the one surveyed had a slightly lower than average cost per resident-week so that, given that similar levels of dependency exist, many other counties must have similar or worse workload problems. The dependency of residents and the proportion of elderly sick is likely to rise and it is suggested that an alternative scheme for a nursing home type of provision within the NHS would alleviate some of the problems existing in residential homes for the elderly.


Ups and downs at unit level.

Ups and downs at unit level. The status of the unit administrator is quite often fourth or fifth in line because under the present structure administrators cannot take important decisions without consultation with other colleagues in different disciplines says the Royal Commission. Author looks at the work of one unit administrator at Tooting Bec Hospital.


Circling the pyramid by camel--via the needle's eye. The Royal Commission's report on the NHS criticised the lack of central manpower planning advice for the nursing profession as well as dwelling at some length on the difficulties that the hospital career structure poses medical manpower planners. The most damaging disadvantage of the DHSS's approach to the latter issue is, says the Commission, 'that it has not delivered the goods'. Author examines manpower problems as they affect both professions.


Why changing the guard is bracing break with tradition.


Simple, quiet, dependable, cost effective--RTSS.


The haves who feel more like have-nots.

The haves who feel more like have-nots. The present and future problems of a so-called 'over-provided' region are defined and delved into by author, who asserts that even with existing human ingenuity the solutions will take time and painstaking planning.


EMS in Kuwait.

EMS in Kuwait.


Three go in search of England.

Three go in search of England.


Disaster response to Chicago air crash.

Disaster response to Chicago air crash.


Update: national registry of EMTs.

Update: national registry of EMTs.


AmCare membership emergency medical and ambulance service.


Emergency medicine; from the street to the ICU.


The development of education programs in EMS systems administration.


Inventories and operating costs slashed with hands-on materials management.


Are clauses on front and back of order enforceable?


Organization is key to surplus disposal.


What buyers want from suppliers.

What buyers want from suppliers.


Legal implications of failure to respond and/or transport.


Infection control maintained during water shortage.


Hospital infection control in Sweden.

Hospital infection control in Sweden.


Duties of I.C. committee chairman.

Duties of I.C. committee chairman.


Infinite variety: the nonprofit sector.

Infinite variety: the nonprofit sector.


CETA: manna for hungry hospitals.

CETA: manna for hungry hospitals.


Community mental health centers are here to stay.


Western viewpoint: what would you like to have the computer do for you that it is not now doing?


The grants clinic: first impressions--the preliminary letter.


The examining room--technology assessment: the fallibility factor.


The marketing mystique.

The marketing mystique.


The trouble with clinical trials.

The trouble with clinical trials.


Technology assessment: an evaluation--definitions, applications, timing, doers.


Health employment requirements under alternate health insurance schemes.


Medical-legal forum: what are the legal issues that are likely to confron hospitals as they increase their use of computers?


Medical education at King Abdulaziz University.


Health planning in the United States: where we stand today.


Education and the quality of health services.


Plan to get your fair share.

Plan to get your fair share.


Computer systems--a management decision.


Dualism in medicine: a scenario.

Dualism in medicine: a scenario.


Increase your odds in the estimating game.


User fees are bad debt in B.C.

User fees are bad debt in B.C.


The future elderly--can we afford them?

The future elderly--can we afford them?


How to publish a winning newsletter.

How to publish a winning newsletter.


Budgets flounder under blanket policies.


Contractual arrangements have complex administrative, medical, legal implications.


How to choose your investment banker.

How to choose your investment banker.


Forecasting operations with time series decomposition.


New cost-finding system necessary for accuracy, budgeting, staffing.


Most institutions have a wealth of potential cost saving areas.


ZBB -- decision tool.

ZBB -- decision tool.


Borrowed package eases computerization inventory.


Cost counsel: Joint Purchasing Corporation.


Payment patterns: possibilities of a recession.


Treasurer discusses 1979--80 plans.

Treasurer discusses 1979--80 plans.


Hospitals are scapegoats for those frustrated with inflation.


The advantages of creative thinking in your department.


Absenteeism plaguing your department? Here's a cure.


In defense of the discharge summary.

In defense of the discharge summary.


Medical record access guidelines promote confidentiality. These guidelines were developed by the AHA's Advisory Panel on Privacy and Confidentiality of Hospital Medical Records. The portion presented here covers only guidelines for disclosure to patients. The complete guidelines for institutional policies for disclosure of medical record information also cover policies for internal and external disclosure and model authorization for disclosure.


Alternatives to defensive medicine.

Alternatives to defensive medicine. The ethics of defensive medicine, as distinguished from unnecessary testing for reasons other than fear of malpractice suits, and the usefulness its practice affords the physician in court are sharply questioned. Physicians, patients, and society are all adversely affected by its practice. Alternatives are recommended that physicians and organized medicine can employ to minimize malpractice problems.


Physicans and CEOs must rediscover common goals.


Filling and refilling practices with diazepam and methyldopa.


Managing the hospital pharmacy. Interview by Nancy M. Agresta.


Predetermined standards in drug use control.


When the pharmacy and therapeutics committee decides.


The pharmacist's role as a member of the institutional review board. Since World War II, concern about the protection of human subjects in biomedical research has increased considerably. The Nuremberg Code and the Helsinki Declaration have been published. The United States Department of Health, Education, and Welfare (DHEW) has developed and published regulations that specify a review process which research institutions must follow in order to receive DHEW funds for research involving human subjects. Part of this process includes a review of research projects by an Institutional Review Board (IRB). Membership on the IRB must be varied and should include allied scientists. Because many of the projects include investigational drugs, the inclusion of a pharmacist as a member is logical. The pharmacist, if properly selected and prepared, can play a vital role in the review of research projects by assisting in the evaluation of the scientific merit of the plan, the appropriateness of the volunteer agreement, and the regulatory compliance of the project. The selected pharmacist should view the duty as another opportunity to practice clinical pharmacy.


Nursing education program: fundamental to successful drug distribution. This paper provides a step-by-step, illustrative example of an inservice program which aided in the successful conversion of a chronic care facility from a routine floor stock drug distribution system to a non-traditional unit dose system. The program remains operational as a part of the orientation program for new nurses. The program is composed of a policy and procedure manual handout, a lecture on the mechanics of the system, a videotape module, a demonstration, practice session, return demonstration, and post-test. One aspect of the system is the utilization of a demonstration cassette and Kardex. This teaching tool enables the lecturer to demonstrate the system, the nurses to practice with the system, and the nursing supervisor to evaluate performance before actual administration of medications. A unique aspect of the program is a videotape module, which had added flexibility to instruction times. The program is beneficial to the entire nursing staff when converting to the unit dose system, and to the newly hired nurse prior to assignment. Because of the success of this videotape module, the use of videotaping has been expanded to other pharmacy education programs.


A survey of the use and educational value of the hospital formularly manual. The medical and nursing staffs of two affiliated hospitals were surveyed on their frequency and purpose of use of their hospital's formulary manual. A numerical rating of the perceived educational value of the manuals was also requested. Twenty-two per cent (141/650) of those surveyed completed their questionnaires. Ninety-six per cent of the respondents indicated use of the formulary manuals at least once a month; 62% used the manuals at least once a week. The frequency and character of use of various sections of the formulary manuals are presented. The perceived educational value of the manuals was rated 3 or greater on a scale of 1 (no value) to 5 (greatest value) by 80% of the respondents. The hospitals' formulary manuals are frequently referred to for various types of drug information. The professional staffs perceive the formulary manuals to be educationally valuable sources of drug information. Reasons for the low rate of response to the survey are presented. A plan of how to increase the response rate in a planned future survey is also presented.


Documenting educational activities.

Documenting educational activities.


Lesions resembling malignant tumours of bone.


Osteoblastic metastasis of parotid carcinoma with sun-ray periosteal reaction.


Professionals' preferences for support systems for the bereaved family. Health-care-related professionals rated the appropriateness and preferred timing of various community intervention strategies for assisting the bereaved individual. Results indicated: (a) agreement about the general need for such assistance programs, but no concensus as to which were most appropriate; (b) endorsement of the "resumption of activity" ethic; (c) belief that the most desirable period in which to intervene is within six months from the death; and (d) the lesser perceived suitability of therapeutic modalities that involve social contact with nonfamily members immediately following the death. Earlier introduction of family therapy and multiple family counseling was advocated by respondents with greater experience treating the bereaved.


A national study of associate degree mental health and human services workers. A random sample of 140 graduates of associate degree mental health/human services programs were studied to determine their work activities, adequacy of work performance, and job satisfaction. Seventy-seven percent were employed in relevant human services jobs. On site interviews with these workers and their supervisors revealed that they were performing virtually the entire range of traditional mental health service functions and performing them well. A majority were satisfied with their work, although low salary levels and restricted opportunities for future advancement were recognized as problems. Many were receiving little supervision and the user agencies had, for the most part, not developed appropriate in-service training programs. The findings appear very supportive to the notion that the mental health associate is a valuable new source of manpower for the mental health/human services field.


Success and failure among male and female Navy paramedical specialists. A comparison of the sexes in Navy Hospital Corpsman (HM) and Dental Technician (DT) rating groups showed that men and women entering these Navy paramedical specialities differed on a number of background, aptitude, and personality dimensions. The same proportion of men and women completed training in the HM group, but significantly more DT women completed training thand did DT men. The proportion of men and women who were still in the Navy one year after completion of training was the same in both rating groups. Among those who failed to complete training, the women were more likely than the men to be in the Navy one year later. These findings show that women were just as successful as men in both of these rating groups when success is defined as completion of training and remaining on active duty for a period of one year after completion of training. The results are contrary to those of earlier Navy studies which showed higher discharge rates and lower reenlistment rates for women than for men. It is suggested that the results may represent changes in values, role, and expectations for the sexes, and changes in Navy policies for women.


Community psychology: where are we?

Community psychology: where are we?


Do family therapists' family ideologies affect their impressions of families? The impact of patients' and family therapists' own family values on judgments about a help-seeking family was investigated via a clinical analogue. Fifty family-oriented clinicians were classified as either traditional or nontraditional in their beliefs about the family. Clinical judgments were rendered of a hypothetical family in which the parents' verbalizations were suggestive of either traditional or nontraditional family values. Little diagnostic value-bias was detected, thereby failing to establish the operation of political bias in the family treatment setting.


A shocking experience: Ohm's Law and the nurse. The Clinical Engineering Center of the Northern New England/University of New Hampshire has developed a seminar on electrical safety for members of the nursing profession. This program provides an understanding of basic circuit theory, grounding problems, wiring systems, and electrical safety. Examples are drawn from actual clinical situations. Portions of the seminar are devoted to equipment demonstrations and to a panel discussion which provides the participants with an opportunity to ask questions. Through this experience, the nurses begin to view the function of a Clinical Engineer in a different light, their awareness of the role of the Clinical Engineering Center is expanded, and they become a second line of defense for electrical safety in the hospital.


A computer system for biomedical equipment maintenance reporting. Biomedical equipment maintenance and repair activities involve an increasing amount of paperwork and report generation. A computer system is described that collects the necessary data on-line for accuracy and efficiency. The system can generate various reports relating to repair history, spare parts usage and preventive maintenance scheduling. It is implemented on a time-sharing minicomputer, and can reduce substantially the time spent by biomedical engineers in documenting their activities.


Use of automatic door closers improves fire safety. In a series of 16 full-scale fire tests, investigators at the IIT Research Institute have concluded that automatic door control in the room of fire origin can significantly reduce the spread of toxic smoke and gases. The researchers also investigated the effects of sprinkler actuation, and the functional relationship between sprinklers and automatic door closers. This report presents the results of the study, and presents recommendations for health-care facilities.


The problem of early outpatient terminations from community mental health centers: a problem for whom? This study examined the relationship between the number of client contacts with a mental health center and the client's evaluation of the services. Responses to 3 structured ratings of the center's services and free response comments were obtained from 130 former outpatients. None of the structured evaluation ratings was related to the number of contacts, but clients with several contacts were more negative in their free response comments. In addition, clients who had dropped out of therapy evaluated services as highly as clients whose therapy reached a normal termination. These results question the traditional assumptions that early terminations usually occur because of client dissatisfaction and represent treatment failures.


The evolution of a human services network. The delivery of human services in most communities is complicated by competition between agencies for money, esteem, and clientele. There is a need for developing a strategy of interagency service coordination. Representatives of human service organizations in a suburban community worked together to establish a network of services emphasizing coordination and the utilization of multiple resources to meet identified program needs. The description of this project includes: (a) a discussion of the community and its special problems; (b) a specification of objectives for service coordination; (c) a presentation of the theoretical framework underlying the development of the network; (d) an analysis of the stages of development; and (e) a summary including evaluations, conclusions, and possible future directions.


Demythologizing mental patients' attitudes toward mental illness: an empirical study. In an attempt to change the medical model attitudes of psychiatric patients in a direction more congruent with the radical psychosocial approach of their clinicians, an experimental group of 13 outpatients was exposed to a series of demythologizing seminars. As predicted, when compared to the attitudes of nontreatment controls (N = 13), on posttest and on a three month follow-up, results indicated that only the patients receiving the demythologizing seminars reported significant and stable attitude changes in the expected direction.


Rapid puffing as a treatment component of a community smoking program. Twenty-six persons participated in a community smoking program, which required a $40 contribution to the sponsoring health organization and a $25 refundable deposit. Clients were assigned to one of two treatment groups; one involved group discussion and rapid puffing, and the other involved group discussion only. The number of cigarettes smoked before treatment and one week, two months, and five months after treatment were determined for each client. Smoking decreased substantially following treatment in both groups and did not differ significantly between the groups across the follow-up periods. Females, however, showed significantly greater relapse in smoking following treatment than did males. Overall, approximately 15% of the clients in each group were abstinent five months after treatment.


Empathic listening test: an instrument for the selection and training of telephone crisis workers. Although telephone crisis centers have been shown to be a viable mode of community service, they are not without problems. Empirically based research upon which to make appropriate clinical and administrative decisions, particularly in the selection and training of volunteers has been lacking. In response to that need, a construct was developed that fused listening, the primary communicative behavior, with empathy, the most important interpersonal function of crisis center workers, to provide a criterion for selection and training. A 60-item situational instrument was developed to measure three dimensions of Empathic Listening, (a) Understanding, (b) Interest, and (c) Response-Ability. This study was designed to establish validity and reliability data for the instrument. The instrument was shown to have potential for selecting and training crisis center workers.


The role of the clinical engineer in hospital energy conservation. The escalating cost of energy is of concern to the hospital industry, and this cost has led to increasing interest by hospital administrators in energy conservation programs as part of their cost-containments efforts. An effective and comprehensive program should be based on an energy management approach which includes the careful analysis of the activities of the entire hospital staff. The clinical engineer has significant opportunities to contribute to this effort through his own department's activities and in other areas where his engineering training can be effectively utilized.


Researching psychotherapy effectiveness in mental health service agencies. The results of psychotherapy outcome research to date are briefly reviewed and the reasons why this research has not had greater impact on the practice of psychotherapy in mental health service agencies are presented. Sources of pressure to conduct evaluation research are enumerated. Involving mental health practitioners in field research is proposed as a means of increasing the relevance of psychotherapy outcome research to service personnel. Difficulties frequently encountered in the planning, data gathering, and implementation of results phases of evaluation projects are discussed and recommendations are made for ameliorating these problems. An improvement-oriented feedback model of program evaluation is presented and the value of individualized measurement, repeated-measures designs, and experimental case studies in maximizing the utilization of research results are discussed.


Transfer completion rates and treatment modality. Client transfers were examined within the context of a large, urban community mental health center. Transfer completion rates were computed on a quarterly basis for a large number of clients over a period of nearly two years. It was found that in a typical quarter about one client out of every seven had a transfer initiated and there was an average of 1.4 transfers per client. On the whole, nearly seven out of every ten transfers initiated were completed. Transfer completion rates among the emergency services, inpatient units, partial care services, and outpatient units were determined. It was concluded that modality and proximity play significant roles in transfer completion rates.


A study of hospital based ambulance systems in Wisconsin. This study was undertaken to determine the advantages and disadvantages of a hospital-based emergency medical service system with hospital employees serving as emergency medical technicians. This type of service is operating in thirteen hospitals in Wisconsin. A series of interviews was conducted to obtain pertinent information regarding the hospital, emergency medical vehicles, ambulance attendants, finances, communications and personal reactions to the system. The data indicate that hospital-based services using hospital employees can operate with minimal interference to regular patient care, and with apparent advantages to the emergency patients. In the rural, sparsely populated areas which were studied, response times from the hospital-based systems were comparable to other rural systems, and the financial and administrative aspects of the system were reviewed.


Polyvinyl chloride--its risk potential in the hospital. A potential risk management problem for hospitals is the thermal degradation of polyvinyl chloride (PVC). PVC is a synthetic, plastic, polymer wire insulating material which releases hydrogen chloride (HCl) gas when it is thermally degraded. Inhalation of HCl, either as a gas or in combination with water vapor, is irritating to all mucous membranes. Thermal degradation of 25 feet of PVC wire yields 1.4 mg HCl/L, which is 70 times greater than the recommended maximum concentration. Because of the potential risks, ther is an immediate need to develop a safe, economical substitute for PVC.


Inter-agency referrals and the establishment of a community-based treatment program. Based upon a treatment program involving the referral of more than 400 "antisocial" children to a community agency, common problems associated with inter-agency referral processes are discussed. The efficacy of selected inter-agency referral processes (computation, bargaining, judgment, and inspiration) are examined. Causes of misreferrals also are discussed. These include those generated separately by the host agency and by the donor agency and those additionally generated by their mutual interaction. Suggested means for preventing dysfunctions are presented.


Training for a supportive geriatric environment: a preliminary report. Gerontological manpower development is the goal of an ongoing project where various training modules are designed, tested, and evaluated within the institutional or community context where the service is delivered. This paper reports initial data on program effectiveness and attitudinal and work assessment changes resulting from staff training in environmental therapy.


Advancement to independent living: a model behavioral program for the intermediate care of adults with behavioral and emotional problems. This article describes and evaluates the treatment effectiveness of a behaviorally oriented intermediate day-care clinic for adults with psychiatric disturbances. The goals of the program included reducing the number of psychiatric hospital admissions and readmissions, providing a community-based controlled environment to assist patients in the modification of specific problem behavior, improving interpersonal relations with "significant others" in the natural environment, teaching patients how to use community resources, and preparing them for employment and/or continued outpatient treatment. The program was structured so that patients advance through a series of four achievement levels for a variety of extrinsic and intrinsic reinforcers. While in the program, patients were introduced to available community resources, and were gradually phased into follow-up services. Results showed that 79% of all patients thus far treated partially, if not completely, advanced through the levels. There was also a high probability that a patient would advance from any given level. Outside-clinic behavior showed sustained improvement, with the authors concluding that the day-care clinic offered promise for the future.


Community mental health ideology and personality preferences of social work students. 105 women social work graduate students completed the Edwards Personal Preference Schedule (EPPS) and the Community Mental Health Ideology (CMHI) Scale. Scores on each of the 16 EPPS variables were divided into deciles and into quartiles for comparisons with extreme scores on the CMHI Scale. Results revealed that high CMHI scorers showed significantly lower needs for deference and order personality variables, and indicated that the degree of commitment to community mental health ideology is significantly related to personality preferences.


Community leaders' attitudes toward family planning. Four separate samples of lawyers, businessmen, ministers, and physicians were requested to complete four separate non-overlapping attitude questionnaires in an effort to assess their attitudes toward sterilization, individual responsibility for contraception, family size, social responsibility, overpopulation, and contraception in the lower class. The data indicated that the four professional groups differed in their attitudes and those differences provided the impetus for suggestions focused on developing and maintaining a positive relationship between the influential members of the community and the family planning clinic. This study concentrates on the differences in family planning attitudes among 1200 ministers, lawyers, businessmen, and physicians resident in Texas.  The survey was conducted with questionnaires to evaluate the attitudes held by the 4 different groups on such subjects as sterilization, overpopulation, induced abortion, and individual responsibility for contraception, so that the local family planning clinics would have some guidelines to interact with local community leaders.  The study of attitudes led to at least 3 conclusions: 1) although all groups were in favor of some form of family size limitation, it was apparent that attempts to introduce government control of family size would not be supported; 2) overpopulation was seen as an economic problem, so that all the groups surveyed believed that poor people should limit family size, while rich people were not under the same limitations; 3) there appeared to be a consensus that there is a need for education about human reproduction and population problems.  Although the findings of this study are important, they need to be validated by large, cross-national samples.


A note on social self-treatment and professional narcicism. A relatively large number (370 students) clustered in a few courses were taught in ways and contents very reminiscent of psychotherapy activities. The instructors were non-mental health professionals. The implication of such training offered independently of any mental health relationship for the profession of psychology is discussed.


Monitoring change in community-oriented treatment programs. Changes in the social climate of two alcoholism treatment programs were evaluated by repeated assessments with the Community-Oriented Programs Environment Scale (COPES). The programs were similar in size and treatment orientation, but differed in physical and organizational setting, program length, and patient and staff characteristics. Specific and unique changes occurring within the treatment programs resulted in corresponding changes in relevant dimensions of the programs' social climates. The practical utility of COPES evaluations in instituting quality control and evaluating the results of change in community-oriented treatment programs is discussed.


The nature and correlates of community mental health ideology in community mental health centers. Five hundred ninety-five staff at 20 CMHCs were surveyed as part of a large study of mental health worker roles. Data on the endorsement of the ideology of community mental health (CMHI) were obtained. Significant associations were found between ideology and level of education and time allocated to Direct and Indirect Services. Different patterns were noted when specific occupations were considered. Significant associations were also found between CMHI and organizational personal role and role discrepancy. Significant increments in the variance associated with CMHI were accounted for by personal role definition and time spent in Direct and Indirect Services. The absolute level of CMHI among staff was not high. The extent to which CMHCs are carrying out the ideology and the implications of this for the future of the movement is questioned.


Opinions about mental illness held by personnel of a state psychiatric hospital and community mental health centers. This was a study of opinions about mental illness among occupational groups from a state psychiatric hospital and community mental health centers. Data were collected with two combined opinions about mental illness scales. The sample consisted of 348 participants, including 227 hospital employees and 121 employees of community mental health centers. The results indicated that occupational groups of both the hospital and the community mental health centers were highly differentiated in their opinions about mental illness. Sharp differences were found between professional and nonprofessional staff, with the latter indicating a much stronger endorsement of Authoritarianism and Social Restrictiveness. The personnel of the community mental health centers were significantly less authoritarian and socially restrictive, and more acceptant of Mental Hygiene Ideology and Nontraditionalism than their hospital counterparts.


The referral problem in the field of alcohol abuse. This paper reports on referral sources and the disposition of 409 problem drinkers who were contacted over a two-year period for participation in a 17-week alcohol abuse treatment program. A longitudinal follow-up design was used with 103 persons to evaluate various learning-based techniques in moderating their drinking habits. Referrals were analyzed by source (75% were legal referrals), percentage completing the program (70%, 72%, and 69% for self, legal, and mental health referrals), and "success" at one year. Legal referrals reported a significantly smaller pretreatment alcohol intake than self and mental health referrals. However, the decrease in alcohol intake for legal and nonlegal referrals were almost identical. The stigma of alcoholism as a disease and the coercion associated with referral by legal agencies were considered to be factors in acceptance of treatment and in treatment outcome.


Extending clinical service through group intake procedures. Group intake procedures have been employed in various mental health facilities to establish diagnosis efficiently, reduce time on waiting lists, and introduce those seeking service to agency procedures. A number of different models reported in the literature are reviewed, including those for adolescents and parents of child referrals. The author points to the importance of intake groups with respect to their orientation function and the peer support they provide for adolescents and members of disadvantaged groups in recounting their problems to professionals.


Recruitment of college volunteers for community service organizations using the lecture method. The present study was undertaken to determine those variables which best predict college students' reactions to lectures designed to solicit volunteers for a juvenile corrections program. One hundred and thirty-four students returned mailed questionnaires which assessed multiple variables related to: (1) audience characteristics, (2) recruiter (lecturer) characteristics, and (3) volunteer program (lecture content) characteristics. Results of canonical correlation analysis indicated that 8 of 17 predictor variables accounted for the majority of the variance in the volunteering behavior variate. Age of respondent, previous volunteer experience, overall lecture quality, understanding need for volunteer services, clarity and comprehension of volunteer roles, the value of the lecture as a significant learning experience, the opportunity for personal growth within the program, and the ability to influence existing structures were seen as important variables in predicting three volunteering behaviors. In particular, the data suggest that for recruitment programs using the lecture method recruiter characteristics have the greatest impact on soliciting volunteer personnel.


Community assistance for rape victims.

Community assistance for rape victims. This paper describes a program designed to use trained volunteer companions in crisis intervention with rape victims in a public hospital emergency room. The history of the extensive negotiations necessary to implement the program and detailed descriptions of volunteer training are included. Results are largely in the form of subjective experience.


Assessment of member satisfaction in an HMO: understanding the interaction of variables and their implications.


Implementation of primary nursing in an ambulatory setting.


A predictive model of clinic output.

A predictive model of clinic output.


Citizen participation in planning: the relationship between objectives and techniques. While citizen participation has become a commonplace element in many planning efforts, both planners and citizens often assess the participatory elements as being unsatisfactory. The contention in this article is that not enough attention is being given to the design of participatory programs and that there is a particular failing in matching objectives to techniques. Five objectives of citizen participation are identified: information exchange, education, support building, supplemental decision making, and representational input. Then through the development of a typology of participatory mechanisms, techniques are matched with their most appropriate objectives. This relationship is further illustrated by examining four techniques in detail. The conclusions suggest that if the relationship between objectives and techniques is ignored in the design of a participatory program, the possibility of a successful program decreases.


Short-term hospital treatment of the acute schizophrenic episode.


Schizophrenia: the potentials and limitations of public care.


Overcoming obstacles in the psychotherapy of schizophrenic patients.


Operational research projects in health and welfare services in the United Kingdom and Ireland.


Technology Center debutes as cost/quality control. Meeting yields policy clues.


Therapists, in policy shift, may boost dealer business.


Jogging on the job--and swimming, playing tennis, weight lifting, stress testing...


Tips for controlling the clock.

Tips for controlling the clock.


The clinic manager's role is what you make it.


Liberalized rules on depreciation sought.


Product liability bill resurfaces.

Product liability bill resurfaces.


X-ray records in developing countries.

X-ray records in developing countries.


Coping with cancer.

Coping with cancer.


What is a nurse?

What is a nurse?


Word processing: a building block to greater office productivity. As this method continues to stand the test of time in business and industry, can any medical practice manager afford not to consider the use of word processing in his facility?


State speaks out: on nurse training and credentialing.


Total medical record: an automated medical information system. The strength of the TMR system lies in its integration of medical and business information in a practical, easy-to-use design. It eliminates the delay, inefficiency, and bulk found in other medical information systems.


The rural health clinic.

The rural health clinic.


A trustee speaks out: on nurse staffing.


Family practice building, Bowman Gray School of Medicine.


1985 proposal spurs debate.

1985 proposal spurs debate.


The planning of health care delivery.

The planning of health care delivery.


The ANA position.

The ANA position.


Nurse staffing: accountability study focuses of staff abilities and patient needs.


National League of Nursing opposes 1985 proposal.


Health care administration in an academic setting.


The MNA position.

The MNA position.


Emergency hospital care: issues of treatment and liability. Increased utilization of hospital emergency rooms, and a departure from traditional physician-patient relationships, have resulted in increased litigation. Risks to hospitals can be minimized if certain policies are pursued.


Hospital responsibility for physician negligence: changing concepts of liability. The honeymoon between the hospital and the courts, under which the institution was absolved from blame in a negligent physician's actions, is over. The relationship between the hospital and patient is taking the center stage in court actions, with some important new developments and future trends to be taken into account by those seeking to prevent malpractice claims.


The significance of the patient-physician relationship in increasing or reducing malpractice claims. Better relations with the patient can be instrumental in preventing malpractice claims. Physicians must understand what they are risking by not dealing directly with their patients, by not admitting error, and by not discussing fees openly.


Should patients have access to their medical records? Rather than opposing patients' access to their own medical records, physicians can use this trend to deter malpractice actions and improve patient communications. By documenting their observations in writing, noting patient responses, and maintaining honest rapport with the patient and his or her family, physicians can more effectively protect both themselves and their patients in the future.


Medical malpractice--statute of limitations. Attempts by plaintiffs to circumvent statutes of limitations in malpractice actions take a number of forms which health providers and their attorneys should be aware of. Careful attention must be paid to the manner in which a summons is delivered.


No-fault insurance in New Zealand and in Sweden. No-fault medical malpractice insurance programs in Sweden and New Zealand, especially the latter country, can offer useful guidelines to Americans considering a no-fault mechanism. In four years of actual operation, the New Zealand program has been generally accepted, fairly administered, and kept within budget. The government's approach to "medical mishap and error," however, encourages physicians to opt in favor of avoiding patients.


Prevention of medical injuries.

Prevention of medical injuries.


Escalating malpractice costs: what's behind them...what preventive procedures can be taken to reduce claims. Medical malpractice actions are increasing at an alarming rate. Within the past five years, the incidence of such claims has escalated to such an extent that many physicians in hospitals are finding it difficult to obtain insurance. When insurance has been obtained, its cost has approached the prohibitive. To understand what's behind this increase in actions and costs, a review of the law of negligence, the law that most affects medical malpractice, is in order. With such understanding, those most affected financially by the escalation in malpractice costs (notably the health facility and the physician) can consider what preventive procedures can be taken to eliminate a substantial percentage of potential lawsuits. Without taking such preventive action, none of the current methods of confronting malpractice costs--private carriers, co-insurance, group policies, self-insurance, or going bare--will be effective for any period of time in keeping those costs in check.


Sample forms.

Sample forms.


Medical malpractice litigation: the discoverability and use of hospitals' quality assurance committee records. Medical staff review committees and their records can play a major role in a hospital's defense against malpractice actions. Members of such committees are liable to varying degrees to actions for conspiracy, tortious interference with a business relationship, defamation and malpractice. Various defenses and statutory immunity in many states provide ample protection where the participant is acting reasonably and in good faith.


Elements of patient representative programs in hospitals. Studies have shown that patient alienation is a major factor in the decision to sue for malpractice. A successful patient representative program can play a major role in reducing the feeling of alienation from the provider that many patients feel. This excerpt from a new publication of the Society of Patient Representatives of the American Hospital Association gives guidance to risk managers and others seeking clarification of the patient representative's role.


The consumer viewpoint on malpractice.

The consumer viewpoint on malpractice. Our malpractice system is geared to compensate, and perhaps overcompensate, the occasional victim of catastrophic injury, while undercompensating, or even ignoring, smaller injuries. So states the author in presenting arguments for changing the system. She protests attempts to change the tort system, get around limits, tighten statutes of limitations, remove the discovery rule, or do away with res ipsa loquitur and informed consent. She cites California as a state, which has done the most to strengthen its medical discipline as a first step in attacking the "real problem of medical malpractice...the reality of injury due to medical negligence and the frequent difficulty of obtaining legitimate compensation."


Psychiatry and the dangerous patient--problem: breach of confidentiality. Malpractice in the field of psychiatry underscores the legal and ethical conflicts between the patient's right to confidentiality of communications and the physician's duty to protect an individual or society from possible harm at the hands of his patient. There are three criteria used currently to predict violent behavior. None are clear-cut and neither the courts nor professional societies offer the practitioner much protection. The author suggests some courses of action for the psychiatrist to minimize the risk of malpractice.


Promoting differences in hospitals.

Promoting differences in hospitals. Hospitals differ from each other in various respects and these differences should be publicized so that patient dissatisfaction can be minimized.


Prevention of unnecessary malpractice claims.


The National Health Service Corps: is it outgrowing its ideals or merely its bureaucracy? Part I. The scholarship program.


The art of listening.

The art of listening.


Bioethics: the burn victim and medical paternalism.


Humanistic medicine: knowing the person as well as the disease.


Adding life to years.

Adding life to years.


The National Health Service Corps. Part II: Corps service. Not just home on the range (and even a discouraging word).


Innovations in patient care: where nurse practitioners expand good care.


Innovations in patient care: focusing on the benefits of NPs in primary care.


Easing the strain on families of nursing home residents.


Recovering from a crisis--living with a family helps.


Released hospital patients rely on 'community friends'.


Social workers and Hispanics speak the same language.


Blue Cross, Blue Shield tighten psychiatric coverages in East, West.


Players focus on problems of patients.

Players focus on problems of patients.


Judicial action report: the statist notion that governmental power should supercede parental authority.


MH coverage said controllable.

MH coverage said controllable.


St. Giles: a mental hospital in Fiji.

St. Giles: a mental hospital in Fiji.


Peer review dispute ' unsettling'.

Peer review dispute ' unsettling'.


Medical schools and the "entitlement ethic".


Ethics allow physician to invest, operate in same facility.


The human experience of dying: the moral primacy of stories over stages.


Emergency medical service systems and poison control.


Hospitals are $aving more than lives--the Texas voluntary effort.


Buggin' around TSICP: information about isolation.


Helping smokers quit.

Helping smokers quit.


Hospital liability for the medical mistakes of physicans.


Policies: an educational tool.

Policies: an educational tool.


Cost containment ideas...

Cost containment ideas...


Energy management: be positive.

Energy management: be positive.


How to make meetings become more productive.


Bringing the hospital world to the boardroom. The Virginia Hospital Association's trustee education program is a statewide approach to board development whose cornerstone is individualized seminars provided in the local community. This article reviews the events that led to development of the program and describes the program's goals, organization, and results during its first year of operation.


HMOs: coming of age in the '80s.

HMOs: coming of age in the '80s. This excerpt from HMOs and the Politics of Health System Reform (Chicago: American Hospital Association and Robert J. Brady Co., 1979) forecasts a period of growth for HMOs due to passage of the 1978 HMO amendments and the commitment of the Carter Administration to HMO development. HMOs have emerged as the most expedient tool to achieve some measure of health system reform.


Dollarsense: hold the line on hiring.

Dollarsense: hold the line on hiring.


HMOs: the real hang up.

HMOs: the real hang up.


The battle over the bargaining rights of house staff.


Report from Washington. Legislation to hold down hospital capital expenditures.


Massive disaster drill staged by community hospital.


As I see it: marketing.

As I see it: marketing.


Why Americans are healthiest ever: a new size-up.


The quality of well-being. How do you measure it?


'Humandrama' in the treatment of hospitalized alcoholics.


Improving compliance in management of hypertension.


LM's system controls production and cuts costs.


MDs take new look at births in home.

MDs take new look at births in home.


Family care for patients to be tested.

Family care for patients to be tested.


Patient education--at last!

Patient education--at last!


Hospitals fight disease with new services.


Medication taking behavior of the elderly: a pilot study. The results of structured interviews of fifty persons aged 65 years and older who were living independently in the community indicated that hazardous as well as wasteful practices were occurring in their medication taking behavior. Sixty-six percent of the medications used by this population were being taken without adequate instructions and twenty-five percent of the medications were not being taken as labeled. There is a need for a greatly improved coordination, improved education, and advocacy involving patients, nurses, pharmacists and physicians in medication use.


Your other half: coping with personalities and mannerisms of EMT partners.


The workplace turns marketplace.

The workplace turns marketplace.


The DHSS health building system: its engineering components with particular reference to the design and commissioning sub-systems.


The Genesee Region Health Education Study.


"Don't hire the unskilled".

"Don't hire the unskilled".


A penny saved: nation's energy consumption problems.


Hospital safety--a British point of view.


"Comfort-zoned" hospital mattress.

"Comfort-zoned" hospital mattress.


Housekeepers' training room duplicates fixtures and surfaces throughout hospital.


Providing pharmacy service to ambulatory patients.


Detailed procedures for area cleaning.

Detailed procedures for area cleaning.


Training: an important link with your employees.


Striving for excellence in trauma care.

Striving for excellence in trauma care.


In praise of surgical hedgehogs: trauma and the compleat surgeon.


Family support, health beliefs, and therapeutic compliance in patients with rheumatoid arthritis.


Pneumatic counter-pressure device.

Pneumatic counter-pressure device.


Paramedics: administration.

Paramedics: administration.


Operating-room utilization and the care of the surgical patient.


Retrofit: upgrading the quality of air.

Retrofit: upgrading the quality of air.


The Gibbon lecture--competence and compassion: two qualities of surgical excellence.


Operating-room design: an introduction.

Operating-room design: an introduction.


Victim-blaming and the "looping" effect of social policy: the cause of physician maldistribution and underserved rural communities. Ryan's (1971) description of the ideology of "victim-blaming" is briefly reviewed. It is then shown how this strategy for obscuring the causes of a social problem is used against rural, medically underserved communities by health care provider and planning interest groups to "explain" critical shortages of physicians in their areas. In addition to lending further support for the existence of this ideology, a "looping" effect of social policy designed to deal with physician maldistribution is identified. It is argued that this can be viewed as analytically distinct from the ideology itself and that it serves the purpose of further obscuring the larger structural sources of the social problem.


Chances are you're not communicating.

Chances are you're not communicating.


Managing for productivity.

Managing for productivity.


Try a little positive reinforcement!

Try a little positive reinforcement!


Guidelines for effective delegation.

Guidelines for effective delegation.


Mastering the techniques of two-way communication.


Creative conflict management.

Creative conflict management.


Public Health Service--grants for residency training in general internal medicine or general pediatrics: final regulations.


Setback in Congress.

Setback in Congress.


Nondiscrimination in federally assisted programs; Title VI of the Civil Rights Act of 1964; policy interpretation--Office for Civil Rights, Department of Health, Education, and Welfare.


Health Care Financing Administration: clinical laboratories; personnel standards--notice of proposed rulemaking.


Hill-Burton and health professions educational facilities programs. Health Resources Administration -- notice of moratorium on approving "refinancings" of certain federally guaranteed loans.


Flammability standards for children's sleepwear; proposed statements of enforcement policy--Consumer Product Safety Commission.


Health maintenance organizations--Public Health Service, HEW. Notice: exclusion from basic health services provided by health maintenance organizations.


Grant programs for schools and hospitals, and buildings owned by units of local government and public care institutions: Department of Energy. Final rule; technical and editorial corrections.


Office of Human Development Services--service programs for families and children, individuals and families, and aged, blind, or disabled persons; federal financial participation in state claims for abortions.


Implementation of the Civilian Health and Medical Program of the Uniformed Services; proposed amendment No. 3--Office of the Secretary of Defense.


Classification of anesthesiology devices; development of general provisions--Food and Drug Administration. Proposed rule.


Disaster assistance: reorganization and revision of regulations--Federal Emergency Management Agency. Proposed rule.


American Medical Association; prohibited trade practices, and affirmative corrective actions--Federal Trade Commission. Final order.


Proposed interim private sector metric conversion planning guidelines: United States Metric Board.


The commodity view of medicine.

The commodity view of medicine. Cassell discusses the dichotomy of medical care as being both a technical service and a personal interaction. He states that consumers want personal medical care to be readily available at a low cost. He sees this as a contradiction arguing that "the forces necessary to keep every medical service identical and cheap discourage the intense personal involvement by the physician in the patient's care that is required to lift medicine above the merely technical." Further, waning trust in individual physicians has been exacerbated by the use of more technical services in medical examinations and by higher costs. Cassell believes that medical care should be conceptualized as a personal service rather than a social commodity which employs individual knowledge, human concern, judgement and experience. This would re-establish trust between doctors and patients and, hopefully, would reduce the reliance on expensive medical technology, allowing health care costs to decline.


Cutting health care costs--why not let the market decide?


Changing attitudes toward the aged.

Changing attitudes toward the aged.


Helping to fill out medical forms pays, if they aren't yours.


Managing change: a psychologist's perspective. The uncertainty of today's economic, social and political climate requires that managers cope with a variety of forces beyond their operating control. To meet the challenges of these new demands, many organizational changes are required. This article identifies five human factors involved in change: (1) "Influence" makes work more meaningful and contributes to the feelings of satisfaction; (2) "Familiarity" reduces the feelings of resistence to change; (3) "Testing" allows individuals to evaluate the feasibility and seriousness of the proposed change; (4) "Stress" is caused by the apprehension of change; and (5) "Chance" describes elements that can send the change process in some unanticipated direction. The author believes that managers who understand the process of change will be able to implement change more effectively.


EEOC jeopardizes pregnancy benefits for women who quit.


Companies absorb the higher charges of pregnancy plans.


Ullman asks tax penalty on large health benefits.


Pa. arbitration officials want panel reform.


Health care economy.

Health care economy.


Insurers underwrite more ASO plans, health study shows.


Medical malpractice fever cools.

Medical malpractice fever cools.


Benefits increase faster than pay: study.


A new approach to design and use of management information. Information, that is both accurate and timely, is probably the most important resource needed by managers to make sound decisions regarding the problems and issues facing their organizations. Unfortunately, sophisticated information systems often fail to meet this need. Managers complain that the data produced by information systems arrive too late, are too general and lack accuracy. Daft and MacIntosh studied the system problems of a number of organizations, discovering that understanding their work activities is critical to the design of successful information systems. The authors also considered the volume of information, preciseness of information and the way in which it is handled by users to develop a model describing information systems. The article illustrates how the model was applied successfully to four case situations.


Managing organizational conflict.

Managing organizational conflict. This article suggests three ways to manage organizational conflicts. The first is the collaboration theory which maintains that people should air their differences and work for mutually satisfactory solutions. Collaboration requires that members of the organization be interdependent, capable of interacting candidly, and sufficiently committed to the organization to justify the time and energy required to develop and preserve mutually beneficial relationships. A second approach, the power play, is a method of handling organizational conflict which is diametrically opposed to collaboration. It is characterized by an adversary ethic and rational self-interest; the parties are involved in a win/lose situation. According to Derr, the power-play is the dominant conflict management strategy for those who seek autonomy and is best suited for idealogical disputes. Bargaining, the third technique, contains elements that overlap collaboration and power-play. Bargaining "trade-offs" are particularly useful in dealing with conditions of scarcity; this method is seen as economical in that it requires parties to meet only periodically to review the old contracts and to develop new contracts. The author concludes that there is no one best way to manage organizational conflicts and suggests that conflict management will require more extensive studies of the realities of power play.


Problem defining and the consulting/intervention process. Although many different approaches are currently being used to create planned change in organizations, Kilmann and Mitroff feel that too little attention has been paid to determining the effectiveness of these different methods in solving the organizations' problems. Based on intervention theory and the consulting process, the authors offer a method of evaluating an organization's approach to change to determine if it is well-suited to the types of problems being experienced. The process of change is diagrammed as a five-step cycle: 1) sensing problems; 2) defining problems; 3) deriving solutions; 4) implementing solutions; and 5) evaluating outcomes. Most consultants enter the process at step 3 which increases the probability that they will try to solve the wrong problem (termed Type III error). A second source of trouble is that consultants are usually trained in one or two disciplines and, therefore, see problems primarily in those perspectives. Kilmann and Mitroff suggest the use of teams of consultants so the problems can be conceptualized from a number of different viewpoints.


Court decision offers corporate tax relief.


"Mayday" for French health.

"Mayday" for French health.


Muriel Driver memorial lecture: managers in occupational therapy. This paper is devoted to a perspective of Managers in Occupational Therapy today. Various facets of management responsibility are described, with emphasis placed on the challenge facing today's manager to effect changes that will continue to result in the delivery of high quality services.


Ethical and practical prolems of a high risk to benefit ratio study in children.


Clinical engineering practices: device acquisition.


Continuing education for employed clinical engineers: review of perceptions.


Training of biomedical equipment technicians.


Practical automation: development and use of an interactive biomedical inventory system.


Pennsylvania hospital finds gourmet meals are recipe for slicing costs.


Marketing your hospital--Part 1.

Marketing your hospital--Part 1.


Marketing your hospital--Part II.

Marketing your hospital--Part II.


Medical instrumentation at midnight.

Medical instrumentation at midnight.


Hospital finds clothing allowance policy more cost-effective than uniform inventory.


Information system--Part 1. Will computerization solve your problems?


Hospitals find suggestion programs thrive when employees receive share of savings.


Nursing staff systems. Gearing care to patient needs.


Information systems--Part II: analyzing the cost of computerization.


Reimbursement by diagnosis: is relating payment to patient care the wave of the future?


A hard look at allied health education.

A hard look at allied health education.


Diabetic patient compliance as a function of patient counseling. The impact of a specially designed patient education program upon the diabetes-related knowledge and compliance of insulin dependent diabetic patients was investigated. The program consisted of an audiovisual presentation, illustrated handout material, and pharmacist-patient counseling. Based on statistical considerations, 65 eligible patients were assigned systematically to a control group (Group I) and a study group (Group II) and were evaluated for compliance following a standardized protocol. Immediately following the interview, Group II patients were instructed utilizing the patient education program. Scores for initial and final evaluations of knowledge and compliance were compared using appropriate statistical procedures. The program was successful in producing improvements in both knowledge and compliance but a need for individualization of patient education efforts was indicated. Significant improvements in compliance were not observed among patients older than the mean age for study patients and those with diabetes complicated by cardiovascular and hypertensive disease.


Board certification in clinical pharmacology: bane or boon?


Alternative sources of drug information: indexing and abstracting systems. The proliferation of information and literature in medicine, therapy, and pharmacy practice in general has created a need for a centralized source of indexing that enables individuals to efficiently locate this type of literature. An excellent example of this type of system would be Index Medicus. But Index Medicus is voluminous and all-encompassing in its coverage. The need for fast, convenient access to publications in specialty areas has led to decentralized specialty indexing and abstracting systems that deal with a particular area of medicine, therapy, or pharmacy practice. This article deals with these specialty systems and encourages their investigation and use when searching the literature.


Modern midwifery: complicated rebirth of an ancient art.


Health promotion policy and the placement of responsibility for personal health care.


Abortion: legal medical and social perspectives.


Living with death: some legal considerations.


Public versus private interest in assuring professional competence.


Public and private credentialing in conflict.


25 die in "boarding house" fire.

25 die in "boarding house" fire.


How much radioactivity is there in smoke detectors?


Problem: how to brighten up hospital patients' Sundays. Solution: the Sunday brunch.


The sharp edge of competition.

The sharp edge of competition.


Hospitals for profit: the challenge of the chains.


The politics of change at South Carolina Baptist Hospital.


The chains . . . yesterday & tomorrow.

The chains . . . yesterday & tomorrow.


Isn't the customer ever right anymore?

Isn't the customer ever right anymore?


Protecting directors of nonprofit organizations from liability.


Uniform licensure: an attainable goal, or a myth?


Candid reflections of a businessman in Washington: interview with Secretary of the Treasury, W. Michael Blumenthal. In the interview published by Fortune, W. Michael Blumenthal, Secretary of the Treasury and former Chief Executive Officer and Chairman of Bendix Corporation, discusses his transition from being a business executive to becoming a senior member of the cabinet. Blumenthal compares the workings of the corporate world with the ways of Washington. Essentially, he views the business world as less complex, allowing a manager flexibility as long as he performs successfully. In government, administrative practices are more regulated with most policy decisions determined in the public arena making the managerial process much slower and more complex. Despite the differences between the corporate world and Washington, Blumenthal identifies four basic management principles that are valid for both; (1) choose very good people; (2) learn to delegate authority; (3) know your facts; and (4) be honest. Blumenthal has found his tenure in government to be interesting and rewarding and encourages other businessmen to seek the challenge of government service.


Publicity for a group practice: opportunity awaiting decision.


An heretical view of management science. This article is introduced with the statement, "There is only one way to manage, and that is to keep it simple." The author is highly critical of the new managerial tools and decision-making modes developed by management scientists in business schools. He asserts that the use of these tools encourages a "corporations zeal for managerial perfection and threatens it with an excessive and paralyzing professionalism." Instead, Levitt suggests using "common sense" and "logical simplicity" in management by subdividing work into organizational units. This approach is viewed as an easy way to avoid being bogged down by "imagined facts" found in mathematical models. Levitt states that sense and moderation are the keys to success.


Academic medical centers: conflict from within. The degree to which the priorities and constituencies of schools of medicine and university hospitals coincide and conflict is examined by the authors who suggest that the differences need not result in continuing unresolved disputes. Because federal support for primary care is likely to continue, medical school emphasis on this area will grow. However, by recognizing that the cost of primary care is highest in the university hospital setting, both the medical schools and university hospitals should realize that the university hospital cannot continue to serve as the sole clinical training ground for primary care physicians. Possible initiatives that might satisfy the interests of university hospitals and meet the educational responsibilities of the medical schools include: (1) the development of regional hospital consortiums which coordinate education and patient services by clinical specialty; (2) the development and expansion of area health education centers to include other non-tertiary care providers; and (3) the growth of medical school based health maintenance organizations. The authors suggest that medical schools and university hospital centers should plan programs that match academic needs with both resource availability and service obligations.


Teaching cost containment.

Teaching cost containment.


Accreditation for ambulatory care facilities.


The patient, the physician, and the regulator.


Diabetes education, not detection.

Diabetes education, not detection.


Navy medical team watches health of Congress.


Hospital born from recycled foundry.

Hospital born from recycled foundry.


The role of health education in health care: an analytic model.


Using the health belief model to predict patient compliance.


Individual rights and the public good . . . no easy answers.


'The business community understands limited resources'. Interview by James D. Snyder..


This clinic makes house calls.

This clinic makes house calls.


The alphabet soup boils over: LCCME continues despite AMA pullout; AMA plans own CME accreditation.


Interior designers prescribe renovation.


The why and how of physician recruitment.


Using the business acumen on your board of trustees.


The hospital of the future: how will it be structured?


Helping the ICU nurse cope with stress: an educational program.


Achieving results through people: by the yard it's hard, by the inch a cinch.


Management techniques for winning employment discrimination claims.


Effective use of supplemental nurses.

Effective use of supplemental nurses.


Planning and budgeting: important tools for the healthcare manager.


Consumer protection... the realities of medical audit. The concept of medical audit is an extension of consumer philosophy, writes Ron McKay, but if you are paying for someone else's treatment how do you ensure your money has been spent correctly? In the United States the answer was auditing treatment and medical competence. In the light of the Royal Commission's recommendation for a greater degree of urgency in implementing medical audit here he asks how much can be learned from the US?


Reality and a mock coalface.

Reality and a mock coalface. Getting back to work after injury or illness often presents problems of readjustment and lack of confidence especially in jobs which involve environmental stress and hard physical work such as mining and the steel industry. Rehabilitation is the key to a successful return to employment. Author reports on a visit to the Miners Rehabilitation Centre at Talygarn in Glamorgan.


Why HAS has no bite may be because it has no teeth. Whither the HAS? Did Normansfield point up its ineffectiveness, as it critics allege? A personable enough body in its way, they say, but somewhat toothless. The Royal Commission saw it differently, approving of its service 'by persuasion rather than coercion'. What are the alternatives to this maligned body?


What makes a team tick as it tackles that goal.


Bucolic scenes in the outpatient's department: pastoral murals in hospital.


Hospital life: pop goes the peppercorn.

Hospital life: pop goes the peppercorn. The concept of leasing hospitals to voluntary bodies has been voiced if not applauded. There are misgivings about the workability of such a scheme on grounds of cost and the commitment required. Author looks at some of the implications of peppercorn renting as an alternative to closure.


Health administration: chasing doubtful shadows. In one of its more decisive moments the Royal Commission recommended the abolition of FPCs and the assumption of their functions by health authorities. In this article, author looks at the debate surrounding this issue and in particular GPs' problems in inner city areas. He says that while more could be achieved by making the management expertise of the hospital sector available in the primary sector, wards will always be easier to control than GPs' surgeries.


Change from within is the essential element. Planning has often been thought of as an 'ivory tower' occupation, too far removed from the operational nerve centres of the NHS. Author argues for a clearer understanding of the planner's role in providing better standards of patient care.


Taking your proposals straight to the people. The saga of the secure units at Prestwich Hospital, Manchester, goes on. A new chapter is added as author recounts the role the local community played (and continues to play) in a development that has had more than its fair share of local and national limelight.


Resource allocation: blueprint for the brave new world.


Chief casualty could be the senior service. A more emotive word than 'private' would be difficult to find in the world of health care at the moment. As public spending contracts, private medicine, or at least talk of it, expands. Guardians of the NHS are rushing to the defence of their embattled institution. The Government-led 'private' army is mobilising. Trade unions have pitched into the battle and even the innocent populace is caught up in the cross-fire.


Health administration: the high and the mighty take a return ticket to the moon. Over the past few years there have been several attempts to bring the DHSS closer to the grass roots of the health service. The aim has been to inject into the department a perspective through which its planners could measure the consequences of their deliberations. Going back to the late sixties one way of helping has been to integrate NHS officers into the DHSS and vice versa.


Signposting the four phase of team development.


When duty calls and calls ...

When duty calls and calls ... A working week for the hospital administrator extends to more than a 37-hour office week. Many incidents occur which require a decision or intervention from an administrator out of normal working hours. An on-call rota system at Derbyshire Royal Infirmary has been in use since 1975.


Health administration: service before self, but . . . what about pay? Author peers throuth the 'perpetual fog' that is pay--pay policy, pay restraint, pay freeze--to try to discern the way wages are negotiated, the 'lumpy' aspect of the structure and the problems of job evaluation and reward; matters which, he says, will keep Whitley in steady and altruistically gainful employment for some time to come.


The art of settling in nicely.

The art of settling in nicely. You are a manager and you are moving to another job. What steps would you like your new authority to take to ensure that you become an accepted and valued member of the staff and that your needs are being met?


Joint care: conflicts in co-operation.

Joint care: conflicts in co-operation.


When security is the key issue.

When security is the key issue.


The art of team management: positive steps against negative behaviour.


Health administration: the war that is waged even after the wage war is over. Conditions are made in every job. It is quite another exercise meeting them. Galling things like telephone rental money; malignant little ulcers like removal expenses; the kind of friction that ensues when, having been promised the moon, you get a handful of dust. Drew Clode, who last week looked into wage packets, now tests the letter and the spirit of something more abstract if no less realistic: the conditions in which you work and indeed live.


National heritage crying out to be preserved.


No magic formula but echoes of sympathy.


Painful memories of the NHS conflict trap. Conditions have been imposed on the NHS by successive governments in pursuit of their economic policies which have had serious repercussions for staff. Saying that it is unfortunate that the Royal Commission did not make any real contribution to an understanding of NHS industrial relations author looks at the deep rooted problems which encompass all health service staff. He also says that it has become the policy of some national newspaper proprietors to give the impression that NHS problems are created by a few untypical malcontents.


What about personnel, then?

What about personnel, then?


Playing consequences.

Playing consequences.


Let's stop creating paper illusions of progress.


It's all been said before even by Flo Nightingale.


Those high pitched screams.

Those high pitched screams.


Ploughing the furrow of clinical freedom ...


Chapter in which the priority ghost walks.


Doctor in the marketplace.

Doctor in the marketplace. Hourly rates of pay and long hours are contentious topics among hospital administrators and junior doctors. The introduction of a DHSS circular on control of charges by agencies is being firmly opposed by junior doctors as well as agencies.


Health administration: the uncommon agency with services common to all. Interview by Sally Burningham. To serve, or rather service, a nation is the avowed aim of the Common Services Agency, a body as unique to Scotland as its skean dhu. The epithet 'Common' in its title alludes to its socio-geographic sweep, one of the things that make it so uncommon.


When no home means no job.

When no home means no job. Recruitment of hospital staff is often dependent upon the accommodation that can be offered. Some hospitals are now finding that single accommodation units are no longer meeting needs. Graham Aston, environmental health and housing officer for Epsom and Ewell, gives an overview of problems and possible solutions.


Titanic's cash course moves towards the tip of disaster. The way regions throughout the United Kingdom cope with the confusion surrounding cuts in the health service is described by Stephen Halpern. In the first of three articles he gives a guide to the financial state of play in the Thames regions and, to bring in a breath of country air after the foggy and depressing financial climate of London, Oxford RHA.


What, how and why does the team think?

What, how and why does the team think? It is all very well being able to 'pick up' what team members seem to be doing and even to speculate on the reasons why. It is an entirely different exercise doing something constructive with the information you garner about team practice and performance. Michael Walton and Graham Smith, in the fourth article of their series, introduce some practical perspectives for assessing your team's performance.


Teaching the three Rs and an L for love. Mothers love to talk about their babies, children love to hear about them and need to hear about them if they are to become, in their turn, caring and responsible parents. Susan Thomas describes a pilot scheme at a Kent junior school which brought the two together along with experts from many related fields and created a comprehensive and involving educational programme which predates the Miles report recommendations.


Catchment populations.

Catchment populations. A method of estimating catchment populations which is easily understood and calculable is described by Kevin Cottrell, North Western RHA statistician. It is based on traditional statistical theory and as such is robust in its application. It can give fairly accurate determinations of the population served by various services.


Hospitals beating inflation on sheet/pillow case purchases.


Focus on critical variables when analyzing hospital linen costs.


How many sheets per bed?????

How many sheets per bed?????


Lack of CON laws may create cash squeeze.


Purchasing salaries follow no consistent pattern.


Pre-retirement planning.

Pre-retirement planning.


Order numbering system promotes controls, cuts paperwork.


Changing employee values: deepening discontent? This article presents a synthesis of data on employee attitudes gathered over the last 25 years. Most of the findings confirm the hypothesis that employees are discontented and expect more from their jobs now than they have in the past. While managerial satisfaction has remained relatively constant, the work satisfaction among hourly and clerical employees has sharply decreased. The authors attribute dissatisfaction to changes in the expectations and values of employees and warn that the deterioration of work attitudes may result in increased operating costs due to poor quality work, reduced output, absenteeism, etc. Instituting an employer attitude survey is suggested as a means of improving communication between management and employees and increasing job satisfaction.


Case study in effective product evaluation.


Open vs closed bidding.

Open vs closed bidding.


Employees' 'bed jack' safely puts patients up in the air.


Retreat for learning.

Retreat for learning.