Patients' trust and the quality of physicians. Patients are uncertain of physicians' quality but learn about the quality of particular physicians through experience in treatment. Patients come to trust physicians who have served them well. This paper explores the economic consequences of patients' learning and trust within a model of the market for physicians' services. In a market equilibrium, there are too many incompetent physicians in practice. Surprisingly, even the more competent physicians have an interest in preventing patients from judging quality except through experience. As we show, all physicians, including the most competent, may oppose steps to inform patients of physicians' quality.


Hospital EDs face 'sink-or-swim' time as urgent care center competition rises. Interview by Jean McCann.


How an ED is notified of disaster often overlooked in planning stage.


The user's role in misuse of ED equipment.


Isolation procedures.

Isolation procedures.


Surviving the performance appraisal.

Surviving the performance appraisal.


Elements of staffing.

Elements of staffing.


Controlling employee absenteeism.

Controlling employee absenteeism.


Contract management: another point of view.


What does the administrator expect from the executive housekeeper and what should the executive housekeeper expect from the administrator?


The legal impact on waste disposal.

The legal impact on waste disposal.


Disciplining the problem employee.

Disciplining the problem employee.


Sterilization: an efficient way to dispose of infectious waste.


Accreditation: new standards published.

Accreditation: new standards published.


A decade of doing video with disturbed adolescents.


Video at an Air Force hospital.

Video at an Air Force hospital.


Career preferences of doctors qualifying in 1974-1980: a comparison of pre-registration findings.


Medical and dental staffing prospects in the NHS in England and Wales, 1982.


Specialized services for the non-institutionalized patient with epilepsy: developments in the US and the UK. Services for the non-institutionalized patients with epilepsy have been the subject of a number of government sponsored reports. The recommended expansion in specialized services (for example, the special centres and the hospital-based epilepsy units) has not come about, and, as a result, services for epilepsy in the UK do not conform to the highest international standards. This paper reviews recent US findings with regard to the cost of epilepsy: contrasts recent developments in the US with those in the UK: emphasizes the need for further audit of the hospital facilities in this country: outlines the role of specialized epilepsy services and the structure these services might take in the UK.


Quality assurance. An overview.

Quality assurance. An overview.


Chinatown Health Clinic.

Chinatown Health Clinic.


Sales trends and survey findings: a study of smoking in 15 OECD countries. Annual data on tobacco sales and recent information from surveys have been used to investigate smoking trends and patterns in 15 countries in the Organization for Economic Cooperation and Development (OECD). These national smoking profiles illustrate wide variations among countries in the consumption of tobacco per adult in the population and in the percentage of male and female smokers in the population. The sales data also illustrate that the development of the market for tobacco goods has displayed marked differences over time from one country to another.


Quality assurance and program evaluation. Some common forces have led to increased attention to quality assurance and program evaluation in the United States. However, these two types of public accountability have developed relatively independently, resulting in somewhat different but related approaches to examining health care. The similarities and differences between quality-of-case assurance and program evaluation are discussed as related to their definitions and approaches to data collection and utilization. Pressures to integrate quality assurance and program evaluation and evidence of a convergence in the two types of assessment activities are also presented. The article concludes with a discussion of the future role of the states and localities in assuming responsibility for these two types of accountability.


Data sources for health care quality evaluation. The central purpose of this article is to review the major approaches to evaluation of health care quality in terms of its use of different data sources. The areas of application, advantages, and disadvantages of seven data sources are presented, including direct observation, clinical records, record abstracts, clinical and administrative staff survey, patient survey, significant others survey, and population survey. Then the selection of data sources is discussed as this process is influenced by the answers to seven critical questions concerning the context of the quality assurance effort.


Planning for program effectiveness in quality assurance. Quality assurance programs are now a fact of life in health care institutions, yet the effectiveness of these programs in improving care is unproven. Reports of quality assurance activities rarely discuss "remedy implementation" or the outcome of such attempts. Effectiveness does not flow naturally from sound methodology or documentation but is the most challenging part of the program. This article examines reasons for this difficulty, and the authors recommend strategies for improving problem resolution and increasing the influence of the program in the organization. They urge attention to program implementation and emphasize active participation by clinicians, patients, administration, and staff. This broad representation promotes examination of a wide range of patient care issues as well as medical audits, allows the program to enlist support for change, and enables the program to anticipate and make timely contributions to the decisions of policymaking groups.


The cost of quality assurance in medicine. Cost analysis has been frequently neglected in program evaluations but is currently of high relevance in policy decisions on quality assurance in medicine. The Ambulatory Care Medical Audit Demonstration (ACMAD) Project implemented and evaluated a program of medical record-based quality assurance in eleven sites for nine medical topics. Total direct costs for the project were $1.22 million over five years; indirect costs, $694,000. A computerized data system enabled disaggregation of the cost data by person, timing, type of work, project phase, health topic, health center, and research or operational nature. Of the costs incurred, 79% were for operational reasons, with 21% incurred for research reasons. Costs per audited case were 31% higher in hospitals than in neighborhood health centers. Audit topics of low per-case costs tended to have automated case findings, straightforward and limited abstracting, little need to examine multiple visits, and a low proportion of case-found patients ineligible for audit.


Market and evaluation roles in quality assurance. Competitive markets and formal evaluations offer distinctly different mechanisms for controlling the quality of care based on patients' choices as consumers and applied scientific methods, respectively. As the difficulty of acquiring relevant information and its skewness toward providers becomes greater, the need for evaluations increases. Thus the complexities of medical care tend to limit the range of the market. Markets, however, provide information on value, accommodating differences in patient preferences and cost conditions not readily obtained with formal evaluations. Through incentives, markets integrate the evaluation and control functions and may create greater efficiency and responsiveness. A variety of organizational structures for quality assurance are available, and formal evaluations are often incorporated within a market context. The policy task addressed here is to specify how, as conditions vary, greater reliance should be placed on market competition or on formal evaluations and external regulation.


Quality of care assessment in long-term care facilities. Quality of care assessment is in a rather rudimentary state of development in most long-term health care settings. Some of the mandates and initiatives in this area of evaluation are described and discussed. A few caveats are presented and suggestions made as to appropriate approaches to quality assessment in chronic care facilities, which are different in many respects from the more traditional approaches used in acute care hospitals. Of particular importance, and at the same time of greatest difficulty, is the assessment of quality of life in institutions where many patients spend the remainder of their lives.


Assessment of the clinical quality of health care. Search for a reliable method. Rating systems and criteria, developed for peer review, were used for evaluation of dental care as part of a study to determine the feasibility of using computers as a first-level screening mechanism for quality assurance. Ten dentists were trained and standardized in the use of the system, and 646 patients received full-mouth examinations by two examiners. Disagreements were resolved by joint examination. More than 22,000 individual judgments were recorded. Of all dental services evaluated, 91.5% were rated satisfactory. Data on subratings, Range of Excellence versus Range of Acceptability and Replace for Prevention (future damage likely) versus Replace Statim (damage now occurring) are also presented, together with interexaminer agreement levels. The rating system permitted full-mouth examination by two trained examiners, including resolution of disagreements, to be carried out in an average of 24 minutes. The system is suitable for verification of computer screening of treatment records for quality assurance.


Analytic procedures for evaluating health care. Statistical control charts. The concern for quality of health care motivates evaluation programs designed to monitor the health care system, patient outcome, and provider expertise. An array of audit methods and instruments for evaluating professional and institutional performance has been developed. Although evaluation is viewed by many as the basis for accountability and improvement of health care, few are aware that most existing evaluation programs are really data-collecting systems. Very little if any, analysis of the data is done with the objective of optimizing the system. The "sampling with intervention" procedures often used to monitor the health care delivery system are primarily directed toward the individual patient while the system and provider continue to operate in the established mode. This article outlines analytic procedures for interpreting evaluation data generated by quality control and audit systems. Five common univariate statistical quality control charts are described.


Mental health quality assurance. Development of the American Psychological Association/CHAMPUS program. In this article, quality assurance efforts in the field of mental health are discussed, especially concerning the reviews of outpatient clinical services. The recently established American Psychological Association APA/CHAMPUS program is described in detail, a national program of peer review that is illustrative of the major conceptual and professional issues inherent in the mental health quality assurance process. Throughout the article, comparisons are made between quality assurance in the medicine and mental health fields.


The evaluation of the quality of health care. A lay perspective. The careful selection of a physician or hospital is important to the quality of health care received. Unfortunately, our present medical/health system does not provide laypeople with the opportunity to take active, informed roles in choosing their own medical care. In order to make such decisions, laypeople need to have more useful information concerning the quality of their medical providers. Nonprofessional users of the system should become more actively involved in the evaluation of hospitals and physicians. In doing so, people will not only improve their health, but also help to restructure the medical system into one that is more efficient and responsive to their needs.


Quality assessment and monitoring. Retrospect and prospect. A commentary on the papers in the two special issues on Quality Assurance which shows how they contribute to some important conceptual, methodological, and policy issues. These issues pertain to the definition of quality; the distinction between quality assessment and program evaluation; the role of the market in regulating the quality of care; the role of more direct consumer participation in defining and assessing quality; professional responsibility for quality; the applicability of the structure-process-outcome paradigm to quality assessment; the format, methods of formulation, and validity of the criteria; probability sampling and purposive selection of the topics to be assessed; problems of scaling and measurement; the applicability of industrial control methods to quality monitoring; bringing about behavior change in response to the findings of quality monitoring; measuring the costs and benefits of quality assessment methods, including a consideration of their screening efficiency; and the relationship between quality monitoring and cost containment through competition or by other means.


Handrails.

Handrails.


Three die in Texas nursing home fire.

Three die in Texas nursing home fire.


Promising improvements in health care firesafety.


Hospital and fire department unite to design new Code Red program.


Fire evacuation: an in-service program.

Fire evacuation: an in-service program.


How to increase satisfaction with nursing home meals.


Assessing differences in chemical disaster proneness: the Community Chemical Hazard Vulnerability Inventory. The increase in accidents with dangerous chemicals makes it incumbent upon community and regional planners to deal systematically with this problem. The first step invariably involves the assessment of the likelihood and type of incident which may impact a given area so that disasters may be averted or, at least, their effects mitigated. This paper presents one such assessment scheme, the Community Chemical Hazard Vulnerability Inventory (CCHVI). This instrument, aside from considering the type and volume of substances posing a threat to a designated area, considers the physical and human resources available, as well as the general state of readiness of the area (including such things as the interface of emergency-related organizations). The use of such vulnerability assessment instruments allows local emergency planners to identify particular dangers within their communities and permits regional planners to allocate funds for planning according to relative needs.


St. Elizabeth's Hospital: The Garden Inn.


Room service at the hospital.

Room service at the hospital.


The micro in food service.

The micro in food service.


If you go micro ...

If you go micro ...


Inside quality circles.

Inside quality circles.


The transition begins.

The transition begins.


"The future is today".

"The future is today".


Staff cafeteria: Columbia Hospital for Women.


How to improve nutrition in hospital menus.


Health care system tests videotex in rural America. In a videotex field test conducted last year, Lutheran Hospitals and Homes Society participated by providing health awareness programming and other information. As this interactive medium grows, so does the potential for electronic fund raising through direct contributions via on-line banking transactions.


The 1983 Herbert M. Platter luncheon address. Problem physicians are hazardous to a community's health.


Concerns regarding foreign medical graduates--update on activities in Michigan.


Writing for dangerous drugs.

Writing for dangerous drugs.


Caduceus confusion or Aesculapius explained.


Concerns regarding foreign medical graduates--update on activities in New Jersey.


Community assessment: an essential component of practice.


Air conditioning design for a fixed humidity environment.


Public hospitals call for federal unemployment health insurance program.


Maimonides Medical Center goes prime vendor.


Legal recourse for vendor nonperformance.


The weekly shortage list.

The weekly shortage list.


Establishing a prime carrier program.

Establishing a prime carrier program.


Health education and the microcomputer connection.


Distributing office supplies by exchange cart.


Differences in perception of health status and health needs between refugees and physicians providing care.


Travels of a health educator.

Travels of a health educator.


An interview with: Ted Olson.

An interview with: Ted Olson.


Establishing loss controls at the loading dock.


An interview with: Charles Sennewald, CPP.


Protecting your administrators and other key personnel from kidnapping, extortion, physical attacks.


Rural affiliations. Why are large systems interested in rural hospitals? What do they offer? And what are they looking for?


AWHERF pioneers a rural alliance: year one.


Energy consumption and energy saving in health care.


Safety in kitchens.

Safety in kitchens.


Preventing Legionnaires' disease.

Preventing Legionnaires' disease.


Actualisation of hospital buildings: problems and work methodologies.


Britain's first all-electric hospital--early operational experience.


Microprocessor-based event recording--the key to managing more numerous, more sophisticated hospital systems.


The United Way and the issue of admissions.


Motivate staff with inservice education.


General parameters of medical space planning.


Student nurses provide relief.

Student nurses provide relief.


Communication is key in design planning.


Keep morale high and turnover rates low.


Critical care nurses form national society.


Hospital guidelines on AIDS developed at UCSF.


A survey of partial hospitalization programs in the state of Indiana. This article presents normative data on the day-to-day operation of partial hospitalization programs affiliated with mental health centers in the State of Indiana. This network of programs was surveyed with regard to (1) the community settings and locations of their facilities as well as their accessibility to patients, (2) the organizational structure within which the programs operate, (3) their staffing, (4) the characteristics of the patient population they serve, (5) their admission and case management procedures and the nature of their clinical programming, (6) their referral source network, (7) their funding sources, and (8) the extent and nature of their program evaluation and program promotion efforts. Generalizations suggested by the survey data are discussed in an attempt to highlight possible trends in the field at large.


Treatment outcomes in a day treatment program. A sample of 63 psychiatric patients consecutively admitted to an adult day treatment program was evaluated with the Colorado Client Assessment Record (CCAR) within 2 weeks of their admission, at regular 90-day intervals, and/or upon discharge from the program. Trained raters using the CCAR made functional assessment ratings of patients on nine behaviorally-anchored scales. A unique feature of this study was that patients' primary therapists were asked to identify the three CCAR dimensions which represented their targeted treatment goals. Purposes of this study were twofold. The first concern was to establish the validity of this instrument in monitoring the level of functioning of a young and chronically impaired sample. The second goal was to assess the clinical outcome of patients in the day treatment program. Results showed the CCAR to be a valid measure of patients' level of functioning. Further results indicated that the functional ratings on the three targeted treatment goals exhibited statistically significant improvement from admission to follow-up or discharge. Findings further suggest that patients' motivation for treatment at the time of admission may be important for achieving successful clinical outcome. This investigation, by establishing the validity and utility of the CCAR for a chronically impaired psychiatric population, lays the foundation for continued monitoring of clinical outcome and program evaluation.


How to negotiate successfully a reimbursement contract for day hospital services. Reimbursement from third-party payers has been identified as a major problem facing partial hospitalization programs. This paper provides an overview of the process by which a contract to reimburse for day hospital services in a general hospital setting was negotiated with the Department of Social Services and Housing in the State of Hawaii. The paper details the specific program development, the determination of direct and indirect cost components, the establishment of costs and charges, the comparative cost data developed, and the nature of the negotiations that ensued with the Department of Social Services and Housing in the State of Hawaii.


The development of a partial hospitalization program evaluation tool. This article discusses the development of a program evaluation tool for partial hospitals. Although it recognizes the many differences between programs, it attempts to identify the commonalities that constitute quality programming. It was developed for use as part of the consultative process, however, it can also be used for self-evaluation purposes.


Are hospitals still the doctor's workshop?


In the interest of quality care.

In the interest of quality care.


Coalinga. The earthquake, the aftermath and the hospital's pivotal role.


Let a committee decide.

Let a committee decide.


Podiatrists: competent and qualified.

Podiatrists: competent and qualified.


Options for rural hospitals. Local and regional approaches to identifying health care needs and sharing services.


How to deal with the impact of: alternate providers.


Privileges for limited-license practitioners: how the state laws stack up.


Carner's codes, chapter 9. Physicians.

Carner's codes, chapter 9. Physicians.


Taking a seat on the hospital board. How to do it--and why.


Making the most of consultations.

Making the most of consultations.


"Take care": the legal duties of board members.


An introduction to capital campaigns.

An introduction to capital campaigns.


How & why to hire a consultant.

How & why to hire a consultant.


Preparing and training volunteers to ask for money.


Asking for money.

Asking for money.


United Way's role in community problem solving.


Improving security through effective report writing and forms.


Building a mailing list.

Building a mailing list.


Cadet training in a professional security setting.


Hiring: the secret of success.

Hiring: the secret of success.


On medical morals and ethics.

On medical morals and ethics.


The people of the world of nursing administration.


Health care in the welfare state.

Health care in the welfare state.


Supervising women in nontraditional jobs.


The hospital supervisor: safeguard to care or threat to autonomy?


Formulary management through therapeutic substitution: factors behind the decision.


Implementing and maintaining a viable formulary.


The community hospital program--some lessons learned.


Improving health and medical care in the United States: a foundation's early experience.


Anatomy of a medical group: the Mercy Hospital story.


Planning for primary care: a case study in population-based demand forecasting.


Opportunities for institutional providers in ambulatory care.


Planning a fire inspection that works for you.


Potential patients and loyal users: access to care in community-hospital-sponsored group practices.


Fire research can lower health care costs.


A display device for biomedical signals. The design of a 20-segment LED display device is presented. The display visually indicates peak levels of slowly changing biomedical data. Its fullscale indication is adjustable from +0.5 to +12.5 volts. The segments can be activated in either a dot or a bar mode, and upper-limit sensing can be indicated by an audio tone and/or a flashing display.


Interdisciplinary grand rounds. Legal consequences of prescribing an approved drug for a non-approved use: cimetidine; a case in point.


The administrative residency in a multi-institutional system.


How staff responds during fire incidents.


The role of hospitals in health promotion: an administrative diagnosis.


Effective training means interested staff.


Proper planning, quick thinking and community cooperation save lines.


Facing disaster and winning. The University Nursing Home fire: a clear case of being prepared.


Coping with Mother Nature's temper tantrums.


Developing a strategy for managing the hospital's growing technology. Successful hospital CEOs, administrators and department heads skilled at their professions, face a major challenge from the onslaught of rapidly developing medical instrumentation technology. To meet this rapidly growing challenge, they must identify their needs, survey their resources, and take positive action now to develop the necessary clinical engineering and equipment control programs to cope cost effectively with the future. This article provides an overview of the fundamental problem for the hospital administrator, suggests a direction toward solution, and provides a primer on the resources available to effectively deal with, if not solve, the enormous problem posed by the ever increasing technology dependence of health care.


Security within the health care facility.


Residential care life safety--protecting people from fire.


A standards primer.

A standards primer.


Administrators gain management tool in quest for quality.


Beyond the Life Safety Code.

Beyond the Life Safety Code.


Facing disaster and winning. A Fire Department's view in retrospect.


Theory Z: a useful tool for hospital management or another fad?


Emergency preparedness for an elephant?

Emergency preparedness for an elephant?


A fresh start for life long professional learning: reuniting the faculty-practitioner partnership.


Identifying consumer segments in health services markets: an application of conjoint and cluster analyses to the ambulatory care pharmacy market. Because of increasing competition, it is becoming more important that health care providers pursue consumer-based market segmentation strategies. This paper presents a methodology for identifying and describing consumer segments in health service markets, and demonstrates the use of the methodology by presenting a study of consumer segments in the ambulatory care pharmacy market.


Candid observations on the status of health services marketing.


A clinical internship program in biomedical engineering, Part II: Administration of the program. This paper discusses the administration of a clinical internship for biomedical engineering students. The interns rotate through sequences of hospital services, divided into four sets, separated by intervening elective periods, and spread over different clinical facilities. Rotations include orientation conferences, counseling sessions with staff personnel, and on-the-job training in each hospital service. Students keep logs of their experiences and submit service reports summarizing each rotation. They also write brief reports illustrating engineering contributions to health care delivery. The reports are graded and serve, together with staff and faculty evaluations, to rate the students' overall performance in the program.


Designing new outpatient health services: linking service features to subjective consumer perceptions. Planners of new outpatient health services deal with objectively-defined features such as hours of operation and use of nurse practitioners, while consumers evaluate these services based on subjective perceptions such as quality and convenience. This research uses a multivariate approach to measure the relationships between features and perceptions, and illustrates how these measurements can be used to design new health services.


What ails our hospitals? Financial distress in the 1980s.


The who, how, when and why of the promotion decision: a middle management perspective in hospitals.


A marketing approach to nurse recruitment and retention: OPT.


Selecting a public accounting firm: a hospital study and heuristic model.


Emerging problems in clinical engineering education. Following an analysis of the differences between Clinical Engineering educational programs and classical engineering education, emerging difficulties in Clinical Engineering education are examined. A shortage of Clinical Engineers is projected along with a possible impact on the nation's hospitals in the next decade. Solutions for these difficulties are proposed.


Gender and social policy: the impact of the public expenditure cuts and reactions to them. In social policy research the gender dimension has been relatively neglected in Britain. The attempt to selectively reduce public spending is examined with reference to its objective impact on men and women using official statistics and specialist reports. In addition, on the basis of a large-scale interview survey the subjective impact of and political reactions to the cuts are analysed by gender. The main findings are that this current social policy negatively affects women as both public sector workers and consumers more than men. Political reactions to the cuts were extensive but unrelated to gender per se. However, when one controls for economic activity and related variables, gender differences in terms of both political attitudes and behaviour were insignificant compared to the contrast between the economically active and inactive. The main social policy implication is that the restructuring of the welfare state hits women first and foremost.


Equity and efficiency in the allocation of the personal social services. This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.


Economic and social policies under the Reagan Administration.


Health and stress management education in three federal agencies.


Involving physicians in hospital cost containment: developing an action research strategy.


Influence structures in community hospitals: a decision contingency model.


Efficiency and effectiveness rating systems for field employees.


Organizational development in the health care field: a confrontational team-building design.


Enhancement of health care settings: the theory and practice of organizational development--a symposium. Introduction: in search of the ultimate treatment.


Developing managers to develop organizations.


Flexitime in an army center.

Flexitime in an army center.


Online information in the health sciences.


Managing change in health care organizations.


Are you a visible laundry manager?

Are you a visible laundry manager?


Lawsuit blocks management shift in Walter Reed Hospital laundry.


Illinois hospital laundry manager fights to change state temperature regulation.


Coast hospital laundry manager calls yellow alert on AIDS linen.


Develop your human resources and become a better manager.


Afghan resistance hospitals.

Afghan resistance hospitals.


By concentrating on four vital areas you can become a good manager.


Nursing home administrator contends 'laundry one of the hardest problems.'.


Telecommunication technologies for libraries: a basic guide.


Wide screen television projection systems.


Microfiche readers for libraries.

Microfiche readers for libraries.


Richard S. Schweiker: an exclusive interview. Interview by F. Kenneth Ackerman, Jr. and Robert J. Saner II.


A prescription for medical group managers and physicians. We are on the verge of revolutionary changes in the healthcare profession. It is essential that managers and physicians take individual responsibility for becoming involved in the political process leading to these changes. Though this is a time-consuming task, it is one we cannot afford to shirk as each and every one of us will certainly be affected.


Risk management in medical groups.

Risk management in medical groups.


Affecting legislation on the state level--the experiences of MMGMA and MAC. Since many political battles over healthcare legislation occur at the state level, it is vital that medical groups become involved with key groups and legislators in their states. The experiences of Minnesota and California managers in rallying behind healthcare legislation is offered as an example to other states, as well as a history of MGMA's involvement with national healthcare issues.


Two medical groups in Washington, DC.

Two medical groups in Washington, DC.


A new, and growing, malpractice threat.

A new, and growing, malpractice threat.


How we've learned to live with full-time ER doctors.


Melvin Belli: don't let informed consent backfire.


Community health worker's training, a new vision of the Diocese of Dumka.


When your patient is angry at your hospital.


Hospital pharmacy continues to expand.

Hospital pharmacy continues to expand.


Public affairs and the Mayo Clinic.

Public affairs and the Mayo Clinic.


Don't overlook the nurse practitioner.

Don't overlook the nurse practitioner.


Telemedicine keeps Newfoundland airwaves buzzing.


Now CME on open-channel TV.

Now CME on open-channel TV.


Four productive uses of teleconferencing.


The advisor's observations: questions and answers with David A. Winston. Interview by Mark G. Brataas.


There's more than medicine to health-care promotion.


Nosocomial infections: washing away the problem.


Optimizing your effectiveness with the board.


Implementing pharmacy services in a family practice. As medical groups compete for patients in the healthcare marketplace, they will continue to evaluate ways to control costs and expand services. One alternative to a traditional family practice is offered at the South Omaha Family Practice Clinic--a model group practice that includes on-site pharmacy services. Designed and maintained by the University of Nebraska College of Medicine, the group's medical and pharmacy services provide continuity of patient care through an integration of medical and prescription records.


When employees help manage.

When employees help manage.


Absence of bias. How to interview impartially for the "best fit".


How one state lab group made a difference.


Marketing strategies for the nonprofit blood center.


A systematic guide to understanding behavior.


Mark-sense makes sense in microbiology.

Mark-sense makes sense in microbiology.


In-house laboratory testing.

In-house laboratory testing. By adding ancillary services such as in-house laboratory testing, the St. Cloud Medical Group has taken a step towards meeting the challenge of today's rising costs and increased competition. The purchase of a discrete clinical analyzer has improved patient service in many ways, and has also increased clinic efficiency and profitability.


Urban health workers in search of a role.


No one catches this second shift off guard.


Woman-to-woman sharing of knowledge, skill and confidence.


HCFA task force recommends national fee schedule for independent labs.


PPOs. Implications for management.

PPOs. Implications for management. The development of preferred provider organization (PPOs) is relatively recent--largely since 1980--and there is little definitive experience to date. The PPO concept does, however, address the major concerns of all involved in health care today: the cost of medical care, the projected physician surplus, and increased competition. It provides a way of working with major purchasers of health care, within the context of a fee-for-service practice, to jointly address these concerns. While PPOs are unlikely to be the "wave of the future" (any more than HMOs were), the concept contains idea which are likely to be of continuing value to medical group managers, as they seek to improve the competitive status of their groups. The author addresses the present situation, implementation of a PPO, alternatives available to medical groups, and implications for medical group management.


Telethon reaps pledges of blood, not money.


Does your lab need an employee liaison committee?


Updating your laboratory computer.

Updating your laboratory computer.


The day the blood supply almost stopped.


How to evaluate a manufacturer's commitment to cost containment.


Making the most of supervisor's meetings.


A tool for better lab-medical staff relations.


How to cope with frustration--yours and others'.


You can't motivate unless you communicate.


Acquiring basic instrument troubleshooting skills.


Disaster blood usage: a case history.

Disaster blood usage: a case history.


Olympics medical care program gets feet wet.


Social Security reform bill: what it does.


Blues point to cost savings of hospice care.


PA. Blues offer jobless lower rates.

PA. Blues offer jobless lower rates.


FTC, insurer support bill fostering PPO development.


A case for CEO contracts.

A case for CEO contracts.


Externship eases entry into nursing.

Externship eases entry into nursing.


Osteopathic hospital statistics, 1981-1982.


An interview with Richard A. Strano, AOHA president.


Public relations is everyone's business.


Stability and coherence of health experts' upper and lower subjective probabilities about dose-response functions. As part of a method for assessing health risks associated with primary National Ambient Air Quality Standards. T. B. Feagans and W. F. Biller (Research Triangle Park, North Carolina. EPA Office of Air Quality Planning and Standards, May 1981) developed a technique for encoding experts' subjective probabilities regarding dose--response functions. The encoding technique is based on B. O. Koopman's (Bulletin of the American Mathematical Society, 1940, 46, 763-764; Annals of Mathematics, 1940, 41, 269-292) probability theory, which does not require probabilities to be sharp, but rather allows lower and upper probabilities to be associated with an event. Uncertainty about a dose--response function can be expressed either in terms of the response rate expected at a given concentration or, conversely, in terms of the concentration expected to support a given response rate. Feagans and Biller (1981, cited above) derive the relation between the two conditional probabilities, which is easily extended to upper and lower conditional probabilities. These relations were treated as coherence requirements in an experiment utilizing four ozone and four lead experts as subjects, each providing judgments on two separate occasions. Four subjects strongly satisfied the coherence requirements in both conditions. and three more did no in the second session only. The eighth subject also improved in Session 2. Encoded probabilities were highly correlated between the two sessions, but changed from the first to the second in a manner that improved coherence and reflected greater attention to certain parameters of the dose--response function.


AIDS. Turmoil in the medical profession.


Techniques in urology patient education.


Center for your good health.

Center for your good health.


Use of lay persons as patient educators.


Social support and health: programmatic implications.


Discussion groups.

Discussion groups.


You, your patient, and the ICU.

You, your patient, and the ICU.


The three faces of personnel--or, PAIR department activities as seen by executives, line managers, and personnel directors. More so than most other departments, the personnel department shares responsibility for its activities--notably with executives and line managers. But the division of responsibility is far from clear-cut, and where to draw the line is subject to controversy, as seen in this discussion of survey results on the viewpoints of 326 PAIR directors, 162 executives, and 217 line managers. The survey was conducted by the authors, all from Arizona State University: George W. Bohlander, associate professor of management; Harold C. White, professor of management; and Michael N. Wolfe, assistant professor. They queried the three groups on four major activities--setting policy, counseling and advising line managers, providing services, and controlling personnel activities in other departments--and 17 duties. The responses are broken down according to degree of unionization in respondent firms. Discrepancies among the viewpoints of the three groups suggest a need for two kinds of programs, say the authors: one to communicate to an organization's line managers and executives the role actually performed by the PAIR department and the other to instruct them on PAIR's potential for greater contribution.


The HRIS: what capabilities must it have? Unfortunately, there are no commonly accepted standards to guide personnel managers in evaluating HRIS (human resources information system) software. Until such standards developed, the advice offered here by author Sidney H. Simon (manager of personnel information systems and benefits administration of Bechtel Power Corporation) will stand the personnel manager in good stead. Focusing on the minimum capabilities that any HRIS should possess, he discusses the basic functions of input, data maintenance, and output in terms of both standard and optional items. This is not to say, however, that the personnel manager need do no homework. Simon emphasizes the importance having carefully and accurately defined the data required to support a company's personnel functions before software evaluation even begins. And he notes that human resources managers will have to familiarize themselves with some of the data processing terminology in use, just as the data processors have to familiarize themselves with personnel terminology. Simon illustrates the text with eight exhibits that clarify the functions explained to help the reader translate the concepts involved in terms of his or her organization's needs.


Monitoring your food service program.

Monitoring your food service program.


Screening optical scanners for personnel.


Can skyrocketing employee healthcare costs be contained?


An action plan for dealing with employment agencies.


Effective manpower planning.

Effective manpower planning.


A manager's guide to selection interviewing.


Choosing the right vending service program.


Policy and procedure statements that communicate.


Evaluating a food services vendor.

Evaluating a food services vendor.


Exit interviews: don't just say goodbye.


A coordinated approach to motivation can increase productivity.


The lost art of writing an employment ad. Good advertising can be more effective than other recruitment tools.


Exploring the relationships between motivation, satisfaction and performance.


Avoid the 'quick fix' approach to productivity problems.


The analytical element is important to an HRIS.


Ensuring privacy and accuracy of computerized employee record systems.


Health care cost containment.

Health care cost containment.


Calculating merit increases: a structured approach. Determining the amount of salary increase appropriate for each employee poses a major dilemma for many human resources managers and/or compensation managers (not to mention the employee's supervisor). This task requires complying with the company's compensation philosophy, meeting market competition, and rewarding employees fairly and equitably. Authors William W. Seithel, vice president, personnel of the Midwest Stock Exchange, Inc., and Jeff S. Emans, director, employee compensation of the Kemper Group, describe a method for pinpointing a salary rate increase that is not only structured enough to move people through the salary range in accordance with a reward philosophy, but precise enough to provide a basis for projecting costs and flexible enough to meet the needs of various performance levels. The method entails the use of a structured matrix that spells out the target percentage raises for various levels of performance. By using both the matrix-which is constructed to meet the individual company's needs-and a guide chart provided by the authors, it is possible to calculate a specific percentage increase for each employee. The manager who uses this system will find that the matrix is a mechanism for control as well as a means for projecting costs.


Between language extremists: find a happy medium for business memos. As business communicators, human resources managers must convey messages to many different people-their subordinates, upper-level management, all employees, or the public. In performing this function, human resources managers, like most managers, frequently find themselves caught in the conflict between language purists and language libertines. Author Ronald Dulek, associate professor and coordinator of management communications, and James Suchan, assistant professor of management communications-both at the university of Alabama-contend that on way out of this dilemma is to use two touchstones (clarity and persona) for determining the appropriate language to use in writing corporate communications. Thus, while it is imperative that managers maintain their "persona,' or image by, for example, making sure that their subjects and verbs agree, it may be perfectly all right for them to use split infinitives or to end sentences with preposition-almost everyone does-as long as the message is clear and the language conveys the image they wish to project. Such a touchstone approach gives managers a checklist for evaluating and guiding others' prose and evaluating and defending their own. Human resources managers, in particular, can incorporate this approach in training.


Chief hospital pharmacists: how they rate wholesalers' services.


Home health care pharmacy: why it represents a new, exciting practice.


How to take a 'common sense' approach to lobbying.


How to properly fit a patient for a wheelchair.


How we teach patients to properly take their discharge medications.


Rx fee in Utah rises if drug quantity extends beyond 30 days.


Energy conservation hazards in buildings.


29 pharmacists served with Project Hope to boost health in lesser-developed nations.


Inhalation injury--a major burn complication. Inhalation injury results from exposure to the toxic gases, chemicals, and particulate matter of smoke to the respiratory tract. New synthetic materials have increased the toxicity of chemicals in smoke and added to the complexity of inhalation injuries. Clinical diagnosis is often difficult, but a high index of suspicion in victims of certain fire situations, coupled with early diagnostic bronchoscopy, will identify most victims. Prior to early bronchoscopy, the mortality rates for the combination of inhalation injury and body surface burn ranged from 75% to 90%. Early diagnosis, expectant management, and meticulous aseptic techniques can decrease the mortality rate to less than 30%.


Quiz: risks in treating the terminally ill.


Malpractice countersuits won by physicians.


10 ways to profit from patient feedback.


Auditing your counselor's performance.

Auditing your counselor's performance.


Legal issues loom for PPOs.

Legal issues loom for PPOs.


Evaluating the effects of reflex-inhibiting patterns among hemiplegic patients using EMG biofeedback. Bobath's hypothesis--that the reflex-inhibiting patterns (RIP)s of a hemiplegic patient's non-exercising limb will prevent an abnormal increase in the muscle tone while the ipsilateral limb is being exercised--is examined in this study with the aid of an EMG biofeedback unit. Recordings were taken of the biceps brachii muscle of 15 patients during performance of lower extremity exercise, and from the medial gastrocnemius muscle of 12 patients during performance of an upper extremity exercise. Each muscle was examined six times in the same session: three of these repetitions being conducted in a RIP, the other three in a neutral position. The highest EMG values recorded in each of the two test situations were compared. The results did not point to a definite relationship between the RIPs and the electrical activity of the test muscles. Bobath's claim that there exists a consistent trend relating RIPs to reduction of muscle tone is therefore placed in doubt. Further research using objective techniques is required as a means of exploring this issue.


1983 Enid Graham Memorial Lecture.

1983 Enid Graham Memorial Lecture.


Getting the most from your research.

Getting the most from your research.


The women's hospital: the other side.

The women's hospital: the other side.


Psychological testing: can it help you hire the right person?


10 criteria for getting good research.

10 criteria for getting good research.


Legal aspects of infectious disease practice.


Diagnosing the doctor.

Diagnosing the doctor.


Progressing toward professionalization: the role of continuing education. The traditional term professionalism--variously linked to such characteristics as an "organized body of knowledge", or a "closely-knit association of people with a high degree of communication"--has been described recently as a static concept. It is professionalization--the dynamic process of refinement through which the character and spirit of a profession is made real and operative--which is more relevant. Part of that process is quite obviously the application of new knowledge which today is growing at an increasing rate. Note this paradox: that although each profession grows by accentuating its own distinctive knowledge, that very specialization leads in turn to the need for closer relationships with allied professions. Equally important is each profession's need to continue to redefine its relationship with its clients. Continuing education is an essential tool in both of these tasks. Recent studies elicited a variety of reasons for the professional's interest and engagement in continuing education: to become better informed; to gain personal enrichment; to achieve career advancement; to satisfy individual curiosity; to fulfill an employer's requirements; to qualify for licensure; to meet new people; or to break out of a routine. Typically, continuing education is promoted by professional schools, university extension divisions, employing agencies, the professional association itself--and even its commercial suppliers. Physiotherapists ought reasonably to ask themselves these questions: What goals are to be sought in the ensuing five years? Which of these can be met through continuing education? What barriers to continuing education now exist? What methodology and delivery of continuing education will best serve the profession? How can this educational thrust be harnessed to improve physiotherapists' relationships with other professionals--and the general public?


Implementing and evaluating continuing professional education: elements of a strategy.


Malpractice: a perspective for physiotherapists. A malpractice action--one aspect of the application of legal principles known as the law of torts--is a means whereby an injured party may seek compensation for harm caused by another party. The primary function of the law of torts is to determine whether the injurer is under a legal obligation to provide compensation to the injured for some loss due to negligent or faulty conduct. A malpractice action against a physiotherapist involves a plaintiff patient who has been injured, a defendant physiotherapist who stands accused of having caused an injury, and a determination as to whether or not the physiotherapist should bear the loss. In order to establish the liability in negligence, a plaintiff must satisfy four requirements: duty of care, breach of standard of care, causation, and damage. In this paper, a case study of malpractice action against a physiotherapist is outlined as an example of the type of arguments used by both the plaintiff and the defendant. Malpractice actions are an important means of controlling the standards of all health professionals. Because increasingly complicated technology and increased pressures on health care professionals are unlikely to reduce the number of accidents, the malpractice action will continue to provide recourse for those patients injured by lapses from the requisite standards of a profession. The threat of a malpractice action alone, however, is not enough to ensure high professional and ethical standards.


The battle for home care reimbursement. Will RTs be ready once it is won? RTs wil have many contributions to make to the home health care team when their role is officially recognized and reimbursed. Training for the special needs of home care patients, including problems of dependence and motivation, is already a part of many RT training programs.


A fiberoptic bronchoscopy assistant program. The increased popularity of bronchoscopy performed outside the operating room has created a need for the bronchoscopy assistant service. The Stanford (Calif) University service is described here as a guide for departments establishing a bronchoscopy assistant service or restructuring an existing one.


Chronology of respiratory therapy for a burn victim.


Redefining death. Are we any closer to a consensus? As medical and technologic advances blur the once-distinct lines between life and death, legal scholars and physicians struggle to maintain a consistent and ethical definition of death. Pressures created by the possibility of organ donation and the problem of terminally ill patients or those in chronic vegetative states further complicate the question.


Taking the initiative to cut health care costs. Report on a policy change to limit bronchopulmonary segmental drainage. Before the study reported here began, the number of bronchopulmonary segmental drainage procedures performed each month at the University of Maryland Hospital averaged 7,200. Adoption of a policy allowing unnecessary treatment to be stopped on the basis of therapeutic objectives reduced this figure by more than two thirds, to a present level under 2,000. Comparison of the incidence of pulmonary infection and the average length of hospital stay during the six months before and the six months after the policy change showed no appreciable change.


Liquid versus nonliquid heparinization of blood samples. Recent studies demonstrate that liquid heparinization of blood samples causes errors in PCO2 that range from 6% to 40%. Various nonliquid forms of heparin are available as alternatives.


Department of Pulmonary Medicine, St. Mary's Hospital, West Palm Beach, Fla.


Will quality circles work in American foodservice operations?


Defining the role of the physician: medical education, tradition, and the legal process.


Fire safety. Protecting people and buildings.


Tomorrow's hospitals.

Tomorrow's hospitals.


ECG testing as a function of the respiratory therapy department. The merger of cardiopulmonary and respiratory therapy services is under way, and the trend toward consolidation is likely to continue. Future-minded respiratory therapists are banking on cardiopulmonary skills to contribute to career growth.


Options for ventilating the pediatric patient. Part 3. Circuits and humidification systems. How important is the ventilator circuit and the humidification system? What problems are created by relatively high compliance circuits? Is circuit volume "steal" important when the level of water in the humidifier changes? What is the state of the art for pediatric ventilators?


Practical aspects of quality assurance.

Practical aspects of quality assurance. Half the task of setting up a quality assurance program is selling the idea to departments and enlisting committee members with positive attitudes to seek out and help solve problems.


A four-day workweek. A retrospective evaluation. Respiratory therapy managers are expected to provide quality patient care while keeping operational expenses at a minimum. One method that has been proposed for achieving this objective is a four-day workweek. Such a system was tried at Samaritan Hospital, Troy, NY, with disappointing results.


Deciding who should receive outpatient oxygen therapy. Comprehensive treatment of advanced chronic airway obstruction includes consideration of outpatient oxygen therapy. A physician's decision as to whether a patient should receive this form of therapy rests on the clinical and investigative information that defines the benefits and problems.


Contracting: alternatives for dietary management.


How to find, select, and use a consultant.


The threat of malpractice.

The threat of malpractice.


Hospital malpractice: coming South.

Hospital malpractice: coming South.


Leaders of the new phase.

Leaders of the new phase.


A linen security system that works.

A linen security system that works.


Behavioral and psychological crisis in emergency medical services.


Greenville Memorial: tertiary care with humanism.


Psychiatric and mental health services in disaster relief.


Abused or neglected children in the emergency department.


Training budgets '83: a case of the blahs.


Legal aspects of behavioral and psychological emergencies.


Management of behavioral emergencies in the hospital emergency department.


Special considerations of emergency physicians, radiologists, x-rays, and legal liability.


Lutheran General makes the most of human resources.


How to cut hospital forms costs.

How to cut hospital forms costs.


Producing power and reducing costs.

Producing power and reducing costs.


Emergency services for psychological and behavioral emergencies.


Cooperative training: getting more for less.


Should supervisors be counselors?

Should supervisors be counselors?


Multihospital systems in Texas. Trends and developments.


Computerized system streamlines communications.


The care and use of surgical instruments.


Perspectives on multis. On the for-profit side...


Perspectives on multis. On the not-for-profit side...


Viewpoint on multis. From an administrator whose hospital is system-affiliated.


New case changes medical disclosure law.


Viewpoint on multis. From an administrator whose hospital is independent.


Marketing, public relations...lessons the multis can teach Texas hospitals.


Administration. Art or science?

Administration. Art or science?


Program emphasizes importance of documentation.


FTC study: nursing home trade rule not needed.


Government report shows nursing home numbers up.


IDB curbs resurrected.

IDB curbs resurrected.


Nursing homes as centers for continuum of care.


Proper fire safety plans: the difference between life and death.


Environmental design: a can do philosophy.


Equal rate law spurs survival techniques.


Big buildup in extended care beds approved using new local process.


As fringe benefits go under the gun.

As fringe benefits go under the gun.


Preparedness drills urged in hospitals.

Preparedness drills urged in hospitals.


The politicalization of institutions. The responsibilities of multinational corporations.


Designing volunteer jobs for results.

Designing volunteer jobs for results.


The need for board errors and omissions insurance.


Children should be seen and heard--as volunteers.


Planning a funding search. How to identify a foundation that could fund your project.


Perspectives. Uninsured, unemployed under scrutiny.


Perspectives. States respond to capital question.


Perspectives. Family planning: surviving the Reagan agenda.


Perspectives. Capital financing in the 1980s.


Perspectives. Has hospital deregulation failed?


Perspectives. Reagan budget: competition, more cuts.


Employer-employee based quality circles in Japan: human resource policy implications for American firms. This paper traces the development of the quality circle in Japan with reference to such traditions as permanent employment, nenko (seniority-based compensation), enterprise unionism, and management paternalism. Quality circles are examined as tools for motivating employees, reducing labor turnover, effecting employee "career expansion," and allowing employee participation in job redesign.


A theory of organizational response to regulation: the case of hospitals. This paper presents a general theory of organizational response to regulation, a theory that integrates adaptation and mutual selection perspectives. Two major forms of regulation in the hospital industry, certificate of need and rate review, are examined. Hypotheses are derived concerning the nature and timing of the various adjustments hospitals make both in internal organizational arrangements and in patterns of interorganizational activity in the face of regulatory constraints. Suggestions and data sources for testing the theory are presented.


Motivating the client/employee system as a service production strategy. Productivity improvement in service organizations is of major concern to managers as one way of countering escalating costs. In service organizations in which the client/customer is directly involved in the production function, improved performance can be secured by viewing the client/customer as a "partial" employee. This proposition in turn leads to the suggestion that productivity gains can be realized for services by expanding conventional motivation concepts to include the client/customer.


Work and nonwork influences on health: a research agenda using inability to leave as a critical variable. A basic path analytic model of stressor-health relationships is formulated from a multidisciplinary literature base. Work, nonwork, and individual difference variables act as exogenous stressors influencing endogenous job and life satisfaction variables, which are then posited to influence health variables. Inability to leave is added to the model as a means of more completely integrating a research framework investigating work and nonwork influences on health.


The stress of excellence. Why our best decision-makers may face the greatest risk of heart attacks.


Organizational cosmopolitanism and innovativeness.


Causal attributions, affect, and expectations for a day's work performance. Two studies were conducted to explore the relationships between perceived job performance, causal attributions, employee affect, and expectations for a day's work. In both studies, causal categories derived from previous attribution research were found to correspond with employee job explanations. However, results somewhat inconsistent with previous laboratory studies were obtained.


Strategic power relationships in contemporary profit and nonprofit hospitals. A comparative analysis of the intraorganizational power distributions of strategic decision makers in profit and nonprofit institutions was conducted to assess the effect of the institution's economic orientation. Hypotheses are tested, and the usefulness of an organization's economic orientation as a major strategic contingency variable is discussed.


Sex differences in job satisfaction revisted.


A measure of styles of handling interpersonal conflict.


Americans needing help to function at home.


Utilization of short-stay hospitals by adolescents: United States, 1980.


Counselor's role: the impact of the microcomputer.


Rehabilitation--whose responsibility?

Rehabilitation--whose responsibility?


Treatment setting or service station.

Treatment setting or service station.


Behavioral techniques for use with noncompliant children in the EEG laboratory.


An evaluation of psychological tests in the selection process for EEG technician trainees.


American Medical News at 25: looking back, ahead.


Two PPOs get good reviews from Justice.

Two PPOs get good reviews from Justice.


Day care center brings new perspective to Mt. Vernon elderly.


Medicare financing at issue in Canada.

Medicare financing at issue in Canada.


The laundry: a well tuned instrument.

The laundry: a well tuned instrument.


Technology promises increased convenience and challenges to the nation's elderly.


Good distribution is vital to institutions.


Co-op's guidelines solve linen problems.


Assessing clinical competence: a five-year experiment comes to an end.


Two-way teleconferencing: room design comes first.


For health care providers too: an outlook of stressful--but hopeful--change.


Wyman-Gordon Pavilion Ingalls Memorial Hospital, Harvey, Illinois. A hybrid hospital and home.


The Menninger Foundation, Topeka, Kansas. Bricks in the service of brains.


The Arbour Hospital, Jamaica Plain, Massachusetts. Designed to 'fit in'.


How to buy...a dental insurance policy.

How to buy...a dental insurance policy.


Test your ability to handle conflict.

Test your ability to handle conflict.


The Cleveland Clinic, Cleveland, Ohio.

The Cleveland Clinic, Cleveland, Ohio.


Neuro linguistic programming--an aid to management. This is an article that asks two questions. Do you presently, get what you want with the people who work for you and with you? Are you able to easily understand what they are asking or telling you and do you easily find ways to communicate your intentions and requirements to them? If you answered no to any of the three parts of these two questions then this article will have information of interest to you. Neuro Linguistic Programming or NLP as it is usually referred to is without doubt the most powerful communication model, to have emerged for use in management, during the last decade. It takes the elements of everyday behaviour patterns and makes them available to any serious student.


How are you, nurse?

How are you, nurse? Nurses are not very well, according to a survey conducted among nurses in the northern region of Sydney. Smoking is the most common health risk. Fifty per cent of nurses smoke. This rate is double that of the population living in Northern Sydney. A tobacco knowledge questionnaire indicated nurses are not as well informed as they could be about the health consequences of smoking. As well, heavy smokers report the highest amount of severe anxiety. Nurses, especially young nurses, report considerable anxiety generated by the nursing profession and depression is common, specifically among the younger nurses. Sixteen per cent of nurses are severely overweight, 42% over 30 years of age are substantially overweight. Nurses also take more sleeping tablets and exercise less than people in the general population and are also more prone to respiratory tract infections, headaches and backaches. Some explanations of the poor health status of nurses are offered and ways of improving the health of nurses discussed.


Hospital cost inflation: the influence of the annual budget. The prevailing assumption has been that decisions made by doctors and hospitals have caused massive inflation in hospital costs. Data of the five Western Australian teaching hospitals over the decade 1970/71 to 1980/81 suggests that it has been funding decisions by the State Government which have had the major effect on actual cost experience. Current funding arrangements appear to give Government very effective control, but create no incentives for hospital efficiency. If efficiency is to become the dominant strategy, alternative hospital funding mechanisms must be designed.


Hospital and prehospital resources for optimal care of the injured patient. Committee on Trauma, American College of Surgeons.


Liability under the extension doctrine.

Liability under the extension doctrine.


How well do you hear?

How well do you hear?


Technology assessment: a look at initiatives.


Relative value studies: a historical perspective.


Unraveling the causes of poor performance.


Performance coaching: hitting the bull's-eye.


The quality of work relationships: a matter of supervisory style.


Planning for the loss of a key employee.


Grievance handling: how to carry the ball.


Cost-containment proposals.

Cost-containment proposals.


An appraisal system that yields results.


Cardiology City, U.S.S.R.

Cardiology City, U.S.S.R.


Baby Doe's legal fate.

Baby Doe's legal fate.


A chance for young fathers.

A chance for young fathers.


Federal allotments to states for social services expenditures pursuant to the Title XX-Social Services Block Grant Act; promulgation for fiscal year 1985--HHS. This issuance sets forth the individual allotments to States for Fiscal Year 1985 pursuant to Title XX of the Social Security Act, as amended. The allotments to the States published herein are based upon the authorization set forth in Section 2003 of the Act and are contingent upon congressional appropriations actions for the fiscal year. If the Congress enacts and the President approves an amount different from the authorization, the allotments would be adjusted proportionately.


The case of Baby Jane Doe.

The case of Baby Jane Doe.


Alcohol abuse, road trauma, and the role of medical professionals.


Debarment, suspension, and ineligibility--DHHS. Proposed rule. The Office of the Secretary, Department of Health and Human Services, is proposing to amend 41 CFR 3-1.6, Debarred, Suspended, and Ineligible Bidders, to implement the provisions of Federal Procurement Regulations [FPR] Temporary Regulation 65, Debarment, Suspension and Ineligibility of Government Contractors.


Health financing research and demonstration grants; availability of funds for grants--HCFA. General notice. This notice announces the availability of HCFA funds for certain priority research and demonstration grants for the Federal fiscal year 1984. It contains information about the subject areas for grants that will be given priority, project requirements, application procedures, amounts and duration of grants, and waiver of State plan requirements for demonstration projects. HCFA makes funds available for activities that will help to resolve major health financing program issues or to develop innovative methods for the administration of Medicare and Medicaid.


Privacy Act of 1974; proposed new routine uses--PHS. Notification of new routine uses permitting disclosures of information from five Privacy Act systems of records. In accordance with the requirements of the Privacy Act, PHS is publishing notice of a proposal to establish 24 new routine uses permitting disclosure of information from five Privacy Act systems of records maintained by the Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of Management, which include: 09-37-0002, "PHS Commissioned Corps Personnel Records, HHS/OASH/OM". 09-37-0003, "PHS Commissioned Corps Medical Records, HHS/OASH/OM"; 09-37-0005, "PHS Commissioned Corps Board Proceedings, HHS/OASH/OM"; 09-37-0006, "PHS Commissioned Corps Grievance, Non-Board and Pre-Board Involuntary Retirement/Separation, and Disciplinary Files, HHS/OASH/OM"; and 09-37-0008, "PHS Commissioned Corps Unofficial Personnel Files and Other Station Files, HHS/OASH/OM". Some of the routine uses added to system notice 09-37-0005 do not apply to that portion of the system that includes the Board for Correction of PHS Commissioned Corps Records. When a routine use does not apply to that portion of the system, the description of the new routine use will include a statement to that effect. When the routine use does apply to the Board for Correction of PHS Commissioned Corps Records, no additional statement will be made.


Rural Development Loan Fund--Office of Community Services. HHS. Proposed rule. The Secretary of Health and Human Services proposes new regulations governing the Rural Development Loan Fund [RDLF]. These regulations embody changes in existing regulations [45 CFR Subpart 1076.50] including a new definition of "rural" and certain amendments and refinements to clarify and make more specific the requirements of the regulations with a view toward strengthening the administration of the program.


Indian health--PHS. Proposed rule.

Indian health--PHS. Proposed rule. The Department of Health and Human Services (HHS) is proposing to make technical amendments to Indian Health Service (IHS) grant regulations to make them conform to HHS regulations on grant administration, thereby eliminating duplication and conflict within the regulations.


Physicians faced with ballooning malpractice rates.


PPOs not just a passing fad.

PPOs not just a passing fad.


Twin Cities' employers compare hospital costs.


Health care costs don't worry Canadian firms.


Protect your patients from expensive out-of-province referrals.


Laying off employees, "a tough job" reflections from four hospital administrators.


The Doukhobor furor: what would you have done?


Human life--its value and sanctity.

Human life--its value and sanctity.


Proposed abortion laws analyzed by the College.


Humanizing health care.

Humanizing health care.


Policy and procedure manual. Discipline--criteria for warning, probation, and dismissal.


Right to die legislation: an experience to be avoided in Canada?


Bacteremia in a Veterans Administration Medical Center (1961-1981). Laboratory data on blood cultures were reviewed for the period 1961-1981. Blood cultures accounted for 18% of all bacterial cultures. Nine percent of all blood cultures were positive for growth, including pathogens and contaminants. Of these, 21% wer contaiminants. Staphylococcus epidermidis was the most common contaminant while Escherichia coli and Staphylococcus aureus were the most frequently occurring pathogens, respectively. Four percent of all positive blood cultures, involving pathogens, had multiple organisms with E. coli the most common. There was no drastic change in the frequency of occurrence of Gram negative or positive isolates over the years, but certain pathogens like Proteus mirabilis, Serratia sp. and Group A Streptococci were more common from 1971-81 than 1961-70. One percent of all patients with positive blood cultures had the same organism for two months or longer. Analysis of these longer occurring infections yielded a mean of 15, median of 7 and range of 2-87 months. E. coli was the most common pathogen in these chronic infections, followed by S. aureus and Streptococcus pneumoniae, respectively.


Program grants for black lung clinics--PHS. Notice of proposed rulemaking. The Public Health Service proposed to revise the regulations governing the grants program for black lung clinics established under section 427(a) of the Federal Mine Safety and Health Act of 1977. The revision is in keeping with the Department of Health and Human Services' desire to remove as many programmatic burdens and restrictions from grantees as possible, while maintaining program integrity.


Lawmakers concur with ACP on key aspects of debate.


Pharmacist role in a family medical residency program.


National Association for Home Care (NAHC) hospice survey results.


Quality assurance: a team approach.

Quality assurance: a team approach.


President Reagan and Mrs. Reagan show special interest in home care.


Perinatal home care--report on a Blue Cross and home care effort.


The construction of the NIH budget for FY 1984.


The National Institutes of Health: a noble experiment.


An attempt to regulate medical decision making.


Confidentiality, informed consent and untoward social consequences in research on a "new killer disease" (AIDS).


Fundraising--new ideas bring dramatic results.


Hemostatic clips.

Hemostatic clips.


Coping with constraints: employee relations. Part 2.


Silver-impregnated porcine xenograft for damaged or missing skin.


Hospital discovers that the best way to control energy costs is to build its own power plant.


Economic grand rounds focus physician attention on how much it costs hospital to treat patients.


Changes ahead for the health-care industry. Unless hospitals begin to act soon, there may be no future for many.


Community relations: a wise investment.

Community relations: a wise investment.


Flexible compensation. Individual benefits package can mean substantial savings.


Don't give up on quality circles.

Don't give up on quality circles.


Trustee accountability in the crunch.

Trustee accountability in the crunch.


On-line nursing care plans by nursing diagnosis.


Nurse in computerland.

Nurse in computerland.


Nursing should be a revenue-producing center.


A nursing management information system case history.


"... On the next roll of the dice".

"... On the next roll of the dice".


Nursings role in computerization.

Nursings role in computerization.


The case for computer literacy.

The case for computer literacy.


What makes a preferred provider group preferred?


Zenith employees have choice of dental options.


The hospital financing system of the Federal Republic of Germany. This paper deals with the present hospital financing system of the Federal Republic of Germany. The structure of the financing system is treated as well as the actual financing process, and, as far as possible, both are also quantitatively described. The first section contains a description of the structure, and is concerned with the major institutions participating in the hospital financing system:--the hospitals are described according to ownership, number of beds, specialization, personnel, regional distribution and utilization;--the health insurance system is illustrated by the two major institutions, i.e. statutory and private health insurance agencies, and its effect on hospital financing is explained;--the regulation of the hospital financing system by the federal political system is discussed;--finally, the major economic functions of the institutions involved are summarized; the interrelations of hospital care and the ambulatory sector are also mentioned. The second section contains a detailed description of the actual financing process, which can be classified according to the sections of financing:--the basic system of the German hospital financing law is introduced;--in the section on investment costs, public grants and their allocation, which are closely related to hospital planning, are discussed;--in the section on operating costs, full cost reimbursement as the basic principle, the structure of costs, the elements and the mechanism of operating cost financing, the actual prices, the financing of private patients' care and special services are described;--a short view of accounting balances, i.e. the differences between costs and financing of hospital services which result in profits or deficits, is given. A few considerations on the evaluation of the financing system conclude the paper.


Prevention: a technical and political issue.


Transporting databanks of medical information from one location to another. If ever clinical information systems, particularly those used to support decision-making, are to become of more than local value, there is an urgent need to develop 'transportable' databanks of information - that is to say, databanks which can be utilised for one purpose or another at different locations geographically without degradation of their effectiveness. This presentation discusses the problems caused by the need to develop 'transportable' databanks. First, the rationale for their need and for their use is discussed. It is pointed out that increasing mobility of patients and doctors demands increasing standardisation and harmonisation of clinical terminology and databanks of information. Next, the present situation is reviewed in some detail. The current lack of 'transportable' databanks is described, and the effects of this set out. Specifically, the factors which prevent current databanks being used outside their own centre of origin are listed; such as differences of hardware and software, differences in perceived and actual needs, inadequate sampling, analysis and testing, and geographical variation in disease spectra and disease presentation. The consequence of this need is a need to develop and test multi-national databanks of information, and this presentation next defines what is needed in order to produce such databanks. Areas discussed include the definition of the clinical problem, construction of proformata and collection of data, matrix construction and testing, and finally wide distribution. In conclusion, the presentation defines some of the future perceived needs in respect of databanks and some of the problems which will arise in their construction. It is concluded that action is necessary now on a multinational basis in order to develop the databanks of information - truly transportable - which will have become mandatory by the 1990's.


Balance sheet of health organisation reform in Italy.


What the National Hospital Union means to its members.


Seattle nurses prove 'unity is power'.

Seattle nurses prove 'unity is power'.


Infectious diseases: a question of priorities.


Drug therapy and monitoring: a team responsibility.


Poisoning: epidemiology and prevention.

Poisoning: epidemiology and prevention.


How to maximize the return from your operational budget.


Graying population means rosier fund raising ahead.


Financial analysis & planning: tools for non-profit organizations.


Copy makes difference in this Salvation Army appeal.


Examining the role of a hospital trustee.


Maximizing the yield from blood cultures in suspected infective endocarditis. The laboratory test of paramount importance in patients with suspected infective endocarditis is blood culture. This article considers the generations-old problem of the timing and frequency of these cultures, describes techniques to increase their yield, and outlines measures to take whenever special cultures fail to identify the etiologic agent.


Balloon atrial septostomy with echocardiographic guidance. At the Childrens Hospital National Medical Center, Washington, DC, two-dimensional echocardiography has been used to guide balloon atrial septostomy in 17 neonates with cyanotic congenital heart disease and has proved helpful in minimizing the risks associated with this procedure.


Technologic explosion pumps new life into Holter monitoring. When ambulatory ECG monitoring was introduced in 1947, few observers could predict the instrument's potential. Today, private physicians, large medical centers, and isolated rural facilities are becoming increasingly more dependent on Holter monitoring's varied diagnostic uses. While the choices in diaries, recorders, and scanners continue to multiply at a fast pace, some experts worry that some options may be gimmicks rather than vital improvements.


FLEX Task Force I update.

FLEX Task Force I update.


Improving the examination for state medical licensure.


The "snitch law".

The "snitch law".


Cardiovascular Fitness and Rehabilitation Program, Sinai Hospital of Detroit. Rehabilitation of persons with cardiac disease involves restoring and maintaining optimal physical, psychologic, occupational, social, and recreational status. It is based on the belief that adequate physical fitness and reduction of psychologic symptoms, including depression and poor self-image, can be attained by physical conditioning and education. The hospital-based and extended community-center program of Sinai Hospital of Detroit provides the environment for this effort.


The Mereworth repair kit.

The Mereworth repair kit.


Beyond economics: the health costs of unemployment.


Hope in Harlem.

Hope in Harlem.


Risen in the East.

Risen in the East.


The Maternity Center Coalition of Greater Philadelphia.


Emergency planning.

Emergency planning.


Hospital porters: lost empires. Interview by Cherrill Hicks.


The down to earth approach.

The down to earth approach.


FPC spending: the cash limits medicine.

FPC spending: the cash limits medicine.


Fire precautions: taking stock of skills.


Victoria's volunteer force.

Victoria's volunteer force.


A message for the hospital leader: marketing begins at the top.


Hospital capital equipment acquisition: improving decision making.


Hospital marketing: what are we trying to accomplish?


A profile of today's hospital director of materials management. Part I.


It's your line to the health computer.

It's your line to the health computer.


Fund raising can be fun, profitable.

Fund raising can be fun, profitable.


Senior citizens have more to fear from family, caregivers than from violent criminals.


Communication system helps home patients keep in 'touch' with care unit.


DME competition from home care 'unfair'.


Can a not-for-profit agency be sold?

Can a not-for-profit agency be sold?


HHAs benefit from owning, here's how!

HHAs benefit from owning, here's how!


Era of stiff home health competition expected.


Meeting the home care respiratory therapy challenge, expert explains.


Iowa. For profits can't compete for state grants.


Marketing: more than a passing word, crucial to home health agency operations, expert says.


Chronic obstructive pulmonary disease: its definitions, its management, and its scope.


The best of times, the worst of times for health care.


Ten commandments of management for supervisors to follow.


The legal responsibilities of nurses and their limits of duty explained by attorney.


An effective off-the-job program brings tangible benefits.


Costs, competition, compassion: issues for a changing health-care system.


Visiting nurse service keeps respiratory patients out of hospitals and in their homes.


Survey helps clear the air on smoking policies.


Philadelphia home health experiencing market boom.


What do general managers do and how do they do it?. Interview by Joe Flower.


Shirt-sleeve congress.

Shirt-sleeve congress.


Technology and the health industry.

Technology and the health industry.


Should hospital water be checked for Legionella?


Price reporting may benefit consumers, payers, providers.


Physicians' views of Catholic hospitals: a roundtable.


Area agencies cooperate in teenage pregnancy program.


Heat-recovery incinerator contributes to energy-conservation effort.


Presidential Ethics Commission: its strengths, weaknesses.


Families of patients find Providence in Anchorage.


Market strategy.

Market strategy.


Basing ethical decisions on love for others, intimacy with God.


The middle manager's compensation outlook.


Carner's codes. Innovation.

Carner's codes. Innovation.


Bill specifies health coverage for unemployed, uninsured workers.


Basis for nursing ethics: paternalism, consumerism, or advocacy.


Hospital initiatives in care for the elderly.


When should Catholic facilities permit withdrawal of life-sustaining procedures?


Health care manager's notebook. Portfolio approach to HRD.


Special employment arrangements should be documented.


CEO's challenge: using resources for the greater good.


Federal mandate confers status, exacts price from ethics group.


Church as steward: our healing heritage.


Stewardship: service, management, advocacy.


Marketing outpatient services as competition increases.


Written relocation assistance policy helps hospitals' executive recruiting.


Legal restrictions govern employee communications groups.


Consortium's hospice volunteer training boosts professionalism, cooperation.


How should Catholic hospitals treat an anencephalic fetus?


Questionnaire encourages children in hospital to express feelings.


Positions with different responsibilities warrant unequal wages.


Employment contract protects against exploitation of recruitment services.


Communication programs aid employee-administration dialogue.


Outpatient program teaches patients to manage diabetes.


Materiel management: the need for a systems approach.


Systematic evaluation of the purchasing function.


The materiel management system: maze or magic?


A systems approach to the control of reusable items.


Implementing an automated inventory system.


Toward task support systems for hospital operations.


The central processing department: its history and function.


Management of an inventory cycle in a health care setting.


Inventory control systems in the hospital pharmacy.


Hospital maintenance storeroom design and control.


Streamlining a policy and procedure system.


Evaluation of the effectiveness and efficiency of health service operations. Part III: Evaluation of the chief executive officer.


Telecommunications provides key to cost-effective security.


Health care trustees and the union dilemma.


Alternative scheduling in departments other than nursing services.


Disposing of hospital waste.

Disposing of hospital waste.


Waste compaction in hospital.

Waste compaction in hospital.


Stoke Mandeville National Spinal Injuries Centre.


The development of the incinerator.

The development of the incinerator.


Summary of the issues presented at the OSHA hearing on ETO.


The Orpington Hospital Canada Wing opening.


The politics of health care in Nicaragua before and after the Revolution of 1979.


The ethnophysiology and folk dietetics of pregnancy: a case study from South India. The contingency between notions of ethnophysiology and the folk dietetics of pregnancy are examined in a region of South India. Attention is focused on lay perceptions of essential body processes and health concerns during pregnancy. Preventive and promotive health strategies employed during pregnancy by the rural poor which involve diet are considered. The tendency for rural South Indian women to prefer smaller babies and the relationship of this preference to dietary behavior are considered in relation to both concepts of the appropriate quality and quantity of food to eat during pregnancy and the concepts of baby space and baby strength. Nutritional ramifications of alternative food consumption patterns are considered. The importance of understanding indigenous health concerns and notions of ethnophysiology when introducing public health programs is highlighted by a discussion of why many pregnant women are reluctant to comply with iron sulfate, tetanus toxoid, and vitamin therapy as currently presented by primary health care staff.


ERISA, not state law, governs employee vacation benefits.


Illustrative rate-setting cases from states with all-payer programs.


FICA refunds on tax-deferred annuity contributions under Rowan.


AHA files amicus brief with NLRB regarding hospital bargaining units.


Open meeting statutes updated.

Open meeting statutes updated.


Court casts doubt on enforcement authority for equal pay, age acts.


Supreme Court decides important labor cases.


Challenge to state licensure agency: Ronwin v. State Bar of Arizona.


The 1983-84 Supreme Court term: important decisions will affect hospitals.


The power of stratified sampling: an aid for estimating attendance at hospital functions.


State laws to date remove impediments to PPO development--an update of state legislative activity.


National data base on health care coalitions shows an increase of 38 organizations over nine months.


An update: Federal Trade Commission antitrust initiatives in the health care sector.


Court of Appeals upholds 1979 Hill-Burton regulations.


California court restrains criminal prosecution of M.D.s.


Court enjoins completion of a hospital parking lot because affiliated holding company failed to obtain a CON.


The real, unique reasons for low nursing salaries.


The 1983 Supreme Court abortion decisions: impact on hospitals, a conflict with Baby Doe?


Arizona business coalition seek initiative to impose rate-setting and CON on Arizona hospitals.


The small hospital administrator as Q.A. coordinator.


U.S. Supreme Court hears oral arguments in antitrust/exclusive contract action.


Responsibilities of hospital in-house legal counsel.


California, Illinois enact methods to allow patients the right to refuse treatment.


Nosocomial infections in the elderly described.


MMs sway grows faster than pay.

MMs sway grows faster than pay.


How to reduce the AIDS hysteria in central service.


How to succeed at health care forms management.


Product standardization: can it be accomplished?


Zero exposure: a comprehensive approach to voluntarily reduce ethylene oxide exposure.


A vendor ethics code.

A vendor ethics code.


Getting beyond the language barrier.

Getting beyond the language barrier.


The pharmacy depot program in group purchasing.


Measurements to boost productivity.

Measurements to boost productivity.


Alter physician performance with successful strategies.


Multiple explosions pinpoint hospital's disaster needs.


Two case histories underline need for documentation of patient consent.


Changes in mortality rate may signal increased risk.


Consent forms, as written, confuse patients, study says.


Another look at C.S. training.

Another look at C.S. training.


Surgical, birth injuries top list of claim causes.


Want a DSA facility? Try a limited partnership.


The antitrust implications of medical staffing decisions.


Credentialing: a testing ground for health care change.


A central supply in transition.

A central supply in transition.


How to forecast to contain your variable costs.


Tax cases important to tax-exempt hospitals reviewed.


Contractual relationships between hospitals and physicians. American Hospital Association.


How to promote hospice to hospital medical staffs. Integration of hospice into the health care system rather than in isolation is often critical for program success. When hospice is seen as part of a continuum of care, medical staffs will much more readily accept the addition of hospice as a specialized hospital service.


Antibiotic control in Veterans Administration Medical Centers.


The P & T Committee secretary as facilitator.


Computer basics for nonprofit organizations.


Trends in health care delivery.

Trends in health care delivery.


The iceperson cometh: cryonics, law and medicine. The "New Biology" has already made profound impact on the law. Cryonics and genetic engineering represent technological triumphs. The natural, organic process of dying is being replaced by a humanly engineered technological process for living. The dying phase of life is prolonged until biological knowledge is available to reverse the dying phase and restore the living phase. Both cryonics and genetic engineering in their attempts to replace the organic process with the technological process disturb the delicate balance of the triad of life which each individual experiences--faith, health, and justice. Since law is a basic tool to achieve justice among human beings, how should it respond to the health argument of the cryonics' physician who views death as a disease which is curable? How should the law respond to the faith questions surrounding the cryonics patient? What am I? A block of ice. Who am I? A living, comatose patient or a dormant, static body with the possibility of a reverter. Why am I? A new human being now endowed with immortality through the triumph of life over death founded on man's current faith in the God called Technology. Cryonics through its unbalancing of the traditional triad of life poses formidable challenges to the major institutions of faith, health and justice. The practitioners in these institutions: clergy, physicians and lawyers must now reassess the rules of the game of life be they religious, medical or legal. This article offers insights to begin this reassessment.


DHHS human subjects protection: the new regulations revisited. In January of 1981 DHHS released its revised regulations for the protection of human subjects. These new regulations established five categories of federally funded research--primarily in the educational, social and behavioral sciences--which, at local Institutional Review Board (IRB) US ISSN (0193-7758) 1168 option, could be made exempt from mandated peer review. A survey of the 562 member IRB system was conducted to determine, among other things, what policies individual review boards had established with regard to these optionally exempted categories. 341 (61%) of the IRBs responded to the survey. Results indicate that the IRBs have overwhelmingly opted to maintain review procedures at some level in each of the "exempted" categories and that these procedures, as well as the other DHHS standards, are being applied almost universally to all research regardless of funding source. This article presents data on IRBs and their implications for the educational, social and behavioral sciences.


Prime numbers: a guide to telephone fundraising.


Interdisciplinary grand rounds: hospice care.


Pennsylvania Senate Bill 361: direct third party reimbursement to nurse-midwives.


Power and skill: a hospital administrator's view of nursing.


Pharmacy--quo vadis?

Pharmacy--quo vadis?


The forgotten rights of defective newborns.


Interview: Senator John Glenn on low level radiation.


MIS development in American industry.

MIS development in American industry.


Effective board development: five areas for concern.


Adaptation and the quality of life in work and family settings. The paper describes the development of scales to assess the perceived social-environmental quality of work and family settings. The use of these scales in comparing and contrasting work and family settings and in examining their role as contexts for adaptation and growth is illustrated. Some tentative conclusions about social-environmental influences on individual and family adaptation are drawn and practical applications for planning ecologically oriented interventions are discussed.


The measurement of quality in community life: introduction to the special issue.