A patient classification system for home health patients.


A community working together: 1983 National Home Care Week in Tucson, Arizona.


How I made Miller's Manors merrier.

How I made Miller's Manors merrier.


Financing health care companies when the stock market is down. Part two.


Contracting for development services.

Contracting for development services.


Golf tournaments: a possible fund-raising gold mine.


Possible savings with appropriate antibiotic prophylaxis. Antibiotic utilization was studied for one month in 52 patients from two surgical wards and one urology ward in an 835 bed teaching hospital. The use of antibiotics was classified as prophylaxis or treatment and the cost of each regimen was determined. The appropriate antibiotic for prophylaxis was chosen according to the surgical procedure and as a result of a literature review. Using cefazolin as the drug of choice in suitable general surgery cases resulted in a justifiable cost for prophylaxis of $17.64 per patient and a possible saving of up to $67.01 per patient (possible total saving of up to $670.05 for the study population). It was concluded that appropriate antibiotic prophylaxis in surgical patients could lead to significant cost savings. Some techniques for improving antibiotic prescribing are reviewed.


Medication related nursing activities in a computerized unit dose system. A work sampling analysis. In planning for decentralization of Pharmacy Services a 2-month study of registered nurses was conducted using the work sampling technique. A quantitative analysis was made of the time which was spent in different medication related activities. Two floors which were thought to be representative of the hospital, a medical floor and a surgical floor, were selected. A classification of activities and a sampling form were prepared and evaluated in a 1 week pilot study. Instantaneous observations were made throughout the 24 hour day at random intervals and recorded on the sampling form. Over 9,400 observations were made. Registered nurses spent 11.39 z 0.66% (mean z SE) of their time in medication related activities.


From service bureau to in-office.

From service bureau to in-office.


Why not high technology for the small hospital?


Computer advice to concerned physicians: what you need to know.


A rose is a rose is a rose.

A rose is a rose is a rose.


It's the approach and the process...not the system.


Medical manpower planning: a neglected task.


Swedish health care maintains standard, despite cost pressure.


Auxiliaries--struggling for recognition.


So you want to buy a computer--sharing our experience.


Microcomputers in hospitals: a layman's guide.


Wrongful termination lawsuits: the employers finally win a few. Much attention has been given of late to the erosion of the "employment-at-will" doctrine. Exceptions to this doctrine began to emerge when courts held that at-will employees could sue if their termination violated public policy. The at-will doctrine was further eroded by court rulings that a contract requiring good cause in order to terminate could be inferred from employee handbooks, company personnel policies, and circumstances of employment. As the initial flood of wrongful termination lawsuits now reaches the appellate level, some guidance on the standards employers must observe can be drawn from court decisions. The authors examine these decisions as well as the legislative reform being proposed in response to them.


Quality assurance: managing changes.

Quality assurance: managing changes.


Einstein's theory of relativity and health care management.


EMS trilingual guide.

EMS trilingual guide.


The ultimate run sheet.

The ultimate run sheet.


How to handle special waste control problems.


Measurement and definition of the link between unemployment and health. Some of the statistical difficulties inherent in any measure of the interaction between employment and health are considered. Unemployment and health are seen to be difficult terms to define and both are seen to contain subjective elements. Micro and macro models are discussed as both have strengths and weaknesses. Most micro models trace the experience of small groups of individuals usually selected either because they are unemployed and/or are ill. Thus the results cannot be acceptably generalized to the population at large. Macro time series are concerned with a measure of the interaction of unemployment and health at the aggregate national level. In macro models the precise link between the unemployment experience of an individual and the health experience of the same individual is lost in favour of the association of a measure of aggregate unemployment with a measure of aggregate health status. Both model types are liable to error in describing what is happening at the national level. Panel data macro models are likely to be most accurate as they answer most of the criticisms mentioned above, but such data are scarce and expensive to collect. However, it is argued that macro time series models applied to data for subgroups of individuals may provide a low cost way to obtain a useful measure of possible interaction.


Hospitals can benefit from converting trash to energy.


Monitoring nutrition care.

Monitoring nutrition care.


How to increase elderly patient's food intake. Serve creative & diversified meals.


Imaging: it's more than mirrors.

Imaging: it's more than mirrors.


How to increase the acceptance of food.

How to increase the acceptance of food.


Making a stronger case for health care philanthropy.


Trends in hospital philanthropy: reacting to current changes.


Corporate restructuring with a development emphasis.


Soliciting patients: the best new source of prospects.


Why don't patients turn up?

Why don't patients turn up?


The nursing home bonanza.

The nursing home bonanza.


Art for the patient's sake.

Art for the patient's sake.


Home truths for the mentally ill.

Home truths for the mentally ill.


How the law can stop a strike.

How the law can stop a strike.


Is the wellness movement dying?

Is the wellness movement dying?


Private...public relationships.

Private...public relationships.


Developing a district strategy.

Developing a district strategy.


The importance of CRT terminals in an OCS/MIS system decision.


Accessing medical data bases via computer.


Practical tips for establishing a coordinated community wellness program.


Information center concept.

Information center concept.


Children's health and safety fair: a new approach to fostering healthy lifestyles.


WIMS--up and running down under.

WIMS--up and running down under.


Queen Victoria Medical Centre--South Eastern Medical Complex--Part 2.


Electrical safety in operating rooms--an Australian approach.


The Austin Hospital, today.

The Austin Hospital, today.


Physician burnout.

Physician burnout.


Nuclear magnetic resonance imaging. The current state of a new diagnostic technology. Nuclear magnetic resonance (NMR) imaging is a promising new technique in diagnostic medicine. Utilizing powerful magnets, radiofrequency transceivers, and computer imaging systems, NMR images reveal subtle yet striking information from an imaged slice segment of a living body. Its applications are numerous and growing rapidly. The central nervous system, the cardiovascular system, and the hepatobiliary tract have been examined with remarkable success. Imaging of musculoskeletal structures, renal studies, and intraabdominal studies have produced quality results. The unique sensitivity of NMR to neoplastic tissues may lead to its use for early cancer detection. Refinements of NMR instrumentation and computer software--and research into paramagnetic contrast agents--lead toward higher quality scans with wider applications. Hazards of NMR imaging are not yet clearly delineated. However, current NMR utilization parameters exclude certain high-risk groups (such as subjects with cardiac pacemakers) to ensure patient safety.


What is the future of emergency medical services?


The economics of wellness promotion: values versus economics.


District Court denies injunction in West Virginia hospital board composition lawsuit.


1984 survey of health care coalitions.

1984 survey of health care coalitions.


U.S. General Accounting Office to review medical malpractice issues.


Tax Reform Act of 1984.

Tax Reform Act of 1984.


Health services utilization and costs of care in terminal cancer: implications for hospice programs. This study examines utilization of health services and costs of care for cancer patients during the last 6 months of life broken down into 3 time periods, and the relationship with costs of patient characteristics and home care/home hospice use. The data were derived from a retrospective study of a random sample of 133 adult cancer deaths in Monroe County. Data sources included review of medical records, including hospital billing records, and interviews with physicians and surviving relatives. Sixty five patients (49%) used home care services; their total costs of care were somewhat higher than those of non-users even after controlling for age, marital status and length of the terminal care period. The implications of the upcoming hospice legislation are discussed in the light of these results.


Quality nursing--a primary advantage.

Quality nursing--a primary advantage.


A standard plan for E.C.T. patients.

A standard plan for E.C.T. patients.


Coping when the caring is intensive.

Coping when the caring is intensive.


Self-care--let the patient take control.


Comprehensive audits--a managerial challenge.


Preparation eases N.Y. strike's impact, say MMs.


Hotel Hospital offers challenges, rewards.


Let's replace EOQ PDQ.

Let's replace EOQ PDQ.


Study says CTs can pay for themselves.

Study says CTs can pay for themselves.


Mortality surveillance: an integral part of quality assurance.


Rx for controversial programs: PR.

Rx for controversial programs: PR.


Structuring a nonprofit's role in real estate syndications.


The geriatric hospital: a new concept in the care of the elderly.


The management audit: a task whose time has come.


Fiduciary duty and the quality of care.

Fiduciary duty and the quality of care.


Management and quality assurance.

Management and quality assurance.


Creative selling. The competitive edge.

Creative selling. The competitive edge.


HGSM gift shop profile: Santa Ynez Valley Hospital.


Management skills. Issues and answers.

Management skills. Issues and answers.


Departmentalize your shop.

Departmentalize your shop.


P & T Committee formulary requests: criteria for admission. The criteria for P & T Committee members to consider when adding or deleting a product to the formulary are discussed. Although each institution will require and develop different standards that reflect the characteristics of the patient population they serve, two general sets of factors should be studied. The anticipated needs of the institution and the therapeutic application of the medication in consideration must be identified. Furthermore, the characteristics of the drug, including pharmacokinetics, biopharmaceutics, and cost must be clearly defined. The P & T Committee formulary decisions are critical in ensuring high-quality, cost-effective health care.


Overfill of common piggyback admixture solutions. The average final volume of 23 commonly used piggyback solutions was determined. Polyvinyl chloride (PVC) containers filled with 0.9% sodium chloride injection or 5% dextrose injection in 50 ml and 100 ml sizes were used for 20 of the piggybacks. A total of ten samples of each drug and dose were measured by draining the entire contents into a graduated cylinder and measuring the volume. The mean volumes, standard deviations, and ranges for each drug and dose were calculated. The volume found in each sample exceeded the volume in the original PVC container by at least 20% in the 50 ml size and 11% in the 100 ml size. The greatest percentage volume difference was 62% in the 50 ml size and 28% in the 100 ml size. The FasPak and the two Viaflex Plus Ready-To-Use containers, which did not require the use of the 50 and 100 ml PVC containers, had a percentage volume difference of 2.6%, 2.2%, and 3.4%, respectively. This information demonstrates the fact that the final volumes of some piggyback admixtures are significantly greater than that which may be presumed from the admixture label.


Utilization of market research in managing hospital pharmacy resources. A market research survey of staff physicians and nurses was completed to obtain information on customer preference to be used in making planning and development decisions about the allocation of the pharmacy department's resources. Survey questionnaires were mailed to representative samples of each professional group and included the optimum mix of open-ended and closed-ended questions that would result in the highest response rate. The survey responses identified differences in wants and needs between the nurses and physicians that demonstrate the value of market research. Data obtained from the survey are being used by a staff advisory committee and management to develop departmental goals and objectives that will reduce costs and increase profit margins under the ever-increasing restrictions of prospective reimbursement.


U.S. health professionals offer expertise to foreign hospitals.


PRN drug utilization in Indiana long-term care facilities. Data collected from a sample of 307 private and Medicaid patients from 20 LTCFs in Indiana showed that patients were prescribed an average of 4.9 PRN medications. Significant differences were found between the types of LTCFs and the average number of PRN medications per patient. In 14 LTCFs classified as both ICF and SNF, patients were prescribed an average of 4.7 PRN medications. In four LTCFs classified ICFs, patients were prescribed an average of 6.2 PRN medications. In two LTCFs classified as SNFs, patients were prescribed an average of 3.9 PRN medications. The average number of PRN medications per Medicaid patient was 5.2 while the average number of PRN medications per private patient was 4.8. Overall, 48.8% of all PRN medication orders were never consumed during the study period. Mean PRN medication utilization per LTCF ranged from 2.5 per cent to 36.4%. It is assumed that if PRN medication not being consumed/used by the patient were to be returned to the pharmacy, a substantial cost savings could be realized by the responsible party.


Program clarifies ethical issues in care of the dying patient.


Lay involvement, parish ties needed in pastoral care.


Considerate job interviews enhance institution's image. A well-planned, considerate interview process for executive and middle-management job candidates leaves applicants with a favorable impression of the organization. Actions the recruiter can take to ensure a candidate's positive attitude include: Sending the out-of-town candidate a packet that includes a city map and information about the city, the facility's employment policies, and a job description; Planning activities for a spouse accompanying a candidate; Providing an opportunity for relaxed conversation by taking the candidate to dinner the night before the interview; Limiting interviews to three or four; Reimbursing the candidate for travel and lodging; Giving the candidate a tour of the facility. In addition, the recruiter should coach those conducting interviews to promote a relaxed interchange and allow candidates to ask questions.


Sexual harassment: how should management handle it? Sexual harassment is against the law and can place health care facilities at substantial risk in lawsuits as well as disrupt their caring and professional atmosphere. In some cases, health care facilities are held responsible for nonemployees' harassment of employees, as well as for harassment by employees. In addition, if an employee receives benefits such as a promotion in exchange for sexual favors, the organization may be liable for discrimination against persons who did not receive such benefits. The Equal Employment Opportunity Commission has established guidelines for identifying and redressing instances of sexual harassment. They instruct health care facilities to issue a policy statement explaining to employees the institution's opposition to sexual harassment and outlining procedures for lodging a complaint. It is strongly recommended that health care facilities: Investigate complaints thoroughly, tactfully, and evenhandedly. Establish a progressive discipline schedule and administer it consistently to all employees. Document the investigatory and decision making process.


Readers rate Hospital Progress content, style, format.


Health facilities' obligations when a patient refuses treatment. Recent cases involving the decisions of Elizabeth Bouvia and G. Ross Henninger to starve themselves to death highlight the ethical obligations of patients, health care facilities, and the courts. When a patient seeks the hospital's cooperation in his or her attempt to commit suicide, society's responsibility is not merely to restrain the patient from suicide but to offer physical care, financial aid, and personal support. The hospital's duty is to intervene, and the court's responsibility is to allow such intervention. The most compassionate way in which the hospital can help is to force-feed the patient. If a patient is mentally competent, the refusal to eat is morally wrong. The patient is morally not permitted to commit suicide, though the avoidance of treatment may be justified in cases when force-feeding would be considered an extraordinary means, because of the patient's age or physical condition, for example. If a patient is incompetent, the refusal to eat is not a fully rational act; for the hospital to refrain from force-feeding would not be considered cooperation in suicide, since the incompetent patient cannot commit suicide. To avoid court rulings that order compliance with a patient's wishes, health care facilities in the future may have to require patients or their families to agree in writing to treatment by ordinary means.


Should Catholic health facilities provide in vitro fertilization?


On-site social worker aids emergency room productivity.


Retreats enable staff to reflect on shared mission.


Physicians, health care educators must assert Christian identity.


Institutional ethics committees as social justice advocates. The idea of involvement in social justice issues transcends the traditional responsibilities of most institutional ethics committees (IECs). Yet precedents for such an advocacy role exist in several areas: the development of regulations that protect handicapped newborns from discriminatory decisions of nontreatment and the institutional committees that review research protocols or formulate "do not resuscitate" policies. The need for IECs to take up social justice issues is based in the concepts of autonomy--the capacity for freedom of choice--and relationality--the capacity to known and to love. All the human ethical questions of freedom, well-being, and justice emerge in the health care setting, where the concepts of autonomy and relationality are intently focused on and sometimes threatened. If a health care institution is to address such questions as affirmative action policies in financing and purchasing, the just pricing of medical care, the ethics of treatment decisions, and the right to medical care, it needs a forum in which to deliberate, collaborate, and discern responsible corporate moral action. For example, an ethics committee can: Call for correction of problems of sexism, racism, and classism in health care institutions; Address government regulations in a way that enables a better understanding of professional commitments; and Lead facilities to discover ways to network with others to meet the needs of the populations they serve. Above all, IECs can help health care professionals find a new "hermeneutic" for interpreting the health care mission to allow them greater power to respond to the dignity and the needs of human persons.


A stewardship challenge: reconciling faith and finances. As financial constraints have tightened in recent years, Catholic health care facilities have undergone the double pressure of having to safeguard the integrity of their Christian mission while maintaining economic viability. The conflict between faith and finances, however, represents a tension that has been felt since Biblical times. The dichotomy between ministry and money can be traced from Scripture's admonition that money is the root of all evil, through the Manichean heresy of the early Church, right up to the conflict that today's sponsoring congregations experience in seeking to reconcile multimillion-dollar budgets with their efforts to maintain a simple life-style and raise the existence level of the poor. Mission integrity and fiscal viability are not irreconcilable, however. Effective management can advance, not impede, the mission's cause. Sound business decisions need not exclude social or mission values. Indeed, ministry and management are united in the Gospel message of stewardship. The Gospel itself abounds in management lessons, perhaps the clearest of which is the parable of the talents, in which we are told to manage our gifts wisely so that they are actually increased and not just maintained. Numerous contemporary Church documents also suggest that the multimillion-dollar services that we have inherited and developed must continue to be managed well so that their yield, ministerial and financial, is increased. To resolve much of the misunderstanding within sponsorship groups and health care facilities, an action agenda is needed: The nature of work must be given prayerful reflection, so that it can be understood as a sharing in the creative act of God and as a part of each person's spirituality. Moreover, an institution should be viewed and managed as a positive power base and educational center for developing and advancing positions consistent with the Gospel. Institutional policies and procedures, of course, should be made to reflect this new understanding of the management-ministry relationship. Considerations of ministry, economy, and quality should be included in mission statements and philosophies, and financial officers and mission personnel should be challenged to integrate fiscal viability with mission integrity. Finally, a model for ethical decision making should be developed and adopted so that both orientations--ministry and management--are harmoniously balanced in the institution's decisions.


Pastoral care personnel have prophetic role. Pastoral care ministers must look to the prophet's role in the Old and New Testaments to establish their own prophetic mission in health care facilities. After evaluating whether their own department acts justly, competently, and compassionately, pastoral care givers must hold themselves accountable to the signs of authentic prophecy: being motivated by love, being critical to promote constructive change, and being willing to confront others' resistance. Then the pastoral care team can begin collaborating with peers to provide a more healing environment for all staff and patients. This can be done by being available to help staff with problems, influencing policymaking, and using ministerial skills when giving sacramental care to patients. Pastoral care persons can link the facility to the outside community by finding ways to reach the needy and to address residents' unmet health needs. Eventually the pastoral care staff and their peers can work toward an active response to social justice. The challenge of being prophets requires pastoral care personnel to confront problems courageously and take advocacy positions while always showing compassion.


Marketing by managing relationships.

Marketing by managing relationships. As competition increases and funding tightens, hospitals will have to realize that marketing largely is the managing of relationships--relationships between health care consumers and the provider. Prospective payment will make a hospital's fiscal viability increasingly sensitive to volume; stable profitability will depend on a steady level of patient utilization. And to ensure stable utilization, the hospital must create a base of loyal patients. Four marketing strategies can help to build this client base: 1. Create a strong care of essential services focused on the most significant customer needs. 2. Customize relationships by tailoring specific services to specific market segments' special needs. 3. Augment the basic service by offering extras and amenities. 4. Offer price incentives for people to become loyal customers. At least four types of patient loyalty exist, and a hospital should concentrate on fostering one or more types among its patients. Service loyalty occurs when a person always goes to the same provider for the same service. Provider loyalty exists when a person seeks a diversity of related services from the same provider. Family loyalty occurs when an entire family uses a particular provider. Organizational loyalty exists when an entire organization is oriented--through a contract or preferred provider arrangement, for example--toward a specific provider.


Malpractice bill stirs discussion, raises moral questions. Catholic health care providers should raise a number of ethical considerations in the debate surrounding the Moore-Gephardt bill, which would establish an alternative malpractice liability system. The proposal encourages states to enact legislation under which providers and patients would reach settlements that compensate for economic losses resulting from negligent treatment. In states that do not enact such laws, HR 5400 would apply to federal program patients only. Under the proposal, if a health care provider who is potentially liable for malpractice offers to compensate for the patient's actual economic loss, the patient would be forever barred from bringing a malpractice suit against the provider. The recovery would be limited to the individual's net economic loss. Though the bill's sponsors have performed a considerable service in identifying a major problem and generating public discussion, the bill raises several important moral questions. How much "defensive medicine," for example, is actually prudent practice that is in patients' best interests? Will thorough and holistic care be sacrificed in the proposal's attempt to save money? If states do not enact an alternative liability system for all patients and the proposal affects only federal program patients, will the result be disproportionate treatment among categories of patients? And is it fair to deny persons recovery for their emotional distress, physical impairment, pain and suffering, and similar kinds of damages? These are but a few of the issues that Catholic providers should raise in the debate, which otherwise might well be oriented toward fiscal concerns only.


What are the moral rights of frozen embryos?


Interview with Rep. James Jones, D-OK. Interview by John K. Iglehart.


Microcomputers in hospitals. Guideline report.


Financing ambulatory health care services.


Physician reimbursement: diagnosis and prescription.


Capital financing for ambulatory care facilities.


The cost of preventive health services in primary medical care and implications for health insurance coverage.


"Telemarketing" hospital services: benefits, pitfalls and the planning process. "Telemarketing" is an innovative concept used by many firms to increase the efficiency and effectiveness of product delivery efforts. It can be used by hospitals to benefit both patients and physicians. Further, it can be a tool that, if used properly, can improve the image of the hospital and assist in positioning the organization uniquely among its competitors. This paper discusses the exploratory nature, potential problems, and benefits of telemarketing hospital services and offers pre- and post-implementation considerations. This paper also provides an outline of a sample marketing plan that could serve as an initial model for hospitals that might consider this unique marketing approach.


Health care marketing at the crossroads.


Synchromarketing: a new concept for hospital administrators.


The distinctive marketing roles of physician office managers and staff. In their roles as public contact personnel in health care marketing, physician office managers are involved in communicative relationships with patients. Such relationships underscore the importance of researching these individuals in their roles of producers, promoters and agents of health care services. The nature of these roles is investigated in this research.


Strategic market planning for hospitals. The application of strategic market planning to hospital management is discussed, along with features of the strategic marketing management process. A portfolio analysis tool, the McKinsey/G.E. Business Screen, is presented and, using a large urban hospital as an example, discussed in detail relative to hospital administration. Finally, strategic implications of the portfolio analysis are examined.


Development of the first graduate program in hospital administration.


Professional maturity and the University of Chicago.


Workplace EMS. The employer's duty.

Workplace EMS. The employer's duty.


Workplace EMS. The ideal system.

Workplace EMS. The ideal system.


Striking similarities. Olympic health services mirrors EMS.


Workplace EMS. CPR goes to work.

Workplace EMS. CPR goes to work.


Attitudes on women in EMS. Part 2.

Attitudes on women in EMS. Part 2.


Workplace EMS. Case studies.

Workplace EMS. Case studies.


Street sense. Understanding and learning.


Federal policies promote socialized prehospital care.


Strategies toward maximum detergent efficiency. Detergent Z demonstrated the most reliable cleaning and detergent delivery system. After the initial detergent evaluation, the data were compared against all detergents. It was found that acceptably cleaned items ranged from 37% to 85% per evaluation. Labor and material costs could be reduced greatly with the use of detergent Z, which had the best cleaning results. We also observed the advantage of a sensor in the detergent delivery system which can override some less obvious equipment malfunctions. Since detergent Z also exhibited the least amount of residue build-up, a savings in maintenance costs could be expected later on. The vendor of detergent Z showed great interest and concern for our department's needs and quality assurance by offering us numerous technical resources during the evaluation. One year following our detergent studies, detergent Z and its related line of cleaning products are being utilized in our hospital. We found that the four months spent analyzing detergents used in our utensil washers provided an interesting resource project that has been a positive investment in improved operations for the decontamination area. In Central Service alone, 61.7 hours a week were saved by the change in products. Quality of cleaning continues to be high. The practice of a weekly acid bath for the utensil washers has been discontinued; the acid bath will now be given when necessary, and has not been done since detergent Z was put into use six months ago. During the next fiscal year, savings of detergent, utilities and labor are conservatively projected at $30,000.


Comparison of instrument container systems...choosing the right one.


Audie L. Murphy Veterans Hospital, San Antonio, Texas. With more than 80,000 beds in 172 hospitals, the United States Veterans Administration operates the largest, centrally directed health care system in the nation. Created in 1930 to coordinate all government activities concerning veterans, the VA provides health care to veterans who have service-related illnesses and injuries or those who are unable to obtain care through the usual channels. For a look at how the management of medical supplies at an individual VA hospital fits into the entire VA system, the Journal visited the Audie L. Murphy Memorial Veterans Hospital. The largest hospital in San Antonio's South Texas Medical complex with nearly 700 beds, Audie Murphy Hospital provides a full range of inpatient, ambulatory and rehabilitation services to veterans. The hospital is the core of an extensive outpatient network that accounts for more than 180,000 outpatient visits per year.


Code blue.

Code blue.


Bar codes & optical scanning systems.

Bar codes & optical scanning systems.


Care & handling of surgical instruments.


Are we reacting or planning?

Are we reacting or planning? This article explores creativity in solving problems and increasing productivity. Although we have much to learn from the successes of our peers in hospital materials management and central service, every hospital and institution is different. Therefore, the author cautions us against overlooking our own abilities to create efficient systems within our own facilities.


Anti-smoking publicity, taxation, and the demand for cigarettes. This study demonstrates that anti-smoking publicity in the mass media in Switzerland has had a substantial permanent impact on cigarette consumption. Extended publicity, following the 1964 U.S. Surgeon General's Report, accompanying various tax increases, and preceding a public vote on an advertising ban for tobacco products, decreased consumption permanently by 11%. In addition, publicity had important indirect effects which are reflected in smokers' strong reactions to nominal cigarette price increases. Estimated nominal cigarette price elasticity is -1.0; by contrast, real cigarette prices failed to be significant. Thus, publicity in the mass media provides a powerful tool for deterring cigarette consumption.


Economic determinants and consequences of self-reported work disability. This paper examines the determinants of and behavioral responses to self-reported work disability in samples of older men and women stratified by race. Strong support is found for the hypothesis that economic factors as well as poor health influence the probability that individuals report health conditions limit the amount or kind of work they do. In particular, lower expected wage rates significantly raise the probability of reporting work disablement, controlling for health status and health-related job requirements. The empirical analysis also shows that only a part of the reduced labor supply of disabled individuals is attributable to health conditions. The policy and methodological implications of these findings are discussed.


Physician treatment decisions in a multiple treatment model. The effect of physician supply. This paper develops a neoclassical utility maximization model of physician behavior in which the physician determines the price of physician office and hospital visits, the utilization rates for physician office and hospital visits and hospital days, and the resources and physician time inputs in the production of visits. The model assumes that the physician acts as a perfect agent for the patient. The analysis traces substitutions between physician office visits, physician hospital visits, and hospital days in response to changes in physician supply. The analysis also traces physician supply induced changes in the input mix used to produce visits. The substitution effects of physician supply are then used to reinterpret previous statistical estimates of the physician supply elasticities of per capita utilization of physician office visits and hospital days, length of visit, waiting time, and physician workloads.


The effect of labelling on illness related absenteeism. An economic explanation for the case of hypertension. What is the impact of being told that one has hypertension? According to evidence from randomized controlled trials one effect of labelling is an increase in illness related absenteeism among those who were unaware of their blood pressure status. Moreover, this effect exists even when no objective medical reasons justify such immediate increases in absenteeism. In this paper we present an economic explanation of this phenomenon based on the interpretation of absenteeism as a demand for days off work. In a two-period life cycle model, we show that a lower perceived probability of survival through the second period increases the demand for first-period leisure.


Publicity, price, and puffing. A health economics contribution to disease prevention.


Measuring disability and health.

Measuring disability and health.


Mass information storage systems and records management: competing technologies and systems concepts. The dominant position of paper- and micrographics-based technologies for records management is challenged by emerging new storage systems. The need to document on paper and store on microform is reduced in applications where information is now communicated and administered in interactive computer-based systems. Properties of challenging technologies (magnetic mass memories, optical data disks) and associated systems concepts are compared with those of paper- and micrographics-based systems. Trends in shifting application advantages for the different records management alternatives are analyzed and guidelines presented on how to plan to avoid premature obsolescence of micrographics systems.


Occupational hazard?...Or?

Occupational hazard?...Or?


Healthcare cost containment programs: zealous, but erratic.


The politics of health: the case of smoking control. The policy of the United Kingdom government towards the control of smoking has been characterized by a non-interventionist approach such as persuasion and industrial self-regulation, as opposed to more direct intervention through fiscal policy or control over tobacco production and sales. The effectiveness of the policies adopted by the UK government is difficult to assess, although there has been a reduction over the last ten years in the proportion of smokers in the population. However, evidence from other countries shows that a more comprehensive programme including direct legislation controlling tobacco advertising has a much stronger impact on tobacco consumption. The determinants of the UK government's policy position are analysed and the evidence suggests that this policy position is determined in part by the power of the vested interests in the maintenance of tobacco production, as well as the confusion of interests within the government itself.


Nursing home OPL saves money. Quality as high as commercial: LM.


Hospital finds five areas of linen loss, reaps results from publicising efforts.


Reuse of disposables and your insurance.


How one hospital laundry will survive in '85.


Focus...current market conditions. Plan for the shrinking market.


EtO standard.

EtO standard. On June 22, 1984, the Occupational Safety and Health Administration (OSHA) published a notice entitled Occupational Exposure to Ethylene Oxide: Final Standard (49 FR 25734) in the Federal Register. This issue's Perspective column examines the contents of the standard, reviews ongoing activities within OSHA and other government agencies regarding EtO and discusses the importance of the standard to all EtO users, both in industry and in hospitals.


Doctor-owned malpractice carriers: who's winning, who's losing.


In search of a viable wrapper alternative.


Improved communication.

Improved communication.


Are fee increases making a case for controls?


How doctors outmaneuvered a nurses' strike.


Shaare Zedek Medical Center, Jerusalem, Israel.


The statewide PPO that couldn't miss--but did.


Computer use in a surgery center.

Computer use in a surgery center.


Meet your new business partner--the hospital.


Medical Electronics buyers guide 1984, Part 4. Balances and microbalances, blood cell counters, blood chemistry, blood coagulation, blood gas, blood pH, ECG analyzers, heart rate meters, hematocrit, NMR/nuclear magnetic resonance, recorders.


Reflections on the university/industry partnership.


Hepatitis B virus infection: relentless spread in the face of prevention know-how.


Hospitals offer incentives to attract patients.


Legal guidelines for blood banking and transfusions. Part 1.


The risk and cost of hepatitis B exposure in the lab.


Avoiding the pitfalls of an open-door policy.


A lab-pharmacy push to cut drug therapy costs.


Hospitals turning to joint ventures to gain access to costly equipment.


Picture archiving, communication systems are grabbing the limelight.


Heart disease equipment helps hospitals to attack rising costs.


Variety of technologies focus on cancer treatment, diagnosis.


Monitoring antibiotic prescriptions can reduce use and cost of drugs.


'Stone crushers' cut length of hospital stay.


Financial woes thin imaging vendor ranks.


Small lab analyzers can be put near patients to speed tests, cut costs.


Computerized patient care system lets hospital work without paperwork.


California's public hospitals may be victims of Jarvis' tax-cutting zeal.


Kentucky case supports hospital's right to enter exclusive contracts.


High court ruling cuts antitrust risk for hospitals and their subsidiaries.


New tax law may discourage some donations, but foundations better off.


Long-term commitment of trustees is one key to Texas chain's success.


Marketing circles can help hospitals satisfy patients, boost staff morale.


Ohio plan would trim excess beds.

Ohio plan would trim excess beds.


Mayo launching out-of-state satellites.

Mayo launching out-of-state satellites.


New York hospitals face shortfall of $29 million following 48-day strike.


Alternative services. Emergicenters cut themselves free from their emergency room roots.


Hospitals in the 1990s: one for all, for profit.


Wake up to wellness.

Wake up to wellness.


Building 6-story addition isn't easy for hospital perched on a river bank.


Negative utilization lowers costs.

Negative utilization lowers costs.


Replacement for Medicare proposed.

Replacement for Medicare proposed.


Unit days in accounts receivable: a management tool. The importance and usefulness of the statistic "Days in accounts receivable" are well known among patient accounts managers. The same principles that apply to that well-known statistic may also be effectively applied to a single unit within any patient accounting department. With the calculation of a unit days in accounts receivable, the same evaluation and measurements of efficiency may be applied to individual files and patient accounts representatives. The results allow individual employees participation in the same measurable goals and objectives as are applied to the overall operation of the department, as well as supplying the patient accounts manager an additional valuable tool in analyzing total accounts receivable.


The validity of Mobley's (1977) model of employee turnover. Unlike earlier tests of an oversimplified version of this model, the validity of W. Mobley's (1977, Journal of Applied Psychology, 62, 237-240) original turnover model was fully investigated. Constructs that were neglected in prior studies were assessed and previously examined constructs were operationalized with more reliable measures. Measures of all constructs in Mobley's model were obtained from a survey of 192 hospital employees. Turnover data were collected a year following survey administration. Following the theoretical causal ordering of Mobley's constructs, each construct was regressed on all causally prior constructs. In general, each construct was accurately predicted by the linear combination of predictors representing its causal determinants. In the majority of instances, the best predictor of a model construct was the construct's immediate causal antecedent. Further, an alternative model was evaluated and compared with Mobley's model using path analysis.


Job offers--pass or jump?

Job offers--pass or jump?


New instrumentation in urinalysis.

New instrumentation in urinalysis. Automated instrumentation and electronic data processing now assist in performing and standardizing urinalyses. These innovations include specific gravity instruments and reagent "strip readers," and one system designed to automate the physical, chemical, and microscopic urinalysis. In this article, the author reviews the features of some examples of these new instruments.


The Hippocratic ethic is dead.

The Hippocratic ethic is dead.


Two experts debate. Is there really a doctor glut?


Erosion of the employment-at-will doctrine. How can employers protect their right to terminate at will? Author Emily A. Joiner (business applications programmer analyst in the human resources area in the management information systems division at Sandia National Laboratories), says that first they must be careful that none of their written (or spoken) policies imply a binding contract that could be used against them in a lawsuit. On a more constructive level, she advocates the establishment of good employee relations programs and in-house grievance procedures that can help keep to a minimum the need to exercise the right to fire.


The litigation exposures posed by preferred provider organizations. Preferred provider organizations (PPOs), which are designed to help contain ever-increasing employee health-care costs, are being eyed favorably by benefits administrators who want to hold down both these costs and the cost of health insurance premiums. But there's a fly in this ointment: According to Anthony M. Vienna (an attorney with the firm of Zobrist, Vienna, & McCullough), such PPOs can place employers at risk of litigation arising from anti-trust violations and medical malpractice. Some types of PPOs pose greater risks than others, however. Vienna explores the nature and degree of risk entailed by three: provider-based PPOs, payor-based PPOs, and interface PPOs.


Benefit programs after tax reform.

Benefit programs after tax reform.


A line manager's guide to training.

A line manager's guide to training.


Work force reduction: strategies and options.


Sex discrimination and comparable worth.


Computerizing the personnel department: do you need a consultant?


Pooling resources through a consortium. Occupational health programs for employees of small businesses.


A new role for HRD in hospitals. How to create a more consumer-oriented work force.


To what extent do hospital pharmacists presently provide outpatient consultation?


What are the top 4 problems related to 3rd-party prescriptions?


How to cope in today's health care market.


Psychotherapy reduces costs for other care, study shows.


An interview with a barefoot doctor. Interview by Mary Widmeyer.


The untold story of Reagan's "new federalism".


Disciplining physicians: how it works.

Disciplining physicians: how it works.


PPO's in a changing marketplace.

PPO's in a changing marketplace.


Equality of opportunity and the demand for medical care by race. In this article I estimate the demand for medical care for eight groups delineated by sex and marital status. I use the results to simulate what will happen to black's demand for care if they are given equality of opportunity with whites and the potential impact on their health status. The findings suggest blacks' demand (and therefore health status) may decrease with equality of opportunity because of lack of coordination in social programs.


Pet therapy with terminal cancer patients.


Program evaluation as a method of assessing the quality of care in physiotherapy. Assessing quality of care is a topical subject in physiotherapy. This paper traces the involvement of the Canadian Physiotherapy Association in quality assessment, and describes the components of the quality assessment process in relation to professionally defined standards. It considers available information as to whether process studies, outcome studies, or a combination of these should be undertaken in determining the quality of care. Finally it proposes the use of a comprehensive program evaluation to assess the quality of care in a physiotherapy program for stroke patients. Four steps in the use of this model are outlined: assessment of needs; formulation of program goals; definition of program and design of evaluation; and assessment of process and outcome. The use of this model is advocated for it provides information on how and why a program does or does not make its desired impact.


Reaganomics: its impact on the voluntary not-for-profit sector. In seeking to diminish government's role in financing human services, the Reagan Administration has advocated increased responsibility for the voluntary sector. This analysis of data from a variety of voluntary not-for-profit agencies documents the initial effects of Reaganomics and considers projections for the future of those agencies.


Antitrust, joint ventures and the end of the AMA's contract practice ethics: new ways of thinking about the health care industry.


Job satisfaction, burnout, and turnover: a national study. A national study found similarities in levels of job satisfaction, burnout, and intent to change jobs among child welfare, community mental health, and family service workers, although the determinants varied by field of practice. The data suggest that a universal approach aimed at increasing job satisfaction and reducing burnout is likely to be of minimal value; interventions must be conducted within each setting and must attend to the idiosyncracies of each group.


The politics of professional ethics.

The politics of professional ethics.


The in-home worker: serving the frail elderly. Little attention has been paid to the special tasks facing the many unskilled in-home workers who serve the frail elderly. With the assistance of the Community Care Training Project at the University of Illinois in Urbana-Champaign, the authors studied the needs in-home workers have for interpersonal skills. A typology of problematic interpersonal situations is presented, along with suggestions for training, assessment, and supervision of clients and workers.


Community screening programs.

Community screening programs.


Health care marketing: has it lived up to its promises?


Marketing health promotion programs.

Marketing health promotion programs.


Patient representatives: where they came from and where they are today.


Patient relations as customer-oriented management.


Reach out!

Reach out!


Someone cares.

Someone cares.


The team approach.

The team approach.


A patient relations-based interpreter program.


Hospital law: the spiraling cost of litigation.


Ask me who cares.

Ask me who cares.


A look at a military patient representative program.


Hypnosis in the surgical suite.

Hypnosis in the surgical suite.


Hospital costs state by state.

Hospital costs state by state.


Booklet designed to alleviate fear, frustration.


Status of lifecare centers in various regions updated.


Tyler & Company/Southern Hospitals. 1984 salary and benefits survey.


Extending the infection control program.


Perspectives. The state of health planning.


Nurse training, particularly for primary health care.


Improving productivity in the health care industry.


A mode of delivery: the cesarean section.


Health services in Japan.

Health services in Japan.


The advent of primary health care in Mozambique.


Emergency services in south European cities.


Introduction of Korean health plan: organisation and financing.


Locating a marketing director.

Locating a marketing director.


Acute, long-term care 'merged'.

Acute, long-term care 'merged'.


A new medical school.

A new medical school.


Know-how in the operating room.

Know-how in the operating room.


City hospitals and health for all.

City hospitals and health for all.


Improving health services in Finland.

Improving health services in Finland.


CAT scan use in short-stay non-federal hospitals: United States, 1979-82.


1983 Summary: National Hospital Discharge Survey.


Health care of adolescents by office-based physicians: National Ambulatory Medical Care Survey, 1980-81.


A laundry manager asks for help.

A laundry manager asks for help.


The White House Conference on Productivity: a summary of the final report to the president.


Tapping satellite communications' potential. Suppliers must key on hospital administrator's concerns in an era of rapidly changing business conditions.


Surgery in 1994.

Surgery in 1994.


The most painful prescription.

The most painful prescription.


The comforts of home. 'Alternative' birthing centers are coming of age.


Privacy Act of 1974; system of records--PHS. Revision and addition of new routine uses to system of records 09-15-0045, entitled "Health Resources and Services Administration Loan Repayment/Debt Management Records System, HHS/HRSA/OA". In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to revise one routine use and to add seven new routine uses to system of records 09-15-0045, entitled "Health Resources and Services Administration Loan Repayment/Debt Management Records System, HHS/HRSA/OA." PHS invites interested persons to submit comments on the proposed routine uses on or before November 23, 1984.


Early and periodic screening, diagnosis, and treatment (EPSDT) program--HCFA. Final rule. This final rule modifies present regulations to conform to legislative changes enacted by section 2181 of Pub. L. 97-35, the Omnibus Budget Reconciliation Act of 1981. That section eliminates the penalty which reduces by one percent Federal funds for a State's Title IV-A program, Aid to Families with Dependent Children (AFDC), for any quarter during which a State fails to: (1) Inform all AFDC families of the availability of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), services; (2) provide or arrange for requested screening services; and (3) arrange for corrective treatment of health problems found as a result of screening. In addition, even though the penalty has been eliminated, section 2181 mandates that States incorporate these three requirements into their Medicaid State plan with respect to all EPSDT eligibles. Further, this rule modifies current regulations to reflect Congressional intent that while States should continue to develop fully effective EPSDT programs, the Federal government should work to reduce current reporting requirements which entail a large volume of paperwork.


Hospital and health services credit union; prohibited trade practices, and affirmative corrective actions--Federal Trade Commission. Consent Order. In settlement of alleged violations of federal law prohibiting unfair acts and practices and unfair methods of competition, this Consent Order requires an Ann Arbor, Michigan credit union, among other things, to cease failing to disclose, when rejecting a credit application or increasing the cost of credit, that the action is based partially or wholly on information contained in a consumer credit report; and provide the rejected applicant with the name and address of the reporting agency together with the specific principal reason(s) for the adverse action based on this information. The Order also requires the credit union to send to consumers who were denied credit between January 1, 1983, and the effective data of the Order, a letter containing required disclosures.


Hospitals that provide for the poor are reeling from uncompensated costs.


N.J. doctors face charge for fund debt.

N.J. doctors face charge for fund debt.


The prime cuts. Employers rate cost-containment options.


Saving lives and money. Wellness programs make good sense for business and employees.


Evaluation of a computer-assisted medication refill reminder system for improving patient compliance. Computer-generated refill reminder notices were mailed to patients receiving continual medication for cardiovascular diseases to measure improved compliance and to discover whether a computer-assisted program was economically viable. Guidelines were established to define compliance. A computer-assisted compliance intervention program did not significantly improve the rate at which patients had their prescriptions filled "on time" and the mean compliance rate for both experimental and control groups was greater than 79%. Also discussed were cost and compliance strategy implications and the receptiveness of patients to the reminder program.


Problems in designing a government drug payment program in Canada.


Nursing education in a burn unit.

Nursing education in a burn unit.


Critical care orientation of burn nurses.


Group practice accounting: up close and personal. There is a distinct need today for timely, consistent, and accurate accounting methods for tracking the financial health of modern medical group practice. For all but the largest groups, the personal computer is the answer. Personal computers are powerful, dependable, and inexpensive, and for accounting, cost projection, inventory control, word processing, and data base analysis, they can outperform all the alternatives and pay for themselves in one year or less. Given the profusion of products on the market, however, it is essential that careful consideration be given to the areas of cost, time, software, hardware, and applications when making a personal computer purchase.


Japanese-style management: lessons for the American medical group administrator. The Japanese have been very successful in developing and implementing a management style that has made Japan one of the most productive and affluent societies in the world today. It is a style of management based on a long-term investment in people and characterized by management techniques that emphasize simplicity, flexibility, and human values in the corporation. These techniques, when adapted to American medical group practices, can provide valuable lessons in management for the American medical group administrator.


Where were you in '82?

Where were you in '82? 1982 was a pivotal year for the US healthcare delivery system. With it came the reality of a new era, an unexplored environment or competition and market reform. The decade ahead means troubled times for some healthcare providers, but it also offers unique opportunities to design and shape a rapidly changing healthcare system. By recognizing trends we are currently experiencing and their impact on group practices, and by identifying what administrators can do to prepare personally and organizationally for the future, medical group practices can place themselves in excellent position for entering the system of the '80s and '90s. The survivors are destined to reap unprecedented economic and professional rewards.


Performance appraisal: a positive management tool. Employees want to know and need to know where they stand. Managers are expected to improve performance and stimulate productivity. What more logical way to fulfill both of these requirements than employee performance appraisals? Informal appraisals are made by every medical group manager on a daily basis. When these appraisals are channeled into a more formal, systematic appraisal program, management, employees, and the organization can all benefit. The ingredients of a positive, effective employee performance appraisal system are identified here and critical areas are addressed, including program prerequisites, setting up a workable plan, completing the written appraisal, and conducting the evaluation interview.


Marketing audit in group practice.

Marketing audit in group practice. The marketing audit, whether large-scale or small-scale, will soon be critical to the success of every medical group practice. This dynamic process, in which the many components of a group's marketing efforts are analyzed, is examined from the perspective of ideal circumstances and unlimited resources, and more pragmatically, from the perspective of various-sized groups, with different resources and marketing talent. The audit components are prioritized, possible adaptations and combinations are presented, and reasonable implementation mechanisms, designed to address audit outcomes, are suggested.


Managerial strategies for cost containment pressures.


Dialogues with hospital pharmacists. John R. Coppola.


Climate survey: an aid to productivity.

Climate survey: an aid to productivity.


Affirmative action in pharmacy.

Affirmative action in pharmacy.


Medical records: whose property are they?


Tax exempt issues: hospitals still find them a major source of new capital.


Occupational health. Is your hospital a safe environment for your employees?


Medical records--location and control.

Medical records--location and control.


Development of an information retrieval system.


Medical records computerized in my family practice.


A continuing care nurse's role on the statewide advisory.


Medical records in the office.

Medical records in the office.


The role of the client in discharge planning teamwork.


Discharge planning models. Sunrise Hospital Medical Center, Las Vegas, NV.


Discharge planning models. Hinds General Hospital, Jackson, MS.


Hospital medical records system--survival tool for the 80s.


The interdisciplinary approach to discharge planning.


A guide to effective lobbying.

A guide to effective lobbying.


Doing right and doing good: ethical problems in practice, an essay.


Radionuclides as cardiopulmonary diagnostic tools. Radionuclide approaches to diagnosis have particular relevance in cardiopulmonary disease because the interdisciplinary collaboration between nuclear medicine, pulmonology, and cardiology has been particularly intense. Quite striking advances in cardiac and pulmonary diagnosis have been made which are firmly based on clinical-physiologic principles.


Discharge planning and multidisciplinary teamwork: a cautionary note.


Involvement in the legislative process: a natural step for discharge planners.


Discharge planning models. Scottsdale Memorial Hospital, Scottsdale, AZ.


Discharge planning models. Daniel Freeman Hospitals, Inglewood, CA.


Discharge planning: can computers help?

Discharge planning: can computers help?


Canadian charter of rights: do you know its implications?


The role of the physical therapist in discharge planning.


Quality assurance: motivating hospital staff. Part 3.


Cultural and institutional restrictions on dying styles in a technological society. The starting medical advances of this century have created unparalleled opportunities for ill and suffering people, but these same forces have combined to make the experience of dying a terrifying, fearful, lonely vigil for many. Devoid of traditional myths, rituals, and family support, many patients now die in sterile institutional settings often appearing as mere appendages to life-supporting machines. This shift from the moral to the technical order manifests itself in doctors' fascination with gadgets, the emphasis upon parts of the body, and a concomitant blurring of distinctions concerning death, personhood, and individual rights. The patient is reduced to a secondary role in his or her own death, thus engendering a widespread desire for a sudden death. In light of these circumstances, health care personnel need to create circumstances that would give people more opportunities to die in styles commensurate with their life styles. Society must seriously study the implications of the unthinking treatment of people; and routines, policies, and procedures based on matters of mere efficiency and technological convenience must be replaced by those human and humane ceremonies, attitudes, and policies that must assure that technology's magnificent achievements do not obscure the human need for individuality and spiritual growth even during the dying process.


Experiences with home hospice care: determinants of place of death. During the past few years the United States has witnessed the growth of hospice care as an alternative approach for the care of the terminally ill. This paper examines a sample of patients who elected to enroll in a home hospice program. Approximately 57 percent of these patients remained at home until death. The other 43 percent chose to return to a facility where they eventually died. Evidence indicates that patients and caregivers who have more difficulty with terminal care at home are more likely to return to a facility. The analysis explores factors that explain why some patients and caregivers have a more troublesome experience with terminal care at home. Four of the factors tested are found to be related to place of death: (1) the number of visits from hospice nurses, (2) the intensity of contact with the hospice nurses, (3) length of time patients are enrolled in the hospice program, and (4) race of the patient. The implications of these findings are discussed and recommendations for delivery of hospice services are suggested.


Special needs of the deaf dying patient. Hospice and hospital personnel who give care to dying patients should be prepared for situations in which a client or family member is hearing impaired. What are the specific concerns of a hearing impaired client? How are needs for meaningful conversation and expression of feelings compromised by the care giver's awkwardness? This article provides practical suggestions for meeting needs of hearing impaired clients with serious illnesses.


Overhauling residency programs may cut down MD 'impairment'.


Getting 'more bang for your buck' in interior design.


Employee involvement in health care cost management.


Proven techniques still work.

Proven techniques still work.


Ergonomics in occupational health and safety.


Worker involvement in occupational health and safety.


Healthcare telemarketing: a unique focus on donors.


What the new postal rates mean for non-profit mail.


Aspects of standardization as applied to the assessment of drug-event associations. Individual case reports about suspected adverse drug reactions are an important source of drug safety data. Their evaluation involves, among other things, the assessment of causality. Usually it is done by expert medical evaluators according to their knowledge and experience. Subjectivity plays a big role as demonstrated by comparison of assessments of the same cases by several evaluators or by the same evaluator at a later date. In recent years, methods of causality assessment based on algorithms were introduced. In these formal approaches, items of information contribute to the assessment in a predetermined and standardized way with a logic that allows operational application. Results obtained with different methods may differ because items of information considered may not be the same and/or strength of evidence attached to them vary from one method to another. The main advantages of standardized assessment are: clear identification of items of information involved, improved communication, reproducibility of results, and the checklist function. Various implications of standardized assessment are discussed and ways to improve their performance outlined.


Discharge planning models. St. Agnes Hospital of the city of Baltimore, MD.


Manitoba survey reveals volunteer board composition.


Legal perspectives in causality assessment. An overview is presented of how drug experience reports most often fit in a product liability lawsuit. The three major areas include (a) the duty to warm; (b) the failure to report adverse reactions as required by regulations; and (c) the requirement to warn of unknown side effects. Recommendations for establishing a company program designed to prevent product liability are also given.


The Swedish drug-event assessment methods. Special workshop--regulatory.


The Food and Drug Administration algorithm. Special workshop--regulatory. The Food and Drug Administration presently receives and evaluates over 40,000 case reports of adverse drug effects a year. Each report is objectively reviewed and evaluated. A causal association assessment between each drug and reaction is made. The objective causal assessments are based on four basic principles: (a) temporal eligibility, (b) dechallenge and outcome, (c) rechallenge and outcome, and (d) confounding factors. This presentation introduces the algorithm used by the FDA Division of Drug Experience and provides the basic information needed to use the FDA algorithm for making causal relationship assessments.


How to improve cafeteria service. Renovate to meet customers' demands.


The Australian method of drug-event assessment. Special workshop--regulatory. In the Australian system, the major aim is to test individual reports for quality, judged entirely by the contents of the report. Prior knowledge of the adverse drug reaction profile of the drug is excluded. The items taken into account include timing (onset of the reaction), setting (nature of the disease, drugs, and diet), and laboratory information.


Standardized assessment of adverse drug reactions: the method used in France. Special workshop--clinical. The method used in France since 1977 for assessing adverse drug reaction (ADRs) is based on a three-stage process: assessment of three chronological criteria (challenge, dechallenge, and rechallenge); assessment of clinical and biological findings; and a combination of chronological and symptomatological assessments to obtain a 3-degree global score (1: doubtful, 2: possible, 3: probable). Bibliographical data (previously reported or unreported ADR) are assessed quite separately; thus, the method has a good sensitivity for detecting new ADRs.


The Yale algorithm. Special workshop--clinical. The assessment of causality in drug-event associations depends on the setting and purpose of such an assessment. Epidemiologists are primarily interested in population-based inferences about whether a given drug can cause a certain adverse drug reaction (ADR), and if so, how often it does so. Pharmaceutical industries and regulatory agencies are also concerned with population-based risks, but in addition must worry about individual cases. Clinicians are primarily interested in the individual, ie, whether a given drug did cause a certain adverse event in a particular patient. The authors describe an algorithm that provides specific, detailed criteria for ranking the probability that an observed untoward clinical manifestation was caused by a given drug. The criteria are subdivided into six axes of decision strategy with a built-in scoring system that ordinally ranks the probability of an adverse drug reaction as definite, probable, possible, or unlikely. To illustrate the use of the algorithm, the authors assess a reference case of pancreatitis occurring after administration of methyldopa.


An ethical perspective on investor-owned medical care corporations.


Doing well by doing good: investor-owned hospitals. The 1984 Michael M. Davis Lecture.


Investor-owned versus not-for-profit hospitals--what are the issues?


A community perspective on hospital ownership.


Clinical clerkships.

Clinical clerkships.


Survey of state laws and policies regarding foreign medical graduates--II.


What do you do when your largest medical group says: "We're selling".


The referring physician: the key to a successful marketing analysis and program. There are a variety of marketing approaches available to hospitals to help maintain and/or increase their influence in the competitive health care system. This article will focus on one important but relatively ignored aspect tha must be an integral part of any successful hospital marketing program. Referring physicians and the network this group forms around a hospital through the different referral patterns is of primary influence on the hospital's future. This article supports the thesis that the hospital's eventual survival or demise is directly linked to this often unconscious referral network.


MeSH--a unique partnership. An interview with Eugene E. Loubier, President, Franklin Medical Center, Greenfield, Massachusetts. HCSM's interview this month is with Eugene E. Loubier, FACHA, President of Franklin Medical Center, Greenfield, Massachusetts. This 162-bed facility is the first to start formally a MeSH plan, a unique medical staff/hospital joint venture or partnership. Through MeSH, the hospital and its medical staff have created a new corporation, equally owned by the hospital and the medical staff members participating in the MeSH. This corporation is responsible for areas where the economic interests of the physicians and the hospitals overlap. Instead of each party independently pursuing economic opportunities that might impact the other party, the MeSH can, as a whole, undertake the venture.


Physician/hospital telecommunications links. The deregulation of the telecommunications industry has made it more difficult for hospitals and physicians to manage their telecommunications expenditures. By concentrating on this disruption, many hospitals and physicians may miss out on the new opportunities made available by deregulation. By selling telecommunications services to physicians, hospital administrators can take advantage of many of these new opportunities. The key to this venture is viewing telecommunications as a revenue producing department or a captive business rather than an overhead expense.


Case in point. Good Shepherd Hospital.

Case in point. Good Shepherd Hospital.


Case in point--the answer. Allied Christian Health.


Liaison: the way to survive.

Liaison: the way to survive.


The progressive upheaval.

The progressive upheaval.


HSSJ guide to salaries.

HSSJ guide to salaries.


Paramedical services. Patients first, or Griffiths?


The Orpington brake bow.

The Orpington brake bow.


Canadians campaign for better private care.


Some newly baked ideas on bulk bean buying.


How to take risks without tripping up.

How to take risks without tripping up.


No more laughing all the way to the bank.


A local response.

A local response.


Trust funds at a price.

Trust funds at a price.


Monitoring the ebb and flow of nursing.

Monitoring the ebb and flow of nursing.


Multi-culture care.

Multi-culture care.


Management consultants. Shall we go outside?


London's cottage hospital.

London's cottage hospital.


Catching up with sector psychiatry.

Catching up with sector psychiatry.


Hospital to community. One step forward and two back.


Unit management. It's not what you do...


The high finances of health care. Subject to surcharges.


Budgeting for the patient.

Budgeting for the patient.


Protection for patient's property.

Protection for patient's property.


District strategy. Worthing 'on the rocks'.


What's in it for the NHS?

What's in it for the NHS?


NHS accounting. A sound framework for finance?


'Nucleus' needs a little nurturing.

'Nucleus' needs a little nurturing.


Management--not accounting.

Management--not accounting.


New view of shrinking promotion prospects.


An automated emergency order procedure.

An automated emergency order procedure.


Stress management.

Stress management.


Looking at today's x-ray film market.

Looking at today's x-ray film market.


Damages when goods are recalled by the supplier.


How blind reliance on the competitive bidding process can work against you.


Can corporate culture enhance productivity?


Productivity: how one hospital saved more than $5 million.


High-technology nursing at home.

High-technology nursing at home.


Denver's 'Access' to lower costs links homecare with new program.


An interview with: Regan Rockhill.

An interview with: Regan Rockhill.


The New York hospital strike: the inside story.


Engineering a trouble-free life for medical equipment.


Training the newcomers.

Training the newcomers.


Video-teleconferencing: education via satellite.


The last wave. Hospital film and annual report aimed at "wiping out" surf injuries.


Landscaping for the future.

Landscaping for the future.


Does the curtailment of emergency ambulance runs constitute abandonment?


How to build an economic partnership. Twelve ways to ensure your physicians' competitiveness.


User fees--the dilemma continues.

User fees--the dilemma continues.


Computerization and the health care executive.


Evaluating your chief executive officer.


Prescription television. Educating patients during hospital stays.


The pharmacist's role in patient education.


P.R.--persuasive communication.

P.R.--persuasive communication.


Health care design. Healing research.

Health care design. Healing research.


Health care design. Sky play. The Child Life Center.


Hospital Forum guide to telecommunications for health care. Plugging in the electronic hospital.


Voice communications in the hospital of the future. Monitoring the regulatory environment: a new priority for 1985.


Contracting guidelines for internists.

Contracting guidelines for internists. Government regulations, the introduction of new health care delivery methods, and the rising number of physicians joining the medical community have combined to increase the importance of the business aspect of medical practice. As a result, many physicians have documented their relationships with various third parties through contracts. As the incidence of contractual relationships between physicians and third parties has increased, so has concern regarding the legal ramifications of the contracting process. This guide is intended to explain the basic characteristics of contracts and to provide the individual physician with information regarding the contracting process. The guide is divided into three sections: key elements of a contract; types of contracts, including hospital/physician contracts, hospital/physician joint ventures, and group practice contracts; and negotiating the contract. Each section offers an explanation of the topic, which is followed by specific questions for the individual physician to investigate. These lists of questions are designed to provide a starting point for physician discussion of the philosophical, personal and practical areas to investigate before entering into a contract.


Countdown to cutover. Changing to a new telephone system.


Computer conferencing. A technology ahead of its users.


Health education through audio-teleconferencing.


The hospital of the future: all in a day's work.


Strong alliances with patients key to public policy change.


The perception is the reality.

The perception is the reality.


Productivity top priority for hospital success, study says.


Negotiate for cooperation and support.

Negotiate for cooperation and support.


Carner's codes. Market yourself.

Carner's codes. Market yourself.


Managers can mold media interviews.

Managers can mold media interviews.


A pox on polls.

A pox on polls.


Is there really a gap?

Is there really a gap?


Gender slap.

Gender slap.


Poor people, poor care.

Poor people, poor care.


Neglecting the mentally ill.

Neglecting the mentally ill.


Educating for illness.

Educating for illness.


Workers on their own.

Workers on their own.


What hath Reagan wrought?

What hath Reagan wrought?


Terminal timidity. The case of Democratic health policies.


"Individualism" for the homeless.

"Individualism" for the homeless.


Hunger: no myth, America.

Hunger: no myth, America.


What can hospitals learn from the hi-tech companies?


Can MHA graduates tackle financial management? Lessons from American corporate industry. American industry, the major purchaser of medical services, is beginning to use its buying power to intervene in the healthcare system. Management committees hav been established to develop cost analysis and containment approaches to the utilization of medical services. With innovations by corporate industry, does the hospital CEO see an advocate or yet another adversary in addition to government regulation? Specifically, what preparation do master's degree graduates have, prior to their subsequent job experience, to make an informed contribution in financial decision making? Research was conducted to obtain data from health administration graduate programs in the United States and Canada to help find answers to these questions. This study addresses the strengths and weaknesses of the two major inputs to health financial management education--the proper mix and delivery of course presentations, and the student's motivation, maturity, and academic background. In some respects, both have been found wanting--not only from the findings of this investigation, but also by the AUPHA Task Force on Financial Management in the curriculum. About one-fourth of the entrants to master's degree programs have a business school background which includes courses in accounting, economics, and finance. However, the remaining 75% have other academic backgrounds, which suggests that teaching financially oriented courses to these graduate students is a major problem. The question of whether a health administration graduate with some finance training or a pure finance graduate is more desirable remains unanswered. This is especially true in meshing the immediate needs of the healthcare marketplace for financial management personnel and the long-range career goals of the graduate. This article presents the survey results and seven recommendations for action.


Cutting the children.

Cutting the children.


Grading administrators in healthcare management.


The mentor's role in developing new leaders.


A career imperative.

A career imperative. The hospital industry has experienced major change in its organizational, delivery, financial, and social schema. As a result, the role of the healthcare executive has also changed. The new professional administrator requirements have called for the lengthening of academic programs to meet the evolving challenges of the industry. The lack of a formal means of entry into the profession has left many confused because of the various professional development models available. Without proper advice, these do not hold significant distinction for the recent graduate. Academic programs have been lengthened from one to two years of academic coursework while the traditionally required residency has been virtually eliminated. Increased demands on both practitioners and professors of academic programs have caused a schism between theory and practice, adversely affecting the student preparing for the profession. The problem is compounded by the various professional development models available and the several opinions as to which is "best". The confusion for students, faculty, and practitioners which has resulted must be minimized through recognition of the problem, clarification of terminology, bridging the gap between academic and practice, and a rekindling of the mentor/protege relationship.


Town vs. gown: a poor excuse for not communicating. This study addresses barriers in the knowledge exchange process between educators and practitioners in healthcare administration. It examines and compares the attitudes of both toward the process of communication, barriers to effective communication, and methods for overcoming them. The study suggests several pragmatic linkages between educators and practitioners. A survey questionnaire was mailed to 400 randomly selected chief executive officers of hospitals and 210 healthcare administration educators. Responses were received from 49.3% of the practitioner group and 54.3% of the educator group for an overall return rate of 51.0%. The results suggest that educators and practitioners have grown remote. However, the two groups agreed on barriers to the effective flow of new knowledge between them and on mechanisms to overcome them. The study indicates that educators and practitioners can interface more effectively by forming linkages in which attitudes and information are shared. There is the potential for creating an environment more conductive to communication, role definition, and knowledge exchange than exists currently. The creation of a symbiotic environment could not only enhance the process of healthcare administration education, but also the practice of the profession.


Quality circles: a new cure for hospital dysfunctions?


The newest miracle drug: quality circles in hospitals. In recent years, a number of hospitals throughout the United States have been exploring the use of Japanese-style quality circles to reduce their operating expenses, improve productivity, and enhance the quality of work life for hospital employees. This article examines the organizational climate necessary for quality circles, methods used to implement quality circles, and management's role in guiding and responding to circle activities. Ideas for building and maintaining staff support are presented along with a cost/benefit analysis of quality circle programs. The author concludes that quality circles are most successful in hospitals where they are part of a larger organizational development effort. When administrators believe in their employees' ability to contribute to the institution and are willing to invest necessary time and resources in employee education and the measurement of quality circle achievements, quality circles can produce creative solutions to perplexing institutional problems.


How sweet it is!

How sweet it is!


Chew on this!

Chew on this!


Collaborative practice: myth or reality? In response to demands of internal constituencies and pressures from external forces, many healthcare institutions have been experimenting with collaborative practice, wherein professionals function interdependently in patient-centered healthcare. In this article, the authors move beyond philosophical constructs and focus on the essential elements of this important innovation. Making collaborative practice a reality in institutions requires an understanding of the essential elements, persistent and continuing efforts, and rigorous evaluation of outcomes. Satisfaction, quality, and cost effectiveness are essential factors on two dimensions: outcomes for patient care providers; and outcomes for patients. Ultimately, collaborative practice can be recognized by demonstrated effective communication patterns, achievement of enhanced patient care outcomes, and efficient and effective support services in place. If these criteria are not met, collaborative practice is a myth and not a reality in your institution.


Wrap sessions.

Wrap sessions.


All in the family.

All in the family.


It's tea time!

It's tea time!


Unionization in hospitals: causes, effects, and prevention strategies. Unionization pressure on hospitals has increased steadily since passage of the 1974 amendment to the National Labor Relations Act extending protection of organizing and collective bargaining to nonproprietary hospital facilities. This article analyzes the current state of knowledge on unionization in hospitals in regard to: future organizing pressures, the impact of collective bargaining on operations, the psychology of organizing, and the fundamental elements of a strategy for improving employee relations and avoiding organization.


Improving the quality of work life in hospitals: a case study. Quality of work life (QWL) programs can improve employee morale and organizational effectiveness. But implementing a successful QWL effort in a healthcare setting is not easy because of the unique administrative structure and inherent complexities of modern hospitals. This article describes a joint union-management quality of work life program that was carried out in a large urban medical center. Despite employee enthusiasm for the program and a major commitment of financial and human resources over its three-and-a-half-year course, the program failed to achieve long-term changes in the hospital. The shortcomings of the QWL program are analyzed and recommendations for future practice are described.


New shop talk. Growing bigger and better.


Trends in hospital unionization and a predictive model for unionizing success. Between 1976 and 1980, the average annual increase in hospital expenses was 12.7%. Wages for employees accounted for approximately one-half of this increase. Because employee wages have such a great effect on hospital costs, it is important to study those factors that could curtail management's control over these expenses. One such factor is the establishment of labor unions. This study outlines the structural factors that encourage union activity, as well as the factors that contribute to its success. Variables studied include: the types of employees in the bargaining unit; the total number of employees in the bargaining unit; the number of hospitals in the same city; the control of the hospital and the presence of a profit motive; the number of beds in the hospital; the occupancy level of the hospital; and the region of the country in which the hospital is located.


Employee assistance: a business and community hospital partnership. Employers are now providing a variety of healthcare services to combat health problems that affect productivity. These employee assistance programs are designed to improve work performance by providing an approach to the prevention, diagnosis, and treatment of such illnesses as alcoholism, drug dependence, mental illness and family, martial, financial, and legal difficulties common to all worksites. This article examines the concept, incentives, structure, obstacles, marketing, and cost containment factors that are part of the development of this new partnership between businesses and community hospitals.


The art of selling in a hospital gift shop.


A professional imperative.

A professional imperative. Nurses at the University of Michigan Hospitals (UMH) have been organized since 1974 into a bargaining unit of the Michigan Nurses' Association (MNA), known as the Professional Nurse Council. There have been several bargaining periods and contracts. The most recent contract prior to the strike terminated in September, 1980. Following this contract expiration, negotiations occurred, month after month, between the union and the hospital's bargaining team. At times, it appeared as though settlement was imminent, but negotiations continued on through the fall of 1980 and into the winter of 1981. A state-appointed mediator failed to solve the problem. The authors contend that the principal issues were not those being negotiated at the bargaining table.


Union organizing activity in the hospital industry. In 1974, the National Labor Relations Act was amended to include not-for-profit healthcare institutions. This triggered an important expansion in union organizing activity in the industry. Based on an examination of National Labor Relations Board election data, this article examines the impact of that development on hospital bargaining units, the labor organizations involved, and the geographical locations of the organizing activity. It concludes with some general recommendations to management.


Hospitals and physicians: an organizational model for a changing healthcare environment. New reimbursement methods are forcing hospitals and physicians to work more closely together to retain patients and improve efficiency. In the last 10 years, most academic medical centers have reorganized hospital-physician relationships to maximize revenues and assure a stable flow of patients. This article examines the organizational model adopted by Pacific Medical Center in Seattle (formerly the U.S. Public Health Service Hospital), when it was transferred from federal to community control in 1981. Planners analyzed the history and mission of the institution, the community being served, and the legal options in the state. The chosen organizational structure is outlined, and the authors present the strengths and weaknesses of the model. The implications for other healthcare institutions considering restructuring are discussed.


Partnerships benefit hospitals and medical staffs alike.


An interview with Leon Davis. Interview by Al Nash. Leon Davis, founder of District 1199, represents the origin of hospital unionization. Known for his devotion to District 1199, Davis was imprisoned several times as a result of his activities as union president. The following interview with the now retired union activist, traces his impact on the union, discusses conflicts between union and management, changes in today's union, plus other first hand insights regarding this issue.


Informed consent: a growing concern for hospitals and medical staffs.


How the public chooses and views hospitals. This article examines factors people consider important in choosing a hospital, as well as their feelings toward hospitals. It begins with a brief discussion and overview of the literature on how people choose doctors and hospitals. The literature on factors involved in people's choices of new physicians is discussed primarily because of the lack of data in this area. After reviewing the issues, we describe the data used in this study and the context in which they were gathered. The analysis is divided into two sections: the first examines the salient issues in choosing a hospital, while the second examines the public's attitudes toward hospitals. Finally, we present a summary of the results and conclusions.


Hospital-physician cooperation in health promotion: the opportunity is there.


Hospital pharmacy services for ambulatory patients.


Development of a pediatric dosing sheet for use in the critical care setting. Choosing the correct dose for pediatric patients in the critical care setting is made difficult by conflicting recommendations in the medical literature. Hence, the University of California at San Francisco (UCSF) Intensive Care Unit medical, pharmacy, nursing, and respiratory therapy staffs developed their own pediatric dosing guidelines, based on a review of the literature and the advice of pediatric and critical care specialists. The sheets have been successfully used in the unit for the past 6 years and are well received by both physicians, pharmacists, and nurses.


Hospital pharmacy supportive personnel utilization: a regional survey. The results of a regional survey of hospital pharmacy supportive personnel (technicians) are presented. The data represents the responses from 118 directors of pharmacy in hospitals within a 150-mile radius of Pittsburgh, Pennsylvania. A high percentage of the hospitals (92.4%) utilize pharmacy technicians in some capacity. In hospitals employing pharmacy technicians, on the average, there is approximately one technician for each pharmacist. The demand for technicians is relative strong with 120 job openings each year because of turnover and new positions. The requirements for employment vary, but most institutions minimally required a high school diploma or equivalent. The vast majority of hospital pharmacy technicians possess a high school diploma with only a small percentage having any additional training. Only about 15% of the hospitals have any type of formal pharmacy technician program and almost 80% of the directors are in favor of external continuing education programs. Regarding how best to train and educate hospital pharmacy technicians, 66% of hospital pharmacy directors feel that a formal college or university based program should be required. Approximately one-third of the hospitals have various levels of pharmacy technicians, and the most important criteria for determining levels are experience, technical responsibility, and seniority. Although only eight percent of the hospital pharmacy technicians have any formal training, 36% of the hospitals would start graduates of formal educational programs at higher entry level positions.


Financial management issues. Position control procedures: Part 1.


Workload measurement study to develop staffing guidelines for the clinical inpatient dietitian. A study was done to develop staffing guidelines for the inpatient clinical dietitian based on the Victoria General Hospital Dietary Department's philosophy of nutritional care. The objectives were to identify the major activities being performed by the dietitian, estimate the average amount of time spent on each activity, determine the number of dietitian consults, determine the time required per patient consult, and establish indicators for workload, performance and productivity. All activities were coded for easy record keeping and tabulation, and the D-unit (5 minutes of a dietitian's time) was used as the unit of time measurement. The results showed that the dietitians were spending 44% of time on direct patient care, 20% on patient care support activities, 1% intradepartmental activities, 6% teaching (other than patients), 4% community, 3% on research and special projects, and 7% doing other tasks. Using the % of direct patient care time available, the % of patients requiring nutritional support, and the patient turnover rate, it was possible to develop a formula for the number of dietitians required to provide nutritional care based on the department's philosophy.


Development of a nutritional care plan for diabetic patients. A nutritional care plan, encompassing all aspects of nutritional assessment, education, and follow-up was designed and implemented at the Victoria General Hospital in Halifax, Nova Scotia. The care plan was developed in response to the results of an audit on nutritional care of diabetic patients. It was designed to assure referral of all diabetic patients to clinical dietitians, set standards for care and its documentation, provide a teaching tool, and enhance communication between inpatient and outpatient nutrition services. The care plan was developed by the authors in committee and approved by the clinical dietitians and the medical staff at the Victoria General Hospital. The care plan format is described in detail. It has been in effect since March, 1982 with positive feedback reported by clinical dietitians. Reevaluation of care, charting, and referrals to outpatient nutrition services are planned. Additional care plans on other nutritional topics are planned for the future.


Nutrition services and the Hamilton-Wentworth Home Care Program: a current overview. The structure of and services provided by the Hamilton-Wentworth Home Care Program are described. The goal of the Home Care Program is to provide coordinated multidisciplinary care for the patient in the familiar home setting, to facilitate early discharge from hospital, and/or prevent admission to a health care institution altogether. Nutrition counseling for patients and consultation for the multidisciplinary health care team is provided by the Home Care nutritionist, a registered dietitian. Her duties and activities are further delineated, as they exist in Hamilton-Wentworth. This unique position provides stimulating and rewarding work for the nutritionist who desires the challenge of therapeutic nutrition counseling in a community setting.