Reducing inequalities in health: political and organisational implications for the British National Health Service. Tackling health inequalities with any hope of success requires an understanding and appreciation of a number of issues concerning the nature and operation of services. Focussing on the British experience, the paper considers notions of need and demand insofar as these have a bearing on health inequalities. Need and demand are not finite, absolute states but are relative notions which are affected by users' attitudes and knowledge and by providers' preferences and interests. Drawing upon recent work, the paper argues that the existence of the National Health Service (NHS) has not fundamentally altered the nature of health inequalities in Britain. Those living in the North of the country generally enjoy poorer health than those living in the South. Inequalities between socio-economic groups are also much in evidence. The paper considers possible policy implications and comes out in favour of process change rather than major structural change of the kind witnessed in recent years in Britain where the NHS has undergone two major upheavals within a decade. This disruption has had the effect of diverting attention away from important policy issues at all levels of service planning and provision.(ABSTRACT TRUNCATED AT 250 WORDS)


Cancer registries: their interest and practical problems. Cancer registries record all new cases of cancer within the population they survey. Thus they provide accurate regional measurements of cancer morbidity and mortality and their geographical distribution. This form of epidemiology allows the study of regional variations and alterations with the passage of time. It also allows the study of environmental factors that might cause cancer. The work of the French regional cancer registries is described to illustrate these points. The problems of running a cancer registry are also set out and suggestions are made for future organization. The statistics gathered by such registries indicate possible methods for the early detection and treatment of some cancers and provide evidence of the long-term effects of all kinds of therapy. The socio-economic aspects of cancer can also be measured by the registry, thus providing valuable data for use in the planning of health care in any community.


Material management spoken here?

Material management spoken here?


Carry-over of medical information system influence to control patients. Evaluations of medical information systems (MIS) often compare one or more dependent variables between experimental patients having the MIS available and control patients. Typically, physicians who are exposed to and therefore are potentially influenced by the MIS during visits with experimental patients also see control patients, thus possibly weakening the internal validity of subsequent comparisons between the MIS and the control conditions. The present study examines the possible bias due to carry-over of MIS influence to control patients in the context of a prospective, randomized design.


Evaluation of continuing education in the health professions. The state of the art. In this article the author discusses three "levels" of the state of the art: the "ideal," for program evaluation; the "practical," with political limitations; and the "actual," for current practices. Starting with a review of the developmental stages of effectiveness variables (from attendance and "happiness' through professional performance and patient outcomes), the article updates a review by Lloyd and Abrahamson (1979) and then discusses current practices. Evaluation as a potential contamination factor leads into consideration of evaluation versus research. Finally a review of "lessons learned" over the last twenty years introduces a look ahead into exploitation of the state of the art.


Dimensions of satisfaction with mental health treatment. This article reports the development and underlying factor structure of a brief measure of consumer satisfaction. Four factors, accounting for 69.1% of the variance, were extracted. They appeared to measure satisfaction with the quality and outcome of treatment, satisfaction with the intake process, satisfaction with the timing of the termination of treatment, and satisfaction with the costs. Analysis of the content of responses to open-ended questions revealed that most consumer concerns had been addressed in the multiple-choice section of the questionnaire. Differences in client groups in level of satisfaction were found on one factor but not the others, supporting the conclusion that satisfaction should be considered multidimensional.


Staff burnout in the perspective of grief theory. The processes leading to staff burnout are poorly understood, due to the very term "burnout." It is a static term which refers explicitly to the end-stage or outcome of a process, rather than to the process itself. Grief theory is an attempt to explore the process of adaptation to high stress work, a process which, through some inadequacy or disorder, too often eventuates in burnout. Concepts of grieving seem suited to this purpose because (a) grief has undergone transformation from a static term to a process term in response to theoretical efforts of the last generation, and (b) burnout entails considerable loss and is, in part, a response to loss. Kavenaugh's concept of the grieving process is used as a framework for a brief description of adaptation to the stresses of professional work with dying person and their families.


Ethics and the law of dying.

Ethics and the law of dying.


Preferred provider organizations offer cost cuts to patients, providers, and benefit plan sponsors.


The reformation of information technology. During the last twenty years there have been major changes in European health services in the need for information, technology and the information user. The need for information for management purposes has been highlighted by the shift away from running institutions to providing health care for defined populations, and the diminution in financial growth available to health services. To provide comprehensive care in the current financial climate there is a requirement for relevant and timely information about the patients being treated, the population from which they come and the cost and effectiveness of the treatment being provided. Major changes have occurred in both the software and hardware available for information technology (IT) applications. Modern technology cannot only process statistical data but also acquire, process, store and disseminate vocal, pictorial, textual and numerical information. Among applications of interest to health service managers are quantitative data systems, planning systems, text management systems and communications both within the organization and with other organisations.(ABSTRACT TRUNCATED AT 250 WORDS)


User-centered evaluation.

User-centered evaluation. Much has been written on graduate medical education and its evaluation. Seldom, however, are mentioned the uses made or the benefits of such evaluations. Drawing on current models for increasing the use of information from external evaluations, the authors offer a user-centered approach for increasing the use of results from internal evaluations, the more typical form of evaluation in graduate medical education. The over-riding emphasis of the user-centered approach to evaluation is the utility of the resultant data. Three features characterize user-centered evaluation: an ordered set of steps with usefulness as the primary concern at each step; delineation of evaluator and decision-maker roles; and attention to the general communication aspects of evaluation. This article describes these three characteristics, concluding with two fundamental points: (1) A user-centered approach to evaluation will help evaluation do what it is supposed to do: provide information that gets used to increase the effectiveness of everyday decisions. (2) A user-centered evaluation accomplishes this, first, by having a pervasive attitude of utility and, second, by carefully attending to the three characteristic features of this approach to evaluation.


Material management information systems: implications for productivity.


Measuring patient perceptions of the patient-doctor interaction. Development of the PDIS. Patient satisfaction has been related to patient compliance, doctor-patient information exchange, and continuity of care. However, the construct of patient satisfaction is not well defined; its measurement has typically consisted of the anecdotal generation of questions that may not tap issues of concern to patients. Generally, neither reliability nor validity of the measurement instruments are considered. The present study investigated the construct of patient satisfaction and developed the Smith-Falvo Patient-Doctor Interaction Scale (PDIS), a patient satisfaction scale based on empirically derived dimensions of patient satisfaction. The project consisted of three studies. The first study involved the generation of physician behavior descriptions by 22 family practice center patients. The resultant 1540 descriptions were grouped into 80 reliable categories. In Study 2, a sample of 30 patients rated the behavior descriptions on a 9-point scale from most preferred to least preferred. Multidimensional scaling techniques were applied to the preference ratings, resulting in the identification of two dimensions: general health care delivery and inappropriate interpersonal interactions. The PDIS was then constructed from items salient to these two dimensions. Outcome of the investigation of the reliability and validity of the PDIS in a third study was quite positive.


Component of health promotion.

Component of health promotion.


Evaluation of a medical interviewing course. Use of the helping relationship inventory. Changes in beginning medical students' preferred interview responses appear attributable to a course that emphasizes communication techniques for developing patient rapport. For each of five successive classes, pre/postcourse preferences were obtained for alternative response modes (categorized as understanding, probing, interpretive, supportive, and evaluative. Analysis indicated significant increases in students' preferences for understanding responses and decreases in preferences for evaluative responses (p less than .001). Changes are in the desired direction with respect to course goals, since rapport is generally enhanced by conveying understanding and refraining from premature evaluation. Effects on response preferences of some instructor characteristics are analyzed. Implications for health professions education and research are discussed.


Legal trends increase hospital liability.


Understanding and managing patients who smoke.


Mild hypertension: the continuing dilemma of treatment.


Cancer: what is prevention?

Cancer: what is prevention?


Stress: sources, effects, and management.


Designing an exercise plan for optimal health.


Motivating your donors through better newsletters.


Cost squeeze, budget ax prods market piggybacking trend.


New life insurance plan boon to endowment fund.


Repositioning development in a corporate reorganization.


Improve customer relations through reinforcement program.


Tax-induced fund raising--new techniques to prosperity.


An investigation of selection bias in an HMO enrollment experiment.


Going at-risk for durable medical equipment.


The 1983 Walter L. Bierring Lecture. Medical discipline.


Capital financing through philanthropy.

Capital financing through philanthropy. Given the financial realities of the next few years, hospitals will need to look for new ways of raising capital. One often overlooked source is philanthropy. Rockingham Memorial Hospital (RMH) in Virginia has, since 1975, developed a particularly successful fund raising program. By dividing their donor base into a number of different categories, RMH is able to design and tailor a gifts campaign specific to each donor segment. Their development effort, including its conception, elements of success, and game plan is presented.


Financing in the 1980s.

Financing in the 1980s.


"What are the reasons for an implications of limiting hospitals' use of tax-exempt financing, IDBs in particular?" In house.


Case in point. Community Memorial Hospital.


Case in point--the answer. St. Mary's Mountain View.


Capital financing techniques for health care facilities: an historical overview. Realizing that a thorough discussion of capital financing techniques for health care facilities would fill several volumes, this article presents an overview of the techniques currently used in the industry. Included is an outline of the basic features, applications, and costs of the various techniques. Because financing techniques in current use evolved from earlier forms, the chronological format adds a measure of clarity and logic to the development of health care financing. The primary focus will be on private, voluntary hospitals since they comprise the majority of the health care financing volume. A particular technique's applicability to public facilities, nursing homes, retirement centers, for-profit facilities, and freestanding facilities is noted, however, when appropriate.


Management development. Staying on top of the job.


A salary for a vital service.

A salary for a vital service.


Are bonus schemes worth it?

Are bonus schemes worth it?


How people treat the public: bottom line in hospital marketing.


How to avoid those tender traps.

How to avoid those tender traps.


Picking up the mental health bill.

Picking up the mental health bill.


Putting a price on a contract.

Putting a price on a contract.


Griffiths report: view from the top. Interview by Peter Merry.


Searching for the hospital sales department--where's the beef?


Policy making. Members in search of an identity.


America counts cost of nursing home boom.


Spring in the staffing trap.

Spring in the staffing trap.


Residential homes. Tightening up the home guard.


Private nursing homes. Two sides of the same coin.


Mental Health Act. The problems lurking in the fine print.


Health management award. A brake on heavy drinking.


How data can make a manager of you.

How data can make a manager of you.


Decoding the bar code mystery.

Decoding the bar code mystery.


Buyer price discrimination and collusion.


Conducting a supply price survey.

Conducting a supply price survey.


Nineteen tried and tested ways to add more staff...cheap.


Reformulating inventory management.

Reformulating inventory management.


P.A.'s keeping trash can liner prices under wraps.


What to expect from teleconferencing.

What to expect from teleconferencing. Like other marvels of the electronic age, teleconferencing has been both oversold and underused. Though it has many potential uses, what managers know, or think they know, about it is generally based on misconceptions. Rather than relying only on vendors of teleconferencing, potential purchasers should first decide what their communication needs are, then choose the system that suits them best. These authors explain the new teleconferencing options and give guidelines for adapting them to a particular company.


America's schizophrenic-care system.

America's schizophrenic-care system.


Managing public opinion in a hostile environment.


Candidates talk home health.

Candidates talk home health.


China's 'barefoot doctors' to get medical training through new exchange program.


Buying your own HHA building helps build equity, cash flow incentives.


An interview with: Henry E. Campbell, PhD.


Choosing a DME company: with over 5,000 medical equipment deals to select from, executive explains how.


Hospital improves service through diversification.


Home health agencies getting into elderly shared housing programs.


Clamping down on office crime.

Clamping down on office crime.


Food poisoning in hospitals.

Food poisoning in hospitals.


Common sense and computer security.

Common sense and computer security. The age of information so frequently described and anticipated in "gee-whiz" language has a darker side. As recent newspaper stories and other media attention show, unauthorized tampering with computer data banks and computer programs is on the rise. And the problem will grow worse with the proliferation of microcomputers, word processors, and data networks and with the swelling ranks of people familiar with their use. Probing beyond the conventional legislative and technological solutions to computer security problems, the authors look at what managers can do to preserve the integrity of their companies' information systems. While it is no longer possible simply to delegate responsibility for computer security to data processing managers, senior managers should not rely on expensive and complex solutions, according to these authors. They argue for simple, commonsense measures and advise how auditing and control systems can be revitalized to help detect security problems before they become serious.


Minimising the spread of Legionnaires' disease--a programme designed to prevent incubation of LP in hospital water and air conditioning systems.


WHO working group on hospital waste.

WHO working group on hospital waste.


Temporary theatre accommodation--a solution unfolded!


Fire precautions in health care premises.


Out-of-pocket spending increase for elderly opposed.


The development of an energy conservation model related to estate management.


Facility's employment practices reflect affirmative action commitment. The U.S. bishops' statements on racism over the last 40 years have addressed the structural as well as the personal aspects of racial discrimination. They have noted its persistence, described it as a moral and religious problem, and called for aggressive action among Catholics to combat it. "Meaningful equality" for blacks, however, remains a distant dream, the U.S. Supreme Court noted in a recent case involving institutional discrimination, because of the basically disadvantaged position into which blacks are born. As statistics on health, education, work, and standard of living illustrate, the socioeconomic opportunities available to blacks are markedly lower than those available to white Americans. Despite these odds, efforts to improve blacks' chances of contributing to society--through affirmative action programs--have achieved striking results in industry. Hospitals, as major workplaces, likewise should focus greater attention on developing and extending minority employment and advancement programs. Catholic health care facilities especially should evaluate their commitments to affirmative action. Increased efforts to eliminate discrimination in all aspects of a hospital's relationships with the business community as well as with its own employees will cause them to be recognized as symbols of justice not only in the workplace but also in society.


CEO must have authority to coordinate governance, management, medical staff. As hospitals attempt to survive in today's new competitive environment, they will find that the traditional organizational structure does not work. This structure can be characterized as a three-legged stool. Governance, management, and medical staff existed in relative harmony, with each able to attend to its own distinct, separate responsibilities. The medical staff regulated itself, the governing board had no serious difficulties in coping with the institution's finances, and the CEO was concerned solely with the physical plant and hospital personnel. In a riskless economic environment, this three-legged stool could remain stable. In the coming years,however, a hospital will need a clear-cut, identifiable leader if it is to survive. To centralize authority primarily in the CEO's hands will be a difficult step for nonprofit hospitals, particularly those sponsored by religious institutions, because of their tradition of operating much as a charitable social agency rather than a business. But this step must be taken, even to the extent of naming the CEO as chairman of the board, for a leader is required who has the authority to make quick decisions in the competitive marketplace. Timeliness is of strategic importance in such an environment, and governing boards increasingly will find it impossible to make timely decisions on a collective basis. Moreover, CEOs will have to coordinate the activities of management, medical staff, and the governing board. They will need to play a strong role in ensuring that target levels in DRG costs are met, and they will need the authority to mediate in issues in which the hospital's economic interests are pitted against physicians'.(ABSTRACT TRUNCATED AT 250 WORDS)


Diocesan-wide NFP program reaches broad population groups. 3 natural family planning (NFP) programs in the Diocese of Harrisburg, Pennsylvania -- programs at St. Joseph Hospital in Lancaster, Holy Spirit Hospital, and Catholic Social Services -- have worked together as the principal NFP provider in central Pennsylvania.  Since May 1978 the program has provided initial NFP instruction to more than 1300 clients (more than 800 women).  Many of those served are farmers and rural people along with small numbers of industrial and government workers.  This region comprises the urban areas of Harrisburg, York, and Lancaster and the remaining rural and small town population.  These programs have focused on recruiting and training teachers, securing an adequate funding base, developing quality assurance and evaluation procedures to establish credibility in the community, providing fertility awareness instruction in the high schools and NFP services in the community, and marketing the service.  Facts and statistics cited are from the unified programs.  Instruction in the ovulation (OM) and symptothermal methods (STM) in the format specified by the Human Life and Natural Family Planning Foundation is provided.  The program has developed an extensive quality control outline containing basic information on NFP service, client outcome, and record audits -- much of which focuses on the outline for distribution to government-funded family planning clinics.  Of those women coming for initial instruction, about 30% never begin charting; 20% chart for fertility awareness only or to plan a pregnancy; and 50% chart to avoid pregnancy.  The St. Joseph Hospital's program has measured the success of menstruating 1st interval acceptors in avoiding pregnancy.  By life table analysis, at the end of 1 year 18% had unplanned pregnancies and another 30% had dropped out for other reasons, including changing their intention from avoiding pregnancy to planning pregnancy.  The majority of unplanned pregnancies are to couples who are in the first months of use and are just learning the methods.  These couples may not understand the methods and can make mistakes in method applications.  Of those accepting the method over a period of 5 years, 1/3 have stopped charting.  Of those who continue, approximately 1/3 are autonomous and need no active follow-up.  The other 2/3 are actively being followed.  The overall amount spent in the diocese on NFP has more than doubled from 1978-83, from approximately $30,000 to more than $60,000.  Public acceptance of NFP is a major problem.  Each service site is underused.  Support structures need to be developed within all areas of the Catholic community.


Can a Catholic hospital tolerate refusal of ethically ordinary treatment?


Volunteer program enhances patient care, participants' skills.


Effective pastoral care budgeting reflects department's goals. Like all department heads, the pastoral care director must develop a budget, negotiate its approval, and keep expenditures within it. Knowing that planning and control are the budget's functions, the director can follow simple steps in preparing a thorough budget. After establishing goals according to quantitative and qualitative resources needed, the director relates these to the services produced. The services budget forms the foundation of the dollar budget. After establishing goals according to quantitative and qualitative resources needed, the director relates these to the services produced. The services budget forms the foundation of the dollar budget. Resources and services are then broken down into the paper major and minor accounts. Estimating numbers of full- and part-time personnel needed is the major task, along with determining costs of nonsalary items such as supplies. The director then presents the budget to management, showing the relationship of goals to dollars and avoiding "highballing" and "lowballing" strategies that undermine personal integrity. With good accounting and control reports the director can use the approved budget to keep the pastoral care department within bounds in providing services.


Drug noncompliance in the elderly.

Drug noncompliance in the elderly. Drug noncompliance is a major therapeutic problem for clinicians who deal with the elderly. This group receives 25% of all prescriptions, although comprising only 11% of the population. Clinicians overestimate their patients' compliance by 100%. One-third of patients always comply, one-third sometimes comply, and one-third never comply. Noncompliance can be determined by pill counts, timing of refills, blood and urine drug levels, and observation of therapeutic effect. Contributing factors to noncompliance include vision, hearing, and memory impairment, side effects, drug interactions, fear of drug dependency, difficulty in obtaining of taking medication, complicated regimens, and lack of confidence in the clinician. Recommendations are given to aid the clinician in overcoming noncompliance. The elderly benefit from verbal instructions reinforced in writing, frequent visits, simplified regimens, clearly labeled, non-childproof containers, and involvement of family members. An illustrative case study is presented.


Terminated employee must prove age was only reason for their discharge.


Tax exemption statute does not cover property leased to hospital for profit.


Maintenance protocol for potential organ donors in multiple organ procurement. Donor organs that are suitable for transplantation remain scarce, especially in view of the number of types of organ transplants now possible and the ever-increasing number of waiting recipients. This scarcity of donor organs can, to some extent, be ameliorated by the adoption of potential organ donor maintenance protocols that protect the organs from irreversible damage. Of key importance to the success of any such protocol is the establishment of hemodynamic adequacy and stability. Appropriate and vigorous antibiotic prophylaxis is also a major consideration, especially with regard to the pulmonary and genitourinary systems. The use of ophthalmologic preparations for protection of the corneas, attention to skin cleanliness, and the practice of rigorous sterile technique in the care of all indwelling catheters are measures that are strongly encouraged in order to provide the best possible chance of successful donation of organs that otherwise may be compromised.


Proposed Sec. 501(e) regulations published--shared service organizations.


Integration of the pieces needed.

Integration of the pieces needed.


Treat health care as a public utility--at least to some extent.


Supreme Court upholds exclusive contract against antitrust challenge in Hyde case.


U.S. District Court enjoins application of New York's rate-setting statute to self-insured ERISA employee welfare benefit plans.


CA appellate court reaffirms statutory prohibition against discovery of medical staff proceedings and records.


Master indenture: capital financing for health care systems. The master indenture enables members of multiinstitutional health care systems to finance capital programs and expansions by borrowing on the basis of systemwide revenues and assets. Participation in a master indenture financing may be structured in two ways. In a restricted group, only the parent organization issues notes, and only the parent is directly liable for the debt. To ensure that each member's revenues flow to the parent, the latter must have sole member status and be permitted to approve subsidiaries' debts, budgets, amendments to articles and bylaws of incorporation, and selection of trustees. Each entity's articles and bylaws must permit it to support the system members' common charitable purpose. In contrast, members of an obligated group have direct joint and several liability for master indenture notes. If one subsidiary misses a payment, the parent can call for payment from other obligated group members. Limitations on a member's obligation to support system debt in case of insolvency or bankruptcy may be included in the master indenture provisions. Whichever structure is selected, the amount of debt that can be incurred is based on the institutions' combined financial statements. The master indenture thus allows financially weak institutions to benefit from the credit strengths of stranger system members and permits the parent organization to control members' access to capital markets.


Health policy: a worldwide view.

Health policy: a worldwide view.


Examining ethics: a necessary first step.


Reasonable and humanistic access, quality and cost required.


How to get and keep tax-exempt and tax-deductible status.


Drug utilization review of parenteral clindamycin therapy. A concurrent drug utilization review was conducted to evaluate the appropriateness of parenteral clindamycin use, the incidence of gastrointestinal side effects, and to implement, if necessary, corrective actions to improve parenteral clindamycin use. Criteria for the appropriate use of clindamycin were prepared, reviewed, and approved by the P & T Committee of the City of Memphis Hospital (CMH) and University of Tennessee Medical Center/William F. Bowld Hospital (UTMCH). Forty-five patients were included in the audit. Overall, in 43/45 (96%) of the patients audited, clindamycin use was deemed appropriate. This audit provided the opportunity for positive reinforcement of physician prescribing practices and helped to foster a cooperative, rather than an adversarial relationship, between pharmacists and physicians involved in drug utilization review.


Drug utilization study of antiepileptics in Hungary. This paper describes drug utilization review activities on anticonvulsant drugs in Hungary. Data on the use of phenytoin, carbamazepine, primidone, and sulthiam in the 20 administrative regions of the country are presented. From 1971 to 1980, consumption of these anticonvulsants doubled, and most of them were used in combination therapy. Estimates of the numbers of epileptics in the country were calculated from data on the international incidence of epilepsy and from total drug consumption data in Hungary.


Total formulary review--the easy way.

Total formulary review--the easy way. In an effort to minimize drug costs, many hospital pharmacy services have limited their drug inventories through the development of a formulary. Evaluation of drug products for addition to the formulary is the responsibility of the Pharmacy and Therapeutics (P & T) Committee. The deletion of rarely used or outdated products is often overlooked. As a means to "clean up" the formulary, Hamot Medical Center (HMC) underwent a total formulary review. Drugs were separated into classes as defined by the American Hospital Formulary Service (AHFS). Approximately three drug classes were evaluated each month by the P & C Committee. Evaluation criteria was based on the following factors: current formulary status, usage statistics, negative comments appearing in six current publications, hospital acquisition cost, and number of formularies containing each product. A final compilation of all deletions and additions were distributed to all medical staff department and division chiefs. Following receipt of all their comments, a final draft of the formulary was made and prepared for publication. This system is a simple, uncomplicated means of either revising or beginning a formulary. It evaluates a drug based on efficacy, individual hospital usage, and cost of the drug while allowing for input of the medical staff. The end result is a formulary tailored to best fit each institution.


Multidisciplinary quality assessment of a unit dose drug distribution system. A two-part multidisciplinary study was performed at a 531-bed community hospital to evaluate the unit dose drug distribution system. The first study identified the relative incidence of medication discrepancies between nursing administration records and what actually was delivered for the patient. The second study revealed the incidence of scheduled medications which were returned to the pharmacy unused. In both studies, the reason for each disparity was noted and tabulated. The results of each study were reviewed and specific corrective measures were developed for each problem area detected. Follow-up programs were also recommended to determine the effectiveness of the corrective measures. Other hospitals with unit dose systems may find these study results revealing and useful in evaluating their own distribution services.


Drug administration and control in a large mental retardation facility. Better control and more accurate drug dosing in the large institution has long been needed. This project focused on the proven unit dose concept with variations for the long-term care institution. The system described serves a client population of 875 mentally retarded persons. Operation and maintenance of the system requires a staff of three FTE pharmacists and three FTE pharmacy technicians. The concept is based on a 72-hour exchange cycle and features the use of a 3-day carrier package for each oral solid medication dispensed. Single dose identification provides pharmacy personnel with the capability to closely monitor drug administration activities. For example, omitted doses can be readily linked to a specific date and time of occurrence. Single doses are dispensed into separate dosing sections, even though several tablets or capsules may be required for one dose. The package design additionally permits first-dose administration times to be programmed by the pharmacist in order to minimize delays in starting newly prescribed medications, such as antibiotics. Use of the package eliminates the need to purchase tablets and capsules in commercial unit dose form. It is also unnecessary to buy automatic packaging equipment. The entire process is adaptable to both manual and computerized pharmacy systems.


A utilization review of digoxin assays: sampling patterns and use. A review of digoxin assay utilization concurrent with patient hospitalization was conducted at the University of Texas Medical Branch. An interdepartmental committee of clinicians adapted audit criteria for the collection and use of digoxin assays. This included rational indications, correct performance (i.e., collection and processing of serum sample) and appropriate dose adjustment. The charts of all patients receiving digoxin were examined daily, whether or not the physician had ordered a drug assay. Contributory data were collected and analyzed, including serum electrolyte concentrations, arterial blood gases, renal function tests, vital signs, physician assessments, and other information relating to pertinent and concomitant diseases or drug therapy. The 2-month review included 104 hospital inpatients who received 245 evaluations. Only 38.4% of the evaluations were determined to be compliant with all criteria. When the audit categories of rational indication, correct performance, and appropriate dosage adjustment were evaluated independently, compliance rates were 66%, 73% and 86%, respectively. In 108 cases (52%), the physicians provided inadequate instructions in their request for the digoxin assay to insure proper collection time by the phlebotomist. Approximately 94% of all assay results were verbally communicated to the physician or returned to the patients' charts for use in patient management within a minimum of 24 hours. Hospital laboratory charges for unnecessary, incorrectly performed, or inappropriately used digoxin assays were estimated to exceed $100,900 annually. The audit was used to demonstrate the need for changes in hospital procedures and house staff training. A collaborative pharmacokinetics service was organized with reimbursement accomplished through the physician billing charge.


Twenty-four hour pharmacy service in hospitals with less than 300 beds--Part 7.


Foundation grantmaking: a review of the process.


United Way: who are its critics?

United Way: who are its critics?


Elderly ambulatory care patients' knowledge about drugs. The extent of knowledge that elderly ambulatory clinic patients possessed about their maintenance prescription and nonprescription medications was determined using 17 selected questions. Information was obtained by using structured interviews from 100 subjects, 65 years of age or older, selected from a general medicine clinic using the simple two-stage cluster sampling method. The medical charts and various medication teaching manuals were used as criteria to determine whether or not the questions were answered correctly. The questions bout adverse reactions, nonprescription medications to avoid, and activities to avoid or perform with caution were answered correctly less than 30% of the time. Thus, practitioners should not assume that elderly ambulatory patients on maintenance drug therapy possess sufficient knowledge to use their medications safely and effectively.


Methodological observations on applied behavioral science. Policy makers and administrators have become frustrated with single-subject designs because these designs appear unable, at first blush, to provide them with essential information that they can use in planning or change at the organizational or institutional level of management. Practitioners have become frustrated with prior exclusive reliance on traditional group experimental designs because they fail to provide useful information for conducting therapy or delivering services. The following article by Professor Gingerich makes a large and important contribution toward mitigating these two apparently divergent needs. Gingerich describes how meta-analysis can provide useful information for managers through aggregations of data obtained from single-subject, time-series designs. The article also discusses the use of meta-analysis of time-series data as a basis for improving the quality of scientific investigations.


Stability of cephapirin sodium admixtures after freezing and conventional or microwave thaw techniques. The freeze-microwave thaw technique has important advantages compared with conventional piggyback delivery systems. A requirement for the implementation of this technique, however, is the documentation of antibiotic stability following freezing and microwave thawing. The purpose of this study was to assess the stability of a commonly used cephalosporin, cephapirin sodium, following freezing and conventional or microwave thawing. This data was not previously available. Cephapirin sodium was admixed with either 5% dextrose injection or 0.9% sodium chloride injection in polyvinylchloride minibags at concentrations of 10 and 40 mg/ml and then frozen for 14 days. Admixtures were then thawed conventionally or by microwave heating. Cephapirin concentrations were determined spectrophotometrically after reconstitution, immediately after thawing, and 6, 12, and 24 hours after thawing. No significant differences in admixture potency after reconstitution, immediately after thawing, or at 6, 12, and 24 hours after thawing were observed when thaw techniques were compared. All admixtures retained at least 90% of labeled content regardless of thaw technique, type of diluent, or initial concentration. In addition, all admixtures retained at least 90% potency 24 hours after thawing when compared with the actual concentration determined immediately after reconstitution. The rate of cephapirin degradation was not influenced by thaw technique, type of diluent, or initial admixture concentration. The results of this study suggest that cephapirin sodium may be added to the list of drugs capable of withstanding freeze-microwave thaw treatment.


The party line returns.

The party line returns.


The revolution and the U.S. Health care in Grenada.


Health and human rights in El Salvador.

Health and human rights in El Salvador.


Birth of a nation. Maternal and child health in Nicaragua.


"The Sandinista revolution is health".

"The Sandinista revolution is health".


Matrix/team management in a public health department.


Integrated rural health care systems: managerial implications for design and implementation.


Measuring provider productivity in ambulatory care.


The clinical equipment coordinator: a new role in the hospital industry. The increase in use, complexity, and cost of medical equipment requires a management response in both large and small hospitals. This paper describes the position of Clinical Equipment Coordinator (CEC) as it developed at Anaheim Memorial Hospital in Anaheim, California. The CEC can be highly effective in coordinating contract or shared services for a small hospital. In the larger hospital with an in-hospital Clinical or Biomedical Engineering Department, the CEC can take on the responsibilities of coordinating the services of the department. A detailed Job Description is presented along with typical forms and guidelines.


"ASAP": a microcomputer-based automated safety & performance testing system. An HP-85 microcomputer programmed in BASIC was interfaced to a PEI 2000 safety analyzer via an HP-6942A Multiprogrammer and appropriate interface cards. This configuration allows automated safety and performance testing as well as report generation. The system is operated by means of a menu displayed on a built-in CRT and the keyboard. Data are displayed and then stored on the built-in cassette unit. Additional testing features are easily added with minimal software development, since all programming is in BASIC and all interface drivers are part of the hardware.


Microsurgical instrumentation for vitrectomy: Part II. The rapid progress in the field of vitrectomy since its recent commencement may be clearly related to the development of microsurgical instrumentation for vitrectomy. In the early 1970s, a number of vitrectomy instruments were introduced in close succession. The experiences gained from this first generation of products were quickly fed back to make modifications and improvements for a second generation of products. Guillotine action cutters and bimanual concepts, for example, became the preferred norm. Concurrently, various instrument systems were developed to satisfy procedures of which vitrectomy is a part. The system concept is still evolving as this new discipline matures.


The Stanford medical group: a university-based group practice.


The outpatient clinic; the crucible of the physician-patient relationship in graduate medical training.


An assessment process for nursing staff patterns in ambulatory care.


A methodological framework for assessing midlevel managerial development needs in hospitals.


Developing effective selection policy models for master's candidates in health administration.


The Andrew Pattullo Lecture. The changing future of administration.


Health for all by the year 2000: its political constraints and promises for the African region.


Myths of mass casualty training.

Myths of mass casualty training.


Lessons from Stony Creek.

Lessons from Stony Creek.


Meeting of the Advisory Committee of the Health Administration Education Program in Latin America and the Caribbean.


Rx for medical control.

Rx for medical control.


EMS by the numbers.

EMS by the numbers.


An historical application of McClean's steady state manpower model.


Safety information bulletins of particular relevance to sterile services managerial staff.


Specialty costs in English hospitals--a statistical approach based upon a cost component model. A previous paper in this Journal compared various regression models designed to relate hospital recurrent expenditure to corresponding measures of hospital activity and services provided. The paper concluded by discussing briefly an alternative approach designed to avoid some of the criticisms raised and to reconcile the differing viewpoints inherent in the existing models. The objective of the present paper is to describe this alternative approach in more detail. The model introduced is concerned with the separate modelling of a number of broad components of hospital inpatient expenditure, rather than with the total expenditure in isolation. A system of simultaneous regression models is proposed, each related to a particular area of expenditure, the structure of each being determined by means of empirical analyses based upon data from some 1505 English hospitals. It is shown that when the total costs generated by aggregating the cost components are considered, the models provide a better representation of the cost structure of English hospitals than the models based upon total costs published in the recent literature. Various applications of the models in the management and planning of hospital services involving the use of micro- or other computers are discussed.


National porous load log book.

National porous load log book.


Privatisation. Report on a talk given by Roger Davis.


Cameroon and Pakistan.

Cameroon and Pakistan.


$2-billion health care center to have laundries for 50,000 guests.


Laundry networking.

Laundry networking.


Electronic surveillance saves hospital $65,000 in linen costs.


Programmatic accreditation: present role and future prospects.


A time for reexamination: advertising of physician services. How do consumers respond to advertising of physician services? In a thorough study undertaken by the author, this area is explored as well as the importance of consumer demographic characteristics and the appropriateness of the advertising media. The major implication of the study is that it is now time for reexamination of physicians' traditional abstinence from advertising. Tasteful advertisement of physician services cannot only provide benefits to the medical group, but also can answer the cries of consumers for more information.


A residency program for group practice administrators. Bridging the gap between the world of education and the world of work, a residency program offers distinct advantages to both the preceptor and the resident. A view from each of these perspectives is presented here, giving the reader a well-rounded picture of the characteristics of an effective residency program.


Predicting group practice conditions.

Predicting group practice conditions. Influenced by the need to be competitive in an environment plagued by an oversupply of physicians, medical groups must give serious attention to major trends in terms of strategic planning. Group practice can benefit from the experience of other businesses which have survived in their respective marketplace. To assist medical groups in their strategic planning efforts, three health-care consultants offer predictions of future conditions in medical group practice.


Teaching the basics of management to resident doctors. When a well-seasoned administrator offers to teach a course in general medical practice management to a group of resident doctors, it can lead to an enriching experience for everyone involved. The residents benefit educationally, the administrator personally, and his group financially. Even the community and the field of management stand to win. Based on eight years of positive teaching experience, the author presents a six-week program format, outlining specific topics of discussion for each session.


Managing multispecialty medical services. A focus on special children and the elderly. A comprehensive perspective is essential to properly manage medical services for patients with multiple needs. For optimum care, all service aspects must be coordinated and a program format developed to meet individually identified needs. The Gundersen Clinic in LaCrosse, Wisconsin, has designed and implemented comprehensive care programs for two very different patient populations: children with special health and education problems, and the elderly. Many important aspects of a comprehensive care program are examined here, including ease of accessibility and follow-through, cost consciousness, staffing and space considerations, the administrative structure, marketing techniques, and evaluation procedures.


Confronting an outdated medical record system. When a new administrator was hired for a group practice, a vintage medical record system (late 1940s) was standing firmly in the way of clinic efficiency and was creating significant medical and legal problems as well. The technical and political obstacles confronted by the administrator in designing, implementing, and monitoring a new medical record system are examined in this case study.


Why this group gave up on computerized clinical records.


The balance between cost and quality.

The balance between cost and quality.


Why fee-for-service will live forever.

Why fee-for-service will live forever.


Electrosurgery and patient monitoring.

Electrosurgery and patient monitoring.


Why business wants to force you into a PPO.


Nuclear instrumentation.

Nuclear instrumentation.


How physicians and consumers view the health-care system.


Medical Electronics buyers guide 1984, Part 1. Market analysis, chromatography, coulometric titrators, electrophoresis, electrosurgery equipment, Holter ECG, iontophoresis, osmometers, radiation detection radiology, refractors, computer hardware, computer software.


Epilepsy: new tactics in an age-old battle.


The automatic call distributor: one answer to appointment-making problems. This case study addresses one problem brought on by a significant increase in patient volume: the inability of appointment desk clerks to answer the telephone within a reasonable amount of time. In response to mounting complaints from both patients and clinic staff, conversion to a computerized appointment system was undertaken. However, when the conversion led to no immediate relief of the problems at hand, an automatic call distributor was installed. Though this experience in instituting two new systems simultaneously was not without its problems, it did prove successful in effectively smoothing clinic operations.


Mastering the art of persuasion.

Mastering the art of persuasion.


Should your hospital enter the outpatient lab business?


A management engineering study of our lab.


A prescription for better writing in the lab.


Deficiency data as a guide to staff training.


Dissenting opinions by Supreme Court justices in federal income tax controversies.


IRS denials of charitable status: a social welfare organization problem.


Some marketing moves unique; others borrowed from industry.


Alternative services. Urgent care centers seek niches.


Hospitals marshal sales forces.

Hospitals marshal sales forces.


Consultants give PPOs mixed reviews.

Consultants give PPOs mixed reviews.


Alternative services. Look before leaping into home care.


Hospital doesn't need lab under new venture.


Hill-Burton rules changed because hospitals didn't meet expectations.


Cut costs by closing beds, applying computer analyses to admissions.


Risk management. More in-house attorneys hired to cut costs, improve access.


Risk management. Hospitals may take shot at paring infection rate to cut patient stays.


Risk management. Fires should spark hospital's suspicion of in-house arsonist.


Majority of consumers support advertising of hospital services.


Who's your target? The answer will help trigger effective ads.


Looking back to look ahead.

Looking back to look ahead.


The primary health care provider's computer as a partner in teaching.


Health care records: a new opportunity for patient access.


Identification of practice problems in dentistry. This paper examines the use of dental insurance claim data for studying the dental care delivery system. Several research projects are described including investigations of the amount, types and causes of variation in dental practice patterns, the cost-effectiveness of different patterns of care in producing oral health, the feasibility of focused utilization review systems and the selection of continuing education topics and participants. The importance of these and other data information systems to the future practice of dentistry and medicine is stressed.


The application of satellite television broadcasting for continuing professional education.


The use of satellites for hospital-based continuing education networking.


Teleconferencing as a medium for continuing education of health professionals. This paper describes 15 years' experience with narrow band telephony applied to continuing education of physicians and nursing staff in the state of Wisconsin. The telephonic approach is shown to be viable, effective and economical; especially so when compared to wideband video alternatives or peripatetic teachers. The department of Continuing Medical Education, University of Wisconsin-Madison, initiated the use of telephony for instructional purpose in non-credit continuing education in November, 1965. Facilities were installed for 18 hospitals, up to 350 miles from Madison, for use by 286 physicians two hours weekly. The program included lecture outlines, visuals and a full array of telephone equipment with lectures strictly timed yet allowing for questions and answers. The technical system was validated by a series of pretests and immediate and late-posttests of 52 physicians taking a telephone course. Technology was found not to interfere with the education process. The University has since enlarged the network by more than a factor of 10. By 1979-80 there were 1,320 program sessions with participation exceeding 34,000--or 270,596 student contact hours, at approximately $5.33 per student contact hours. Drawbacks include lack of eye contact, difficulty in understanding foreign accents, and necessity for videocassettes when demonstrations require movement. Strong points of telephony include its flexibility; variation in numbers attending and in visual aids; location of instructors and use in single subject/single day teaching. Telephony was found to be a uniquely useful means of providing continuing education to hospital and medical staffs.


Risk management. Legal threats scare board recruits.


Video display terminals: a potential occupational health hazard?


Interdisciplinary continuing education.

Interdisciplinary continuing education.


An assessment of the client-centered planning approach in continuing education for public health professionals. This paper reviews the concept of client-centered planning as an approach to program development for continuing education in public health. Client-centered planning is aimed at the identification of individual practitioner needs and the development of educational interventions tailored to improve competency in selected areas. This paper presents the essential elements of client-centered planning and examines findings from continuing education programs in public health conducted by the Center for Continuing Education of Public Health Professionals at the University of Michigan. The Center model is presented as one approach to program planning. As such, protocols for needs assessment, program planning, implementation and evaluation developed according to client-centered theory serve as a baseline for improved program planning for use by instructors and agencies.


Do parents have a right to decide whether or not their handicapped infant should have surgery?


Approach-avoidance conflicts regarding participation in professional activity studies. The intrapersonal conflict hypothesis was used to explain participation and nonparticipation by health professionals in a demonstration program in quality assurance and continuing education. Two variables, "perceived benefits" and "social barriers," predict participation (p less than .024, less than .005, respectively). A discriminant analysis suggests that "benefits" has a greater impact than "barriers." The model has practical value in enhancing participation in important professional activities.


A conjoint medical/nursing diabetes education program: impact on care in a rural community. This paper describes the planning, teaching format, and evaluation of an interdisciplinary education program in diabetes mellitus for physicians and nurses in a rural Canadian community. Most participants preferred the conjoint teaching format to the unidisciplinary didactic programs traditionally offered. An evaluation, by chart review, of the management of diabetic patients cared for before and at 3, 6, and 12 months after the teaching program revealed significant changes in the referral practices of both the home care nurses and the physicians. Our findings suggest the occurrence of a program-related change in collaborative care practiced by the physicians and nurses who participated. A more extensive three year project has been initiated to further document the effectiveness of interdisciplinary continuing education in this community.


How critically do we examine obstetrical technologies?


Ethics committees: a turn for the worse.


Nuclear weapons, nuclear war and the health professions. Curriculum development in medical schools. The role of health care professionals in educating the public and policymakers about nuclear weapons, nuclear war and issues involved in preventing thermonuclear warfare is increasing. It is based on the professional and ethical responsibility to promote public health and prevent epidemic disease and death wherever possible. In the case of nuclear war, which has been called "the final epidemic," increased public knowledge is a primary method of working for its prevention. Policymakers in the United States and internationally are turning to physicians and scientists with important questions about the effects of nuclear war, questions about human behavior under stress, questions about long term ecological effects and survivability, and questions about technical aspects of the weapons themselves. The profession itself is asking questions about its proper role in these issues and the ethical basis for political activity on behalf of public health. Thus, concerned physicians are seeking education in these areas. Many medical schools have developed courses, one of which is described here. Consensus on a core curriculum has been achieved and curriculum materials are now available.


The health and social costs of the weapons race.


Nuclear war and nursing ethics. What is the nurse's responsibility?


The work of International Physicians for Prevention of Nuclear War (IPPNW).


Designing benefits to cut costs.

Designing benefits to cut costs.


Health professionals in a nuclear age. Professional obligations and continuing education needs. This paper explores the ethical responsibility of health professionals to become involved in issues concerning nuclear technology. Different contexts are identified in which health professionals could make a unique contribution, and their obligations and/or justifications for doing so are examined. The parallel implications for continuing educators are also discussed.


Why Honeywell left: a tale of a health-care coalition.


Annual Report of the American College of Osteopathic Hospital Administrators.


Consignment purchasing saves.

Consignment purchasing saves.


System building. Opportunities for all.

System building. Opportunities for all.


The revolving door--patterns in executive termination.


Preadmission: a valuable tool for the admitting department.


Physician manpower planning: at what point do we intervene?


Lessons for America.

Lessons for America.


Inside the walls of prison medicine.

Inside the walls of prison medicine.


The pathologist and malpractice.

The pathologist and malpractice. Although malpractice claims in pathology are relatively infrequent, the potential always exists. The author discusses some important areas in which pathologists could be held liable, and illustrates her points by citing some leading cases.


Women in medicine. The choices and challenges.


Why new manpower studies are needed.

Why new manpower studies are needed. Future pathology manpower needs have been the subject of recent debate. Despite pathology manpower studies that indicate a balance between supply and demand through the end of this decade, many view the future with uncertainty. These studies do not take into account larger issues that are radically altering the 1990s health care scene. To make reasonable projections about manpower needs, the author believes recent changes need to be examined and debated as well as the pathologist's role in the practice of medicine.


Breast self-exam: current status and concerns.


What are the elements of effective pre-operative education?


Using dolls to prepare children for surgery.


Individualizing preparation for medical procedures.


Child-care policies.

Child-care policies.


Five types of non-union grievance systems. Organizations without a process for hearing and resolving employee complaints leave their employees feeling powerless to affect the system that drives their working hours--a feeling that can send morale and motivation plummeting and fuel a vote to "go union" in an organizing effort. Even if unions fail to capitalize on such situations, the federal government may see a need to step in. Thus there is good reason, says author Alan Balfour (associate professor of management at the University of South Florida), to institute grievance systems for non-union employees. But which system is best? Balfour discusses the advantages and disadvantages of five: an open-door policy; ombudsman; juries of peers; hearing officers; and binding, outside arbitration. In doing so, he distinguishes between those that simply address the facts of a case and those that try to get to the root of a problem and solve it in ways that repair the relationships involved.


Intent vs. effect: Title VII case law that could affect you (Part II).


Deinstitutionalization.

Deinstitutionalization.


Outplacement services at Interfaith Medical Center.


Performance appraisal and career development: a shotgun marriage. Both performance and career development have potential for developing human resources--potential that can be increased by linking them together, says author Beverly L. Kaye, organization consultant. This marriage of convenience--and common sense--not only produces synergy, but also strengthens each process individually. Stressing a win/win approach designed to meet the needs of both individual employees and the organization, Kaye first examines the preparation required--preparation in terms of communication, especially listening and giving feedback; awareness of employees as individuals; the recognition that developmental moves are not always upward ones; and time assigned to soul-searching and self-assessment. However well the processes are integrated, the manager is still primarily responsible for performance appraisal and the employee for career development. Kaye offers a checklist of questions designed to help each.


Some case studies of social work practice involving ethical dilemmas and decisions.


Going after seniors. A program for 55-plus.


A hard-working quarterly.

A hard-working quarterly.


An extended calendar.

An extended calendar.


Pre-operative preparedness in print.

Pre-operative preparedness in print.


Executive wellness.

Executive wellness.


Emergency game plans.

Emergency game plans.


Photo gallery.

Photo gallery.


"From deadlines to headlines". A guide to working with the news media.


Nursing literature.

Nursing literature.


Talking about a hush-hush subject.

Talking about a hush-hush subject.


Publication gallery.

Publication gallery.


How do I develop a new logo and slogan for my hospital?


Time to explore alternative care systems, says NY Senator.


David and Goliath. Small hospitals take on big competition.


Doll birth certificates.

Doll birth certificates.


Quality circles and safety committees.

Quality circles and safety committees.


Quality people, quality care.

Quality people, quality care.


Computer assisted telephone interviewing: effects on interviewers and respondents. The effects of using a computer assisted telephone interviewing system on response distributions, interviewer behavior, and other nonsampling errors are measured through a survey experiment which randomly assigned cases either to a paper questionnaire or a CATI version. There were few differences in response distributions obtained in the two modes, some evidence of reduced interviewer variance among CATI cases, but little difference in response rates between the methods. Interviewers, who conducted interviews in both methods, tended to have no clear preference between them, but favored the CATI system for ease of following the questionnaire and the paper version for ease of making changes to prior answers.


Self-generated identification codes for anonymous collection of longitudinal questionnaire data. The success of a self-generated identification code for linking longitudinal questionnaire data was examined. The matching procedure developed for linking questionnaires, including a simple technique to compensate for nonidentical codes, yielded a high success rate (92% linkage of cases over a one-month interval and 78% over a one-year interval) and very few incorrectly linked cases. The procedure worked equally well with elementary and high school students, and the resulting samples were representative of the student population on a wide range of measures. Some suggestions are offered regarding the elements comprising self-generated codes.


Radiation exposure to nursing personnel from portable radiographic procedures.


Two techniques for alternatives analysis. The two techniques described span the range of problem-solving and decision-making techniques. Brainstorming is a very personal and innovative tool when a fresh viewpoint and creativity are called for. It can strengthen individual and organizational relationships by making staff a part of the solution to problems. In contrast, linear programming is a planning tool that enables a manager to organize facts about problems and alternatives, aiding the manager in planning the action required to translate the conclusions into operational reality. It is an efficient procedure that is particularly effective when results must be precise and will find growing application in health care as we enter the era of contracting for patient populations, prospective payment systems and limited resources.


A career ladder for radiological technologists. A career ladder is a mechanism for employee progression within a chosen field. This paper describes the design and implementation of such a system in a large community radiology department. The career ladder system included integrated job descriptions, salary scales and evaluation procedures for radiology technologists. The implementation of this new system had a positive effect on employee morale manifested in decreased turnover, less absenteeism and increased job satisfaction.


Developing an educational program to meet the needs of the radiology administrator. This article describes a model for an interdisciplinary undergraduate program in radiologic sciences and administration. The article discusses the four major components of the program: the core, the professional discipline, the human competence area, and the project.


Technologists' guide to contrast reactions.


The desktop personal computer for the radiology manager. Although the benefits of a central computer in the operation of a successful radiology department have been well documented, there has been no information regarding the use of the personal computer by the radiology manager. The personal computer is specifically designed to be used by one person and does not require the operator to be a computer expert. Many practical daily functions can be performed by using this computer. These uses will be described based upon my own experience over the last eight months.


Preparing children for the stress of hospitalization.


Anesthesiology and antitrust law.

Anesthesiology and antitrust law.


Diet manual helps hospital stick to nutrition standards.


Preferred provider organizations: what can these highly touted health-care delivery systems really offer?


Ethical assessment.

Ethical assessment.


Brain surgery. A patient's story.

Brain surgery. A patient's story.


Marketing social services.

Marketing social services.


The role of ideology in self-help groups.


Tax-exempt hospital laundry co-ops outlawed.


The paraprofessional movement: an update.


For the new trustee: preferred provider organizations.


Governance and management: where do you draw the line? Is there a clear-cut division between the responsibilities of governance and management? Or, will the role of both parties vary depending on the issue and the circumstances? In this article, the authors suggest replacing a "turf model" of corporate leadership with a "continuum model"--that is, viewing governance and management as related functions, and allowing the issue and circumstances at hand to help determine the most appropriate roles and responsibilities for both parties.


Team up for success: a CEO & board chairman discuss the ties that bind. As the health care delivery system faces increasingly complex issues and changes, the need for an amicable, productive working relationship between the governing board and the administrator grows in importance. Both the chairman of the board and the administrator of a California hospital give their perspective on how they view their own and each other's roles, and the factors that have been decisive in the development of a mutually supportive working relationship.


Trauma nursing: a collaborative model.

Trauma nursing: a collaborative model.


A lender's view of the medical office building market.


Business is stocking up its ammunition, and hospital spending is the target. The business community is serious about putting the brakes on hospital care spending. The author relates what various coalitions around the country are doing to try to hold down their employee health care benefit costs and how their efforts are affecting business/hospital relations.


Hitching up to the business coalitions' bandwagon. Business coalitions are pushing hard for changes in the health care delivery system. The author outlines the history of the movement, current concerns that coalitions are focusing on, and the important role that hospital governance and management need to play in business coalitions.


How competent is social work's approach to the assessment of competence?


As I see it: Assembly of Hospital Governing Boards.


A new challenge to doctors and lawyers.

A new challenge to doctors and lawyers.


Home respiratory care seen cheaper, better.


The 1983 amendments to the Social Security Act: the issue of intergenerational equity.


Avoidance of the alcoholic client.

Avoidance of the alcoholic client.


VA considers new evaluation process for elderly patients.


Veteran insurance cost recovery drawing interest.


Computer literature: now what do I do?

Computer literature: now what do I do?


Military outpaces state trend in permission for mastectomy.


Non-physicians: directive requires close monitoring.


U.S. Medicine--smoking report. Hospitals' efforts seen still 'weak' in reducing hazards to patients.


Local certificate programs for volunteer administrators.


The business of boards is serious business.


The 1983 Gallup survey on volunteering.

The 1983 Gallup survey on volunteering.


Preparing an effective recruitment campaign.


Recruiting volunteers through an annual appeal.


1983 VAC survey: supporting the volunteer community.


Substitute mother fills void in Duke Pediatric ward.


Perspectives. NMR challenges health planning.


Perspectives. Legislators push PPOs.

Perspectives. Legislators push PPOs.


No vacancies. 'California has more physicians than it needs'.


Perspectives. Integration, conversion mark HMO growth.


Race, income and health status: implications for health education programs.


Teenage pregnancy prevention: an Atlanta program. this article describes the Fulton County (Georgia) Health Department Teen Clinical Services Program, which has 3 goals: 1) to reduce unplanned teenage pregnancies in 3 high risk health service areas in Atlanta by providing sex education and access to contraception, 2) to improve the health and well-being of teeangers by offering periodic disease screening, and 3) to educate adolescents on their total health needs.  Clinics are held in inner city community health centers and all services are confidential.  An introductory health questionnaire is used to assess the areas of counseling to be emphasized in the initial interview.  65% of teenagers initially attending the clinic are sexually active, but only 60-65% have ever used birth control.  The reasons for sexual behavior are explored during the initial interview and contraception and sexually transmitted diseases are reviewed.  Teenagers who are not sexually active are encouraged to postpone sexual activity.  Community outreach and education is another component of the program.  Rap sessions are held during each clinic session and peer counselors work as liaisons between the schools, community, and Teen Services Program.  Peer counseling is believed to facilitate feelings of acceptance and support.  In 1 of the high risk areas served by the program, the adolescent birth rate fell 17% in 1979-82.  94% of clients who accepted contraception returned and maintained contraception for 1 year.  Approximately 20% of participants in the program are male.  This experience suggests that this type of program is effective and should be expanded to other areas of the US.


Black community hospitals: a quest for survival.


Optimal and dysfunctional turnover: toward an organizational level model. Dysfunctional turnover is defined here as the level that produces a divergence between the organization's optimal balance of costs associated with turnover and the costs associated with retaining employees. Under this approach, the optimal level of aggregate turnover for most organizations will be (1) greater than zero and (2) variable across organizations, contingent on particular factors influencing retention costs and quit propensities. The model presented posits that individual, organizational, and environmental attributes influence individual quit propensities of employees and, hence, expected turnover rates for the organization.


The influence of the physical environment in offices. Physical settings in offices have largely been ignored by managers and scholars. Physical settings can influence behavior in numerous ways. This paper pulls together relevant research and writing and examines it in terms of the physical structure, physical stimuli, and symbolic artifacts that comprise office settings. The implications of this work for both research and practice are considered.


The Japanese management theory jungle.

The Japanese management theory jungle. Many competing hypotheses have been advanced to account for the apparent effectiveness of Japanese management practices. The present review of some of the leading theories attempts to classify and clarify the state of knowledge of Japanese management. Although each theory may be correct as a partial explanation of Japan's success, no single conceptualization has captured the complexity of Japan's managerial achievement. Further development of integrated, internally consistent models is needed.


Who is superior and who's merely very good?


Utilization of analgesic drugs in office-based ambulatory care: National Ambulatory Medical Care Survey, 1980-81.


Quality and applicability of an undergraduate psychopharmacy rotation: a survey of pharmacy students. This paper details the results of a study of an undergraduate psychopharmacy rotation in an inpatient hospital setting and assesses its influence on pharmacy graduates careers in pharmacy. Significant features of the rotation include the students' participation in patient care activities and patient education about medications, as well as presentation of case histories. The students also took medication histories and revised patients' charts with the preceptor. Graduates of this program were sent questionnaires to assess their impressions of the rotation for quality of experience and for applicability to their pharmacy position. Ninety-four percent of the students responding worked as pharmacists and all reported dispensing psychoactive agents. Three-fourths of the respondents gave the program a positive rating for its influence on training in customer/patient relations and communications.


Differential amplifiers and their limitations.


Sound advice. After suggesting improvements, a consultant stayed around to carry them out.


A Canadian giant.

A Canadian giant.


Evaluating the evaluator (or how to lose a job).


Reasons for change: why a hospital went outside.


Security targets help cut linen pilferage.


Radiologists see role for synchronized NMR...as a new way of viewing the heart.


Buying a new CBW.

Buying a new CBW.


Plan a retreat to set goals and objectives.


Refusing treatment--who shall decide?

Refusing treatment--who shall decide?


Baby Doe legislation passes in the House...despite newly adopted HHS regulations on the care of handicapped infants.


Medicare: impact on state governments.

Medicare: impact on state governments.


Medical student group backs national health service concept.


Quints' birth provide challenge for hospital.


Shortage of MDs seen hampering research.


Tomorrow's teaching hospital: more competition for patients and dollars?


Survival instinct keeps Chicago Mercy Hospital in black.


Physician burnout: the seeds are planted early--in the critical years of residency.


Ambulance corps offers plenty of competence, care.


Seven years later: an update on the Telemedicine Project.


MTN updates its image.

MTN updates its image.


Insurers fight for cost containment.

Insurers fight for cost containment.


Exploring videodisc's potential.

Exploring videodisc's potential.


Labor applies the Rx.

Labor applies the Rx.


A new prescription: PPOs.

A new prescription: PPOs.


A healthy remedy: HMOs.

A healthy remedy: HMOs.


New options for reducing blue-collar stress.


Military strategists combat fraud.

Military strategists combat fraud.


Board reports that get results.

Board reports that get results.


Free market principle reigns in Utah.

Free market principle reigns in Utah.


Peer review experiment succeeds in Delaware.


States exert control over health costs through tighter capital spending regulation.


The health effects of job stress.

The health effects of job stress.


Stress management for the 80's.

Stress management for the 80's.


Hiding from health costs.

Hiding from health costs.


Health systems agencies and state health planning development agencies; certificate of need reviews--HRSA. Notice regarding adjustment of the expenditure minimum for annual operating costs. This notice provides necessary information for each State which chooses to adjust the capital expenditure and annual operating cost expenditure minimums that are used to determine whether proposals are subject to review under a State's certificate of need program. The notice also provides guidance to assist a State Health Planning and Development Agency (State Agency) in determining the exact minimum dollar figure it will use and in seeking further information.


Grants for various health professions projects--PHS. Final regulations. These regulations govern grants to public or nonprofit private entities for various health professions projects authorized under section 788(b) of the Public Health Service Act. The specific types of health professions projects for which support will be available will be announced from time to time in the Federal Register.


Withdrawals from list of designated primary care health manpower shortage areas--HRSA. This notice provides a list of those areas that have been withdrawn from designation as having primary care health manpower shortages since the most recent list of all designated Health Manpower Shortage Areas ( HMSAs ) was published in the Federal Register on August 19, 1983 (48 FR 37822). Such areas are designated or withdrawn by the Secretary of Health and Human Services under the authority of section 332 of the Public Health Service Act. A forthcoming notice will list those HMSAs that remain designated or have been newly designated.


Privacy Act of 1974; report of new system of records--SSA, HHS. In accordance with the Privacy Act (5 U.S.C. 552a (e)(4], we are issuing public notice of our intent to establish a new system of records: the "Disability Insurance (DI) and Supplemental Security Income (SSI) Demonstration Projects and Experiments System, HHS/SSA/ ORSIP . 09-60-0218." The purpose of the proposed system is to maintain information which we will use to conduct demonstrations and experiments of approaches to encourage individuals receiving either DI benefits under title II of the Social Security Act (the Act) or SSI disability payments under title XVI of the Act to find gainful employment. We also are proposing to establish routine uses of information which will be maintained in the proposed system as discussed below. We invite public comments on this proposal.


No innovators need apply.

No innovators need apply.


Delaware hospital offers flexible benefits.


Extra-billing: your right or privilege?

Extra-billing: your right or privilege?


R. vs. DeCoste: when taking blood is an unlawful procedure.


Patient education can boost your efficiency.


Legally acceptable standards of care set by you, not the courts.


Alberta's Dave Russell speaks out.

Alberta's Dave Russell speaks out.


Debunking the myth: Canadians are healthier than they think.


A public inquiry: the case of Canadace Lynn Taschuk.


Considerations in the implementation of drug holiday programs in long-term care facilities. Drug holiday programs have been implemented in many long-term care facilities in North America to reduce drug use, decrease nursing time in drug administration, and assess the need for drugs in elderly patients. Before the program begins, adequate preparation of staff and discussions among patients and families are encouraged. The pharmacist's role is to coordinate inservice programs for nursing and medical staff, develop policies and procedures, dispense drugs as prescribed and assist in program evaluation.


Certificate of need requirements for home health services.


Health care coalitions focus on home care. Group of Six.


Survey finds respiratory home care saves $250,000 per person annually.


Canada Health Act--the debate continues.


Continuity of care in the home: building a diversified service system that works.


Are helicopters worth the cost?

Are helicopters worth the cost?


Measuring the shape of corporate fitness plans.


Significant benefit changes occurred 1979-1983.


How Xerox explained cost sharing to employees.


Cutting costs of medical claims by identifying excesses in service per illness, costs per service.


Multi-institutional arrangements: an overview.


Quality circles: why do they work?

Quality circles: why do they work?


Title VII retaliation claims.

Title VII retaliation claims. Section 704(a) protects employees who engage in activity aimed at remedying employment practices they believe to be unlawful. Such activity may take the form of participation in governmental investigations or proceedings, or expressing opposition to an employer's practices through internal complaints to management, circulating petitions among employees, directly challenging an employer's affirmative action plan, etc. As the Ninth Circuit's recent Crown Zellerbach decision demonstrates, employers must proceed with caution before taking disciplinary action against an employee who engages in arguably protected 704(a) activity. The following article discusses employee activity protected by section 704(a) and examines various employer defenses and concerns in a retaliation case.


Roles for an effective board: a five finger exercise. Part 2.


The pharmacist in home health care: Part I--Drugs and the elderly.


Hospital strikes: complying with NLRA notice requirements. Section 8(g) of the National Labor Relations Act, added in the 1974 amendments to the Act, requires a labor organization to give an employer in the health-care field ten days' notice of an intended strike or picketing. The purpose is to allow the health-care employer time to make arrangements to ensure the continuation of health-care services to critically ill patients. Failure of a union to give this notice constitutes a violation of the Act, and individuals who engaged in the activity may, as a result, lose their status as employees under the Act. In the following article, the authors examine the requirements of section 8(g) and the case law interpreting this statute. They suggest likely future interpretations of this law and make practical suggestions for responding to strikes in the health-care setting.


The National Labor Relations Board and Taft-Hartley Funds: confusion reigns.


Comprehensive audits: a methodology. Part 2.


An employer's guide to preferred provider organizations.


Major crackdown expected after woman dies while son pleaded for ambulance from EMS.


Recognizing health care megatrends can help strengthen EDs in future.


Federal government is seen opting out of EMS support.


MAST suit 'myths' are dispelled as effects become understood.


The emergency department as a center for research.


Characteristics of burn patients who use EMS transportation.


What steps can EMTs, paramedics and other health professionals take to prevent burnout?


The bells, lights and whistles syndrome. Part 4. The EMS/computer connection.


Hospital dust mopping procedures: the special 'ins' and 'outs'.


The needs of the family of the critically ill.


Close-up: floor care made easy....

Close-up: floor care made easy....


Do's and don'ts of floor care.

Do's and don'ts of floor care.


Emergency crisis intervention service: a new approach.


The risk and cost of hepatitis B exposures in hospital housekeeping personnel.


The constant challenge of pest control.

The constant challenge of pest control.


Code enforcement. An overview: Part 1.

Code enforcement. An overview: Part 1.


Eight mentally handicapped occupants die in Georgia fire.


Speciality shops.

Speciality shops.


Contracting.

Contracting.


Taking on the competition: risks.

Taking on the competition: risks.


The Transition Task Force answers questions about the new Flex program.


The relationship among accreditation, certification and licensure.


Hospital stocks: the vital signs are good.


Integrated building systems: a constructive dialogue.


The care by parent unit. A tool for decreasing anxiety in mothers of high risk infants. The delivery of a premature infant, especially one of very low birth weight, represents a crisis for a family. Bidder et al. have determined through a series of interviews that mothers of preterm infants are anxious at two particular points in their infant's neonatal course: the time of birth and the time of discharge. The Care By Parent Unit (CBPU) was developed at Hermann Hospital in Houston, Texas, to provide a transition from the specialized care of the Neonatal Intensive Care Unit (NICU) to home and to aid the parents in viewing their infant as a normal, "safe" child to take home. To evaluate the impact of a CBPU on maternal anxiety, the mothers' responses before and after the CBPU experience were evaluated.


Hospital parking: analysis and master planning. Providing adequate parking facilities has become a major concern for many health care institutions. By performing a demand analysis based on information provided here, hospitals can begin to address the issues of: number of spaces needed to serve their present and future parking needs, pooled vs. segregated parking areas, and distance from parking area to hospital entrance for each group of hospital users. Also presented are three other factors that must be considered when planning for parking facilities: traffic flow around the lot or structure, parking fees, and location of new spaces.


Planning for the facility of today and tomorrow.


Trauma victims support one another.

Trauma victims support one another.


A-ward winning performers.

A-ward winning performers.


Case in point--the answer. Community Memorial Hospital.


Hospital space planning: what happened to all the magic numbers? "Magic numbers" and user "wish lists" have traditionally been used to determine space needs in health care institutions. Today, however, combining functional and space planning to yield a space program that integrates with the facility's long-range strategic plan can be accomplished through a user needs approach. These three approaches are discussed in light of their positive and negative aspects and their contributions to the planning process. In particular, a methodology for examining a department's potential "space generators" is provided. Along with this methodology is the reasoning behind beginning the detailed analysis early in the planning process.


The budget Ealing welcomes.

The budget Ealing welcomes.


Public/private partnerships: useful but sterile.


Unit management. Where devolution works in Wales.


Ancillary management. A case for cooperatives.


Strategic planning. Pompey waives the rules.


Members' role. Yes administrator, but...


Incentive bonus schemes. Tackling the bonus bogeyman.


General managers: executive action.

General managers: executive action.


Unit management. Small cogs in a big wheel.


Health management award. Sharing the video experience.


Drug administration. Safer than plastic cups.


Theatre staff waiting in the wings.

Theatre staff waiting in the wings.


Health management award. Hi-tech charity begins in the community.


Health promotion. Accentuate the positive.


Three national intermediaries are picked to replace direct reimbursement option.


Advantages, disadvantages of converting a nonprofit HHA to for-profit are discussed.


Learning the art of interrogation.

Learning the art of interrogation.


Resources available--recent trends--resource forecasts.


Outlook for health care--a local management view.


Health administration in Zimbabwe. Part 2.


A survey of patients in the private sector.


Going private--a comparison of management in public and private health care.


A survey of very old patients in hospitals in Newcastle upon Tyne.


Who is monitoring the use of diagnostic services?


A new hospital materiel manager's view of the prime vendor concept.


A clinic under siege.

A clinic under siege.


Making the most of a prime vendor agreement: a receiving manager's point of view.


The buyer's role on prime vendor relationships.


Inflation is more than higher prices.

Inflation is more than higher prices.


How to select a prime vendor.

How to select a prime vendor.


A standardization process for capital equipment.


Prime vendor systems: an analytical approach.


Decision-making tools: designing effective questionnaires.


Using the wholesaler to procure group contract pharmaceuticals: the hospital pharmacist's view.


Vendors: adversaries or allies?

Vendors: adversaries or allies?


The impact of prime vendorship on health care industry distributors.


The prime supplier concept.

The prime supplier concept.


A second look at the prime vendor concept.


The impact of prime vendor relationships on hospital operations and facility.


Inventory control and performance measurement.


Psychiatric technician training program saves time for staff.


Hospital marketing is here to stay.

Hospital marketing is here to stay. In 1983, a study was conducted to determine to what extent privately owned acute care general hospitals used formalized public relations and marketing programs in the management of their institutions. The results indicate three major concerns common to all respondents: (1) The potential for developing new services and community programs; (2) The need to reevaluate and redefine the target market of the institution's services; and (3) The need for more accurate and comprehensive strategic planning, both short and long-term.


Integrating clinical and management systems in nursing.


Capital investment for revenue saving?

Capital investment for revenue saving?


Hospital communications.

Hospital communications.


Defining where, what, and how in a cost conscious manner can improve patient care in all areas.


Factors affecting the implementation, success and failure of primary nursing as a delivery system in U.S. hospitals.


Telecom considerations.

Telecom considerations.


RN Hospital Haslar. Crosslink building.

RN Hospital Haslar. Crosslink building.


Ipswich Nucleus Unit.

Ipswich Nucleus Unit.


Approachable hospitals.

Approachable hospitals.


Anthropological study of health beliefs, behaviors, and outcomes: traditional folk medicine and ethnopharmacology.


Staying alive: fitness programs for hospital staff and a marketable service for the community.


Anthropology, communications, and health: the mass media and health practices program in Honduras.


Career advancement ladder--morale and productivity builder.


An operating room orientation program for SPD personnel.


Losses due to pilferage cost hospitals 3.5 billion per year--about $2500 per bed!


Role issues, technology and economics in hospital nursing.


Developing an employee fitness program on a shoestring.


Productivity and nursing strategies for the 80s.


Using the resources you have to optimize your control of C.S. and materials management.


Psychiatry--an emerging malpractice issue and what to do about it. Frequent malpractice situations arise in the overlap between medical and psychiatry diagnosis in the E.R. Examples of positive risk management and risk prevention measures are described which will lead to improved patient care for psychiatric patients. Now is the time to take a preventive approach through a review of hospital policies and procedures in Psychiatry. This will lead to risk prevention and improved patient care.


Hinsdale Hospital lighting change saves $52,840 a year.


Public attitudes toward community mental health: services, funding, and voter behavior.


Quality assurance in the care of the disabled.


A marketing readiness survey: step one in mental health marketing.


Influence of information about side effects on perceived risk of prescription drugs.


Developmental marketing strategies for community mental health. This article contains a marketing plan that was specifically designed for The Greater Lawrence Mental Health Center in Lawrence, Massachusetts. It is a full service, non-profit mental health facility that employs 85 allied health professionals and serves Lawrence and its neighboring communities. The plan was developed by a marketing consultant, in conjunction with the agency's Executive and Administrative Directors. This article illustrates a format for developing a marketing plan, and includes specific approaches that must be considered. The concepts are generic, and can be applied to similar endeavors undertaken by a comparable agency.


Market planning for mental health: a "target group" based approach.


Work around "black holes" in the O.R.

Work around "black holes" in the O.R.


Clinical pharmacy--are you accountable?

Clinical pharmacy--are you accountable?


Control infection with a good defense.

Control infection with a good defense.


How to write a disaster plan that isn't.


Holistic care of the AIDS victim.

Holistic care of the AIDS victim.


Hostel links wide ranging health needs.

Hostel links wide ranging health needs.


Solving "wet pack" problems.

Solving "wet pack" problems.


Hospitals "tool up' to offer long distance phone services.


Hospital earns money by paying bills early.


Marketing savvy: two hospitals share successful ideas.


A sampler of marketing strategies for private practice. When a practitioner sets out to develop a broad base of influence in order that referral sources are varied and active, marketing must address client, business and professional issues. When resources of money and time become scarce, a satisfied client must be and always will be the best recommendation. To maintain a long line of satisfied clients, credibility, reliability, and reputation must be fostered through personal drive, energy and eternal optimism. Other marketing alternatives must be evaluated for cost effectiveness and ultimate outcomes. All of this can be consumingly fun and rewarding.


The Medical Care Committee: clearinghouse for medical staff quality assurance activities.


New battles, partnerships emerge for administrators, physicians.


State statutes, regs define scope of access to hospitals by nonMD professionals.


Providers face business of growing private UR. In response to continuing increases in health care costs, big business has begun to lower the boom on hospitals and physicians through outside utilization review. Physicians, however, are seen as the key to controlling costs.


Withdrawing life support: a legal assessment and a possible response. How to deal with terminally ill incompetent patients is a painful dilemma for for hospital medical staffs and administrators, not to mention families of these patients. Case law on the removal of life support is emerging, and physicians and administrators may find the hospital-based ethics committee one means to guide them in making difficult decisions without involving the courts.


A decisive decade for HMOs.

A decisive decade for HMOs.


Rationing and the identified life.

Rationing and the identified life. Economics, patient characteristics, health status, and "objective" measures have served as rationing agents for diminishing health care resources. The big question, however, is whether the lessons of past restrictions on health care can be applied today- and should they?


Hospital and physician advertising: forging a constructive response.