New NME unit will resell equipment.

New NME unit will resell equipment.


Survey portends changes for hospital sales reps.


The give with the take.

The give with the take.


Ambulatory care in the fast lane.

Ambulatory care in the fast lane.


The launch of Healthcare Choice: an osteopathic-based IPA.


Automated hospital information systems. Part I.


Winning through cooperation.

Winning through cooperation.


Patient account representative system provides personal touch in collections.


Preventing the harmful effects of medical care.


Helping the COPD patient help himself.

Helping the COPD patient help himself.


Addressing the environmental barriers of patient adherence.


Improving life for the wheelchair user.

Improving life for the wheelchair user.


Weight management: a practical approach.


Application forms: keep them easy and legal.


Job descriptions made easy.

Job descriptions made easy.


Who's pulling the strings on employment at will?


How pharmacists can boost patient compliance re prescription drugs.


How we use antimicrobial order sheets in our hospital.


The nonproliferation mandate and the appropriate legal standard in health care bargaining unit determinations.


Weighing the value of wellness.

Weighing the value of wellness.


Birth pains for a new machine.

Birth pains for a new machine.


Advantages of a construction contract vs bidding.


Need motivators and resource savers? Consider the interactive computer.


Citizen empowerment: a developmental perspective. Since the late 1970s, the notion of empowerment has appeared with increasing frequency in discussion of preventive social and community intervention. While the idea of empowerment is intuitively appealing both for theory and practice, its applicability has been limited by continuing conceptual ambiguity. Based on a small N study of emerging citizen leaders in grassroots organizations, this article proposes a view of empowerment as a necessarily long-term process of adult learning and development. In this framework, empowerment is further described as the continuing construction of a multi-dimensional participatory competence. This conception encompasses both cognitive and behavioral change. Implications for practice are also addressed.


Empowerment and synergy: expanding the community's healing resources. This paper suggests an alternative to the commonly-held "scarcity paradigm" of thinking about valued human resources, which assumes individuals must compete because resources are scarce. The alternative--the "synergy paradigm"--is empitomized in "synergistic community," where valued human resources are renewable and expanding, and distributed equitably to members, so that what is good for one is good for all and the whole is greater than the sum of its parts. Three field studies present cross-cultural evidence for the functioning of empowerment within a synergistic paradigm. Empowerment is considered as access to and control of valued resources; the specific valued resource focused upon is community healing. The studies suggest that community healing resources can become renewable and expanding, as can the process of empowerment which accesses them. Community members share these resources, combining conflicting resources into unexpectedly effective treatment packages. Given present inequities in resource distribution, transformative education is offered as one means to support a shift in thinking toward synergy.


Help seeking and receiving in urban ethnic neighborhoods: strategies for empowerment. This paper presents findings from a National Institute of Mental Health funded research and demonstration effort aimed at addressing impediments to seeking and receiving help in two white ethnic communities. A community mental health empowerment model was developed and implemented in the target communities over a four year period. This model succeeded in building upon the strengths of individuals and neighborhoods to help overcome help seeking and receiving obstacles. Mechanisms were developed through a variety of means to enhance the ability of lay and professional helpers to interact and work with each other.


THRM forum: My boss.

THRM forum: My boss.


Records management: purpose and direction.


Records management audit.

Records management audit.


Records management control system: central files.


Managing a filing system conversion.

Managing a filing system conversion.


Forms management.

Forms management.


Micrographics: an overview.

Micrographics: an overview.


Designing hospitals in the computer age.


An overview of records managements.

An overview of records managements.


The decision-making process for developing an in-house microimagery center.


The disruptive physician.

The disruptive physician.


Texas trends in mental health care.

Texas trends in mental health care.


A decentralized approach to word processing in a hospital setting.


Discoverability of peer review committee records.


Volunteers.

Volunteers.


Monitoring hospital productivity.

Monitoring hospital productivity.


The Texas Mental Health Code.

The Texas Mental Health Code.


Reinforcing the family bond.

Reinforcing the family bond.


Hospital linen cost control.

Hospital linen cost control.


The total healing environment.

The total healing environment.


Hospitals cope with microcomputers.

Hospitals cope with microcomputers.


Inpatient psychiatric treatment of adolescents. The increasing number of inpatient psychiatric programs for adolescents is an obvious reflection of the willingness of hospitals to meet the challenge of helping so any teenagers with emotional and behavioral problems. Not only are these hospitals meeting the needs of the community, but they are providing services and training opportunities for many health professionals who are interested in learning to work with this age group. The decision of a hospital to initiate an adolescent program not only depends on an identified community need, but also must have the necessary physical space and attract qualified professionals to develop and manage the program. It is also necessary for the hospital to have a cooperative agreement with the public school system to provide the essential academic component of the program. Working with troubled adolescents is challenging and difficult with its own unique problems and rewards. An adolescent program provides professional satisfaction and opportunity for the teenager to mature, and hope for the family.


Fitness trails: good health and good will.


Corporate restructuring: what, when, where, why, and how? Today, more and more hospitals have either gone through a corporate restructuring or they are considering one. This article presents a hypothetical discussion between a trustee and an attorney about the process--what it involves, the different forms that it may take, the advantages and disadvantages, and the role the board should play in the corporate restructuring process.


Guidelines for hospital renovation.

Guidelines for hospital renovation.


Antitrust implications for health planning.


Personnel management.

Personnel management.


Using a corporate structure 'check-up' to spot potential problems. Hundreds of hospitals across the country have now completed a corporate restructuring. As a result, many hospital boards and administrators are now dealing with a multiple-entity corporate structure for the first time. Moreover, the legal, accounting, management, and other specialists who helped to plan and form the new structure probably will not be involved in its day-to-day operation and maintenance. This combination of factors creates a risk that the various entities will not be run as required in order to maintain their separate corporate status. This article explains why it is important to preserve the separate corporate status of these entities, it identifies common problems in this area, and it shows how an audit of the corporate restructuring can help prevent those problems.


Moving from crisis to rational management. An increasingly harsh and complex health care environment is forcing hospital managers to make the transition from crisis to rational management. In the 1960s and early 1970s, American businessmen had to make this same transition. The author discusses some of the insights that hospital managers can gain from the previous experience of their corporate counterparts--namely, the need for effective delegation, administrative contracts, and receptivity to change.


The board's varying role in financial accounting and internal control issues.


Supreme Court relaxes exclusive contract rules in antitrust decision. If there is no evidence that a hospital is using market power to "force" its contracting physician upon patients and if the exclusive contract does not adversely affect price or quality, an exclusive arrangement should not violate the federal antitrust laws. These are the insights gained from the decision handed down by the Supreme Court in Hyde (Jefferson Parish Hospital District No. 2 v. Hyde , No. 82-1031).


Motivating patient care staff to teach: a plan for action.


Medical staff bylaws.

Medical staff bylaws.


Military legal claims at plateau.

Military legal claims at plateau.


As I see it: how much profit or excess earnings or reserve is acceptable.


DONs share insights on personnel management.


VA's goal: "model care" for 9 million older veterans.


Why it's harder to fire workers these days.


Don't re-use disposables, panel urges.

Don't re-use disposables, panel urges.


Army clamps down on MD credentials.

Army clamps down on MD credentials.


Military construction projects controversial.


Redirecting our human resources in a changing health care environment. The doctor as an individual.


Perspectives. IRS assaults flexible benefits.


Health services in the People's Republic of China.


Perspectives. Congress looks for transplant solution.


Hospital accreditation: the Catalan experience.


The health administrator in India.

The health administrator in India.


A Swedish hospital standard for signposting symbols.


Primary health care in industrialized countries.


Health services in Portugal.

Health services in Portugal.


The management of new pain in office-based ambulatory care: National Ambulatory Medical Care Survey, 1980 and 1981.


Boats in the art and fantasy of children.


Building types study 601: hospital planning. An unfinished business.


Growing in place. The Johns Hopkins Hospital, Baltimore, Maryland.


Building from strength. Valley Presbyterian Hospital, Van Nuys, California.


Expanding up and out. Eastern Maine Medical Center, Bangor, Maine.


Membership requirements under attack.

Membership requirements under attack.


Bring your grassroots network back to life.


Reading between the lines.

Reading between the lines.


Quickening debate over life on ice. Do orphaned embryos have legal rights?


Health maintenance organizations--HRSA. Notice; qualified health maintenance organizations. This notice sets forth the names, addresses, service areas, and dates of qualification of entities determined by the Secretary to be federally qualified health maintenance organizations (HMOs).


Debarment, suspension, and ineligibility of contractors--HHS. Proposed rule. The Office of the Secretary, Department of Health and Human Services, is proposing to amend the HHS Acquisition Regulation by adding a new subpart concerning debarment, suspension, and ineligibility of contractors. This new subpart will implement the provisions of Subpart 9.4, Debarment, Suspension and Ineligibility, of the Federal Acquisition Regulation.


Privacy Act of 1974; system of records--PHS. Notification of a proposal to add a routine use and to add a special disclosure statement to the existing system of records 09-37-0015. In accordance with the requirements of the Privacy Act and the Debt Collection Act of 1982 (Pub. L 97-365), the Public Health Service (PHS) is publishing notice of a proposal to add a new routine use and the (b)(12) special disclosure statement to consumer reporting agencies to system of records 09-37-0015, National Center for Health Services Research Grant Records System. The new routine use is for the purpose of determining credit worthiness of individual grant applicants of the National Center for Health Services Research (NCHSR).


Privacy Act of 1974; system of records--PHS. Notification of establishment of a new Privacy Act system of records. 5n accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new Privacy Act system of records: 09-20-0162, "Records of Subjects in Agent Orange, Vietnam Experience, and Selected Cancers Studies, HHS/CDC/CEH." We are also proposing routine uses for this system. The Center for Environmental Health (CEH), Centers for Disease Control (CDC), will use this system of records to support studies of the health effects of human exposure to the herbicide Agent Orange and to other environmental factors associated with service in Vietnam, and to assess the risks for selected cancers among Vietnam veterans. PHS invites interested persons to submit comments on the proposed routine uses on or before July 30, 1984.


Privacy Act of 1974; report of new routine use and minor revisions--SSA. In accordance with the Privacy Act (5 U.S.C. 552a(e)(11)), we are issuing public notice of our intent to establish a new routine use of information in the system of records entitled Master Files of Social Security Number (SSN) Holders, HHS/SSA/OSR, 09-60-0058. The proposed routine use will permit disclosure of information to organizations/agencies which are required by law to provide SSA with SSN information. We also have made minor revisions to the Federal Register notice applicable to the system. We invite public comments on this publication.


On the fringe--1985 could be the year Congress zeroes in on employee benefits.


Hospital chain designs health cost-control plan.


Dave Russell speaks out--Part two. Interview by Barry Nelson.


Hospitals eye underwriting health plans.


Ethics committees on trial: are they serving a useful function?


Bouchard vs Savoie: a surgeon sues a nurse.


Grief.

Grief.


Home health care market trends.

Home health care market trends.


Brief to the Task Force on Allocation of Health Resources.


Economic considerations in MRI.

Economic considerations in MRI. The newest product of the medical technologic revolution, magnetic resonance imaging ( MRI ), has come at a time when many medical facilities are under unusual financial strain. Ultimately, MRI must be justified economically as a means of shortening hospital stays, reducing the need for other services, or both. Further, MRI introduces special problems referable to purchase decisions.


Facility report: New York University Imaging Science Center. Current activity at the New York University Imaging Science Center, New York, is focused on diagnostic ultrasonographic imaging of soft tissues and computerized neurosurgery. For the latter, a new computed tomographic scanner has been designed.


The VNA of Baltimore: a long history of caring.


The pharmacist in home health care, Part II: The hazards of drugs: a case history.


Woman's Breast Center, Santa Monica, Calif.


Promotion of spiritual values in health centres.


The coming crisis in health care cost management.


CAHSAH publishes salary/benefit survey. California Association for Health Services at Home.


Medicenter interview: mobile imaging. Interview by Robert Bottinelli.


Cash management programs: they just might be what you are looking for.


Trends in insurance coverage for home health care.


The benefits solution--the NAHC sponsored TSA/IRA program.


Why some form of self-funding is now utilized in over 30 percent of private sector America's health care plans.


Controlling health care costs: five industry spokesmen express their opinions.


Drug distribution: a philosophy.

Drug distribution: a philosophy. Hospital pharmacy has made significant progress in the last two decades by any of a number of program evaluation methods. However equally apparent are our current deficiencies in the level of service provided in our drug distribution systems in Canadian hospitals. It is apparent that we will not be allowed to abrogate our responsibility any longer in that it is becoming recognized in medical, nursing and administrative circles that compounding and dispensing functions are clearly in the realm of a pharmacist's responsibility and these issues must be addressed if we can truly claim to be part of a world class health care system. Hospital pharmacists must take the initiative in accepting responsibility for chemotherapy preparations, I.V. additives and compounding as well as the adoption of a unit dose drug distribution system as a positive means to reduce medication errors. The report of the Hospital for Sick Children Review Committee makes it equally clear that society has expectations of an institutional pharmacy service that are considerably beyond that which we are accustomed to providing. The recommendations relating to pharmacy provide adequate support to facilitate the establishment of a contemporary drug distribution system in Canadian hospitals. Similarly the C.S.H.P. Standards of Pharmacy Practice and the Canadian Council on Hospital Accreditation Guidelines for Pharmacy Service offer additional "ammunition" for us individually and collectively to change the face of hospital pharmacy practice. The profession must take stock of its responsibilities before society insists that someone else take over where pharmacists have failed.


A new idea in malpractice coverage.

A new idea in malpractice coverage.


A self-medication program for rehabilitation patients. The purpose of this project was to develop and establish a self-medication program on the rehabilitation ward at Mount Sinai Hospital. Upon discharge most of the patients on this ward are responsible for the self-administration of medications, some of which they will be taking chronically. The objective of this program is to teach patients about their medications while still under medical supervision. Patients are counselled throughout the program by nurses and a pharmacist. Family members are also counselled on request. The program is completed by a final discussion with the patient prior to discharge. As a result of the program a manual was produced for use by pharmacy and nursing personnel to help define their respective roles in the program. Results of a patient survey indicated that a definite benefit was perceived by all patients who were helped to develop their ability to self-medicate. Errors made while in the hospital were discovered and corrected prior to discharge. Pharmacy time required to set up the program was, initially, extensive. Once the program was established, however, nursing medication administration time was greatly decreased and freed for other activities on the floor.


Improvement of pharmacy services at Melfort Union Hospital. Approval for capital equipment funding and appropriate staffing was granted in August, 1982 for conversion to a unit dose drug distribution system at Melfort Union Hospital. All necessary packaging equipment, kardexes, forms and supplies were ordered in September and had arrived by November 1982, the same time a second pharmacist was hired. Prepackaging began in December for the proposed unit dose starting date of January 6, 1983. Inservices were performed to nursing three times prior to the implementation of unit dose on our 30 bed medical floor on January 6, 1983. During implementation one pharmacist spent a great deal of time with the nurses to ensure proper use of the system. Numerous meetings were held to correct the minor flaws inherent in any new system. Normal resistance to change was experienced, taking about 3 weeks to subside. Clinical services such as patient counselling, a monthly drug information bulletin and a formulary have been developed. These changes were not difficult and have provided a superior pharmacy service at a reasonable cost.


Integration of design elements creates productive environments.


Length of stays high, expenditures are rising for mental health services, says Fact Book.


Developments under the Freedom of Information Act--1983.


How flexible benefits affect rising health costs.


Slicing away complexities of health care costs.


IRS opinion that nonprofits can have profit-sharing plans stimulates public sector interest.


A.S. Hansen survey. Health education now being used for cost control.


Mercer-Meidinger on setting hospital discounts.


Segal discusses preferred provider organizations.


Their own brand of industrial justice: arbitrators' excesses in discharge cases.


One way to teach malpractice: 'Sue a resident on his first day'.


Ethical concerns in the practice of emergency medicine.


Innovative concept would grant laymen tax credits for attending health meetings.


Utility and equity: attributable risk or relative risk as tools for planning health care with limited resources.


The quality of medical care in outpatient imaging centers.


Will our health system fall apart? The need for a new paradigm. It is a truism that medicine is in a crisis but the truism is right. This paper sets out the symptoms of the crisis. The effectiveness of modern medicine has been questioned by many. Doctors use too many tests and do not always understand the results. This is the practice of 'decerebrate medicine'. The alleged triumphs of modern medicine have made only a modest impact on mortality rates and death from iatrogenic causes is real. Modern medicine is allied to the industrial society with its hierarchies and division of work. This leads to tensions between doctors and between doctors and their patients. Administrators fear the progressive rise in health costs and ask whether more really means better. Economists demand evaluation of medical procedures and there is a growing demand for real preventive medicine. Health is a problem for the whole of society. This paper then sets out the epistemological aspects of the crisis in medicine. It suggests that a new paradigm must be constructed in the light of the scientific revolution. The concept of medicine based on analytical science with its reductionism and disjunctivism is not enough to cover the complexity of man. The new paradigm needs to embrace all the sciences, both of nature and of man. A view is given of how this process of comprehending an exceedingly complex problem should be tackled and the role to be played by information sciences.


Selecting a health indicator for comparative health surveys among different social categories using employment as example. In the last decade a number of subjective health indicators have been developed and validated. In view of the investment involved in developing a new one, a researcher designing a health survey will preferably choose one of the existing indicators. To facilitate such a choice, a set of criteria is developed. Six existing indicators are valued according to the stipulated criteria. Unemployment is taken as the example because there is a demand for comparative health surveys between unemployed and employed in order to validate findings in the unemployment literature. The comparison of the health of unemployed and employed is used as an example on the basis of which more general statements can be made about the comparison of the health of people in other polar social roles like divorced versus married, immigrants versus residents, that involve a transition from one social role to another.


The role of clinical epidemiology in medical practice. Epidemiological research has been carried out traditionally in the field on non-clinical populations and has sought to reveal the aetiology of disease. But in the 1960's a possible role for epidemiology in the study of clinical practice emerged. A series of articles on scientific methodology and clinical medicine argued that much of the reasoning underpinning clinical practice might be expressed in numerical terms. This numerical expression would require the counting of diseases and events in groups of patients and would thus employ similar methods to traditional epidemiology where diseases are counted in populations. Although the term 'clinical epidemiology' was introduced as early as 1938, Sackett was instrumental in promoting the concept in 1969 as the 'application by a physician... of epidemiologic and biometric methods to the study of the diagnostic and therapeutic process in order to effect an improvement in health'. The management of individual patients involves the clinician in a multitude of decisions, concerned with making a diagnosis, ordering tests, prescribing treatment and estimating prognosis. Decisions are often made in a state of uncertainty because no reasonably objective information is available to indicate the best decision in the given circumstances, or because the most appropriate sequence of decisions for an individual patient is not apparent. Although the state of the art does not allow us to do this completely, the role of clinical epidemiology is, by way of clinical research, to provide clinicians with the information to make decisions that are most appropriate for the welfare of their patients, and in combination with information derived from decision theory to make these decisions rapidly and logically.(ABSTRACT TRUNCATED AT 250 WORDS)


Technology assessment in the U.S.A.

Technology assessment in the U.S.A.


When the press meets you....

When the press meets you....


Finding the right system.

Finding the right system.


When you meet the press.

When you meet the press.


A fertile ground for marketing.

A fertile ground for marketing.


Preparing funding proposals: a component checklist.


Quality assurance: building trust. Part 1.


Responding to a crisis: the role of the hospital board.


When the press calls...what do you do?

When the press calls...what do you do?


Expectations, evaluations & standards.

Expectations, evaluations & standards.


Stevens Point packages wellness.

Stevens Point packages wellness.


How to feed patients during emergencies & low census periods.


Hospitals test the wellness market.

Hospitals test the wellness market.


If it reads like a business letter--tear the page up!


Physician support keyed to hospital marketing success.


Statistical considerations in the design, analysis, and interpretation of comparative clinical studies. Comparative clinical studies are extensively used as a basis of support for the potential approval of treatments by the Food and Drug Administration and also for other general health policy decisions. The purpose of this paper is to review statistical principles that are relevant to the design, analysis, and interpretation of comparative clinical studies. Three general criteria are emphasized: clarity, comparability, and generalizability. These criteria are discussed in terms of their implications to such considerations as scope of patient population, sample size, randomization, and covariance analysis. Also, an extensive reference list further addressing these topics is presented.


Comparative clinical trials--a clinical perspective.


Inspection of computer-supported toxicological data submitted to the FDA. The FDA's Good Laboratory Practice Regulations (GLP) have been formally amended (once) and two formed advisory opinions have been issued. The FDA is now in the process of reviewing the GLPs to comply with both the Regulatory Flexibility Act of 1980 and Executive Order 12291 of 1981. Inspections since 1979 have revealed compliance progress; however, certain areas of the GLPs have been a problem--the definition of "raw data," the documentation process for the maintenance of "raw data," standard operating procedures, and study protocols. The increasing use of computers for supporting toxicology/pathology studies raises several questions concerning the impact of the GLPs on computerized data collection/reporting. This paper will address the above questions and discuss systems, procedures, interpretations, and some unresolved problems, as well as provide practical approaches for internal review of computer-supported nonclinical laboratory studies.


Hospital utilization: an epidemiologic perspective on possible future trends. Like the noted Mr. Holmes, epidemiologists work with details. This article focuses upon the use of detailed epidemiologic data to explore potential changes in hospital service utilization during the next decade. Although epidemiologists share with Mr. Holmes a commitment to inductive reasoning based on specific data, only a fictional detective would claim infallibility. In practice, data describing human populations are limited, inferences fragile, and changes always possible. These cautions need to be kept in mind when estimating future trends.


Query/response. Productivity.

Query/response. Productivity.


Overnight accommodations for visitors and outpatients: a nationwide study. With the trend toward greater emphasis on ambulatory care and preadmission testing and the need to minimize travel and lodging costs for visitors and outpatients, a closer look at the hospital's role in arranging overnight accommodations becomes necessary. Unfortunately, little literature is available concerning the different types of overnight accommodations arranged by hospitals. The hospital interested in information on how it might upgrade its services to visitors and outpatients must rely primarily on brief descriptions of individual situations such as hospital-owned hotels or hostels and Ronald McDonald Houses. Although the literature indicates that some hospitals do offer some types of overnight accommodation services, the array of arrangements available and the level of hospital involvement is not always clear. Given this lack of information, the staff of the Patient and Visitor Participation Project of the University of Michigan Hospitals decided to conduct a nationwide study.


Hunger--Chicago. The Cook County Nutritional Surveillance Project.


"A national tragedy." The task force that could not find hunger but found a block grant instead.


No more blue sky forecasts.

No more blue sky forecasts.


The opinion poll approach.

The opinion poll approach.


Shuttle diplomacy can win support.

Shuttle diplomacy can win support.


Pharmacist meets the patient.

Pharmacist meets the patient.


Darenth Park: countdown to closure.

Darenth Park: countdown to closure.


A pharmacist among the social workers.

A pharmacist among the social workers.


A look back before leaping forward.

A look back before leaping forward.


Planning the Mereworth way.

Planning the Mereworth way.


When incompetence at work equals misconduct.


DHSS library: Elephant's memory bank.

DHSS library: Elephant's memory bank.


Women in the NHS.

Women in the NHS.


Overseeing the care of an ill relative from a distance proves difficult, help is here.


Salary growth near inflation rate in 1984.


Social service training in turmoil.

Social service training in turmoil.


Advances in surgery. A cut above the rest.


Michigan. University organizes 1st HHA Administrator Program.


Wales today.

Wales today.


Health authority performance indicators.


Management, budgeting and the use of resources--a private sector view. This very brief talk can only scratch at the surface of the way in which we approach these matters within AMI. I would remind you that we are very small in comparison with the national health service, and what is effective for us, may not be effective for you. Our philosophy is to give the manager responsibility, along with authority to act, to control the direction of the organisation centrally, but to delegate downwards the detailed day to day decision making, to measure managerial performance by results, and to emphasise above all the quality of the service we provide to our patients. Our various management structures are pyramid-shaped and identify a responsible leader at each level of the organisation. Our budgeting process enables us to set our financial plans, and our financial control process enables us to measure progress against those plans. Finally, I referred to the vitally important part which our people play translating that management philosophy and those goals and objectives into reality and our efforts to equip those people through training programmes to meet the heavy demands which we place upon them. In summary, we select the right person, train him, provide him with the necessary resources, motivate him and leave him alone to do the job. Whether any of this is of relevance to you in the national health service is for you to judge. My suspicion is that if there is relevance, it is to do with attitudes and expectations and demands and performance, rather than simply in structures and systems and organisational charts.


Another health care system: a visit to Newfoundland.


Management budgets after Griffiths: impact on the management process.


Planning in the French health care system--the example of the Assistance Publique de Paris.


Consent to medical treatment: the choice is yours.


Problems of patients waiting for orthopaedic out-patient appointments.


Working abroad--time for a new perspective?


Building and engineering assets--a total information system to support cost effective management.


Microprocessor nurse call handsets--an application of advanced electronics for easier patient operation and greatly reduced maintenance costs.


Family selection of long-term care services: it's not just the facility that's important.


Essendon and District Memorial Hospital.


Is the future of health marketing going to be directed by videotex systems?


Challenges in marketing mental health senior services.


Skilled nursing facility marketing: a better piece of pie.


The medical marketing audit: technique for today's competitive extended care environment.


Marketing services for seniors.

Marketing services for seniors.


Control of the marketing effort in health care organizations.


Queen Victoria Medical Centre--how the South Eastern Medical Complex got off the ground.


Summary statistics describe 131 operational coalitions.


SC Court of Appeals establishes rule on malpractice informed consent.


West Virginia hospital board composition law challenged; TRO denied.


Illinois attorney general defines due process requirements for medical staff applicants.


Small-shop friendliness in big sky country.


Mix & match: the problems of display merchandising.


Promotions for profit.

Promotions for profit.


Planning for change.

Planning for change.


"Big" isn't everything, Part I.

"Big" isn't everything, Part I.


My cup runneth over.

My cup runneth over.


A look at job descriptions. Who does what.


Ring up sales with good telephone technique.


It's show time!

It's show time!


Holiday buying.

Holiday buying.


Gifts for the older person.

Gifts for the older person.


Christmas is coming (it's that time again!).


The effects of emotional support on perceived job stress and strain.


Enforcing ethics in social work.

Enforcing ethics in social work. The attention paid by the social work profession to ethical issues has waxed and waned since the formal inauguration of the profession in the late 19th century. For the first half century of the profession's life, relatively little attention was devoted to problems of professional ethics, though social work's literature was filled with discussions of value-laden issues that arise in practice. In recent years, interest in professional ethics has increased substantially. This article discusses the growth of interest in professional ethics, the formulation of the social work code of ethics, the adjudication of grievances in social work, and the strengths and limitations of the profession's code.


The importance of employee expectations in organizational diagnosis.


Management conference accents success through change.


Codes of professional responsibility for lawyers: ethics or law? The American Bar Association has three times in this century produced a code of ethics for lawyers. The movement has clearly been from a general, hortatory format to one of a statement of principles of law. In the ABA's latest effort, the problems of client confidentiality loom as the most serious and most difficult to solve. The question of ethics versus law weighs heavily in this context, and the ABA's latest resolutions of the confidentiality problems are found to be unsatisfactory.


The ethics of profession in dental medicine. Changes in technology, public policy, and the multi-dimensional relationships of professionals have resulted in renewed interest in the ethics of health care practitioners. This article considers the obligation of dentists to a life of morality in common with all humanity. Additional responsibilities are incurred by a practitioner of dental medicine in keeping the moral rule to "do your duty." These duties are explicated utilizing three classical characteristics of a professional. The Principles of Ethics and Code of Professional Conduct of the American Dental Association are the dental profession's guide to ethical conduct. The Principles and Code are traced in their development, reviewed in their content, and critiqued in comparison to the ethical obligations of the dentist as previously delineated. The use of the Principles and Code as a basis for professional self-government is evaluated.


Are codes of professional ethics ethical? This essay reviews and situates codes of professional ethics within the general field of ethics and considers the specific characteristics of such codes. In the process, the author argues against the view that one's professional role and code take precedence over other roles or codes. One's personal value system, once clarified and criticized, provides the appropriate basis from which to continuously assess our codes of professional ethics.


Hospitals face turbulent times.

Hospitals face turbulent times.


Codes of medical ethics.

Codes of medical ethics. With one of the oldest codes of ethics in history, the medical profession continues to arouse controversy. This author examines the fifth major revision of the American Medical Association's code of ethics, published in 1957. Within this revision are the basic premises in establishing a medical code of ethics. Subsequent ethical dilemmas, involving technology, for example, can still be applied to the 1957 fundamental code.


Ethics in hospital and health administration. Until recently, hospital and health administrators had no formal code of ethics, despite growing ethical dilemmas within the field. This essay defines those ethical issues as set forth in the 1941 Joint ACHA-American Hospital Association Committee's code of ethics. The present ACHA Ethics Committee is also described.


Articulating health promotion into a health services curriculum.


The American Nurses' Association's Code for Nurses: purposes, content, and enforceability. Using Levy's criteria of appraisal for a code of professional ethics, this article assesses the 1976 American Nurses' Association's Code for Nurses with Interpretive Statements in terms of purposes, specificity, inclusiveness, and enforceability. The assessment shows that the Code for Nurses meets generally accepted purposes for a code, contains enough specificity and inclusiveness to serve as a useful guide to professional conduct, and describes initial and follow-up action nurses can take when they witness questionable or inappropriate conduct that may adversely affect the patients' health care or safety. However, limited data are available regarding how the professional body has applied sanctions for violations of the Code. Further study on this matter is indicated and, fortunately, is forthcoming by ANA in an ongoing, planned survey.


Medical confidentiality: can it still be protected?


Hospital manager role demanding more complex skills.


Interdisciplinary grand rounds. The fluoridation controversy: understanding the opposition and effectively meeting the challenge.


Labor cost-cutting options catalogue.

Labor cost-cutting options catalogue.


Malpractice arbitration agreements in Ohio and Michigan.


Manufacturers' duty to warn employees of occupational health hazards.


Nutritional deprivation to terminate a patient's life. In re Conroy, 190 N.J. Super. 453 (1983).


Professional liability insurance coverage. Dayno v. Argonaut Insurance Companies--Pa. Super.--464 A.2d 501 (1983).


The Aalto alternative.

The Aalto alternative.


Micromatrix. Computer lib.

Micromatrix. Computer lib.


The positive side of productivity for ambulatory care management.


Hospital cutbacks' effects on employee wages. Massachusetts Nurses Association v. Dukakis, 570 F. Supp. 628 (1st Cir., 1983).


Lessons learned from the Urban Health Network Program.


Community-based ambulatory health services: the logic of the 1960s.


Reducing the rate of missed appointments among patients new to a primary care clinic.


Practice management: an exploratory comparison of dentists and physicians.


Analyzing HMO membership patterns: a microcomputer application.


Where contract medicine has already led to chaos.


Here's a hands-on battle for referrals.

Here's a hands-on battle for referrals.


Economics of image and document handling: the changing role of micrographics. The various tasks associated with image and document handling are analyzed with respect to properties of competing technologies and media, such as micrographics, video technologies and interactive computer systems with magnetic or optical data disks. It is shown how changing economic parameters modify the spectrum of advantageous applications of micrographics. The benefits of integrating micrographics components into various types of computer-aided systems are emphasized.


Immanence and transcendence in pastoral care: some basic considerations. Sees pastoral care as the total response of pastor and congregation to people in crisis. Both immanent and transcendent aspects of such responsiveness are important. Immanence is being with troubled persons in understanding and dependable ways; transcendence is being sufficiently detached from the situation to make realistic assessments, identify growth goals, and find ways to facilitate spiritual growth. Both modes need to be combined in pastoral care as a form of crisis ministry. Discusses assumptions and methods for such a combination and illustrates with an actual case.


Using a computer in sterile services management.


New potshots at patient confidentiality.


Spiritual and religious need of mentally retarded persons. Describes the special spiritual and religious needs of the mentally retarded, at the same time proclaiming the necessity of thinking of them firstly as persons. Gives specific illustrations of how the spiritual and religious needs of the mentally retarded may be met by peers, chaplains, and family members. Offers a personal testimony on how the mentally retarded can contribute to the growth and insight of the caregiver.


Fair grades for sterile services staff.

Fair grades for sterile services staff.


The National Spinal Injuries Centre, Stoke Mandeville Hospital.


Cost of capital and investment strategy: guidelines for successful acquisitions.


South Carolina central laundry pays its own way while it expands.


Adequate linen supply, superior quality forgotten keys to quality patient care.


More teaching of compassion needed.

More teaching of compassion needed.


Laundry modernization program pays off--Bethesda Hospital cuts costs dramatically.


Renovations complete at 31 VA hospitals--cost of 89 laundries to reach $180-million.


I'm betting my bundle on NMR.

I'm betting my bundle on NMR.


The malpractice plaintiff wanted blood money.


Social differentials in the use of preventive and ambulatory care services.


Think big or sink. That's the best strategy in this competitive era.


How to survive a courtroom ambush.

How to survive a courtroom ambush.


How could so many people miss a phony doctor?


The earnings gap is hurting all of us.

The earnings gap is hurting all of us.


Your most dangerous malpractice gamble.

Your most dangerous malpractice gamble.


The industry is tuning out on direct-to-consumer advertising.


Suicide and public policy: a critique of the "new consensus". Several writers have recently developed proposals calling for a public policy that would allow a number of individuals to commit suicide if they so choose. Suicide, it is argued, is a fundamental matter of personal liberty and as such only very minimal restrictions should be placed on it. In this essay I offer a critique of these views and the public policies they entail. The result is a defense of the general outlines of current professional and legal policies which permit intervention, even coercive intervention, with suicidal persons in almost every case.


The workstation: a new way to mine the wealth of research information. The IMSPACT system.


Evaluating supervisory candidates by their meeting performance.


Developing cost awareness at the bench.

Developing cost awareness at the bench.


Faster, easier cost accounting by personal computer.


A case review system for chemistry QA.

A case review system for chemistry QA.


Alternative services. Investors cool on hospital companies while interest in alternatives heats up.


FDA's approval of MRI units warms up insurers and competition in industry.


Layout, scale of children's hospitals should consider kids' special needs.


Financial pressures force hospitals to take a second look at incentives.


Medical megatrends reshaping delivery and evaluation of care.


Product manager must decide what products to market and how.


Being patients' 'personal' hospital is survival strategy in hard times.


Hospital 'mechanism' urged for review of bioethical issues.


Experts urge hospitals to wait on purchase of expensive MRI.


New payment system sparks interest in computer systems.


Marketing efforts yield profits for hospital wellness programs.


Hospitals find efficient designs can boost workers' productivity.


New RAHBs offer Good Samaritan short-term liquidity, long-term security.


Bid to build hospital is greeted by stiff competition in Silicon Valley.


Job security called key to dispute as 6,000 Twin Cities nurses strike.


Jury will decide if call to sick patient is 'outrageous' debt-collecting tactic.


Associated, United tying merger knot.

Associated, United tying merger knot.


For-profit chain's plans to acquire Catholic hospital riles association.


Hospitals are selling their ability to cut big employers' health costs.


Employers battle rising healthcare costs, but their efforts lack direction.


Employers urged to overhaul benefits, to promote use of alternate services.


HCA tests health plan on its own workers before marketing it nationally.


Participative management is an ethical imperative. Sashkin presents a model of participative management and contends that when value biases are absent and the need for skillful application and management are taken into account, participative management is effective. When properly implemented, participative management fulfills three basic human work needs--the need for autonomy or control over one's behavior, the need for completion or achievement of a whole task, and the need for interpersonal contact in the context of work. Failure to fulfill these needs can have serious consequences: Employees may be harmed both psychologically and physically. Thus organizations may be killing their employees--but not with kindness. Sashkin argues that it is unethical to manage in any way but participatively if one adheres to the fundamental values of Western civilization. Thus participative management is an ethical imperative. With this in mind, he provides some action guidelines for managers, organizations, and management educators.


Most consumers would accept lower quality hospital care to save money.


Clinic zeros-in on fitness.

Clinic zeros-in on fitness.


The Blues continue early discharge program.


Cut expenses by attacking chronic absenteeism.


Getting tough on professional patients.

Getting tough on professional patients.


Laboratory management: lessons from the Japanese. The laboratory director needs numerous technical and management skills to perform effectively. However, the study of management is often neglected in residency training programs. R.T. Pascale and A.G. Athos, in the Art of Japanese Management, offer seven parameters that can be used to evaluate the management of an organization. Here, the author discusses these corporate concepts as they relate to the laboratory.


HCFA lab task force urges 60 percent fee schedule, direct billing.


What do technologists expect of pathologists? The results of an informal survey that explored technologists' expectations of pathologists are examined in this article. The poll served as the basis of the author's presentation at a CAP seminar titled "Effective Laboratory Communications," held at a past CAP/ASCP Spring Meeting.


Teaching residents to teach patients.

Teaching residents to teach patients.


Absenteeism control.

Absenteeism control.


In praise of performance.

In praise of performance.


Are PPOs the answer to rising health care costs?


The 10 most common interviewing mistakes.


Using home monitors for infant apnea.

Using home monitors for infant apnea.


Shift workers.

Shift workers.


Avoid the traps of relying on interviews.


The when, why & how of discipline.

The when, why & how of discipline.


Quality circles, fine--what next?

Quality circles, fine--what next?


Help employees motivate themselves.

Help employees motivate themselves.


Outplacement services at Interfaith Medical Center.


Ways to encourage cooperative problem solving. Making conflict productive.


How will hospital pharmacy respond to today's major pressures?


The development of hospital wide patient-education director competencies. Members of the patient-education divisions of the Michigan Society of Healthcare Education and Training and the Great Lakes Chapter of the Society of Public Health Education drafted a model job description and related competencies, using representative position descriptions and a role delineation project as a basis. The product of this effort can serve as a model for hospital administrators hiring patient educators, professional organizations supporting patient education, universities and colleges training such specialists, and patient-education specialists pursuing continuing education.


Reading materials used in the preparation of nurses for the teaching role. Patient/client teaching is an important responsibility of the practicing nurse. Various health manpower task forces have recommended that all professionals engaged in health teaching be better prepared for this role. Others have cited the need for client/family education programs as one of the national priorities in nursing research. A study was undertaken to ascertain patient-teaching content and types of assigned readings used in baccalaureate nursing programs throughout the United States. Questionnaires were mailed to a random sample of 108 schools of nursing. The response rate was 83%. Fewer than one half of the nursing programs reported using resources that included the actual process of health teaching. Most schools did report the inclusion of key teaching concepts, such as learning theories and principles of teaching in their curricula, yet the assigned readings to provide the content were absent.


Life-style intervention: a conceptual framework. Improving one's life-style may improve one's health. However, there is a lack of consensus on how to promote compliance with newly adopted health habits. This paper presents a conceptual framework that individuals can learn to assess their life-styles and plan for health-behavior changes. It can also be used by professionals from different disciplines who are developing programs to teach healthy life-style choices. The framework is organized into three ideas: (1) Health status to a large extent reflects the individual's styles of living (a composite of beliefs, emotions, and action patterns). (2) These styles can be encouraged or sabotaged by the individual's support structures (relationships, environments, and equipment). (3) The change process can be seen as a series of steps that cycle through phases of readiness appraisal, decision making, experimentation, and reevaluation. clinical examples and documentation from relevant theory and research illustrate and substantiate the framework.


How corporations are trying to control health care spending.


Administrative and management issues in developing a health-education component of a large HMO: a case study. A case study of the development of the health-education component of a large, complex health maintenance organization is based on the first three years. The structure and management is described along with programmatic examples and descriptions of activities. Issues are generalized from the problems that have evolved and discussed in terms of broad health education and organizational development points. The issues of structure, function, and accountability; financing; program objectives, priority setting, and strategy; and evaluation are interrelated.


High technology and home health care. Proceedings from the PRIDE Institute Conference, December 8, 1983.


Medical education concerns new AOA president. Interview by Gail Finlayson.


Evaluating patients for their applicability to home dialysis.


CAPD: an evolving technology in home dialysis.


Chemotherapy.

Chemotherapy.


The acquisition experience. Another perspective.


Applications of technology: morning session. Introduction.


High technology and home health care. Future directions: research and development.


Information technology: 2. Using personal computers to increase the productivity of compensation specialists. Primarily intended for the computer novice, this article includes information that may be helpful to compensation specialists who already have access to a personal computer. No novice himself, author Henry L. Russ, Jr. is manager, compensation policies & practices, for R. J. Reynolds industries, Inc. Pointing to the greater versatility and lower cost of personal computers (in comparison with terminals), he describes how their prowess at recordkeeping/word processing, and performing "what if" calculations in compensation analysis frees those working with compensation to address objectives that previously went unmet because no one had time for them. Compensation programs that provide this "what if" capability are sometimes referred to as a spreadsheet: a combination electronic scratch pad and calculator. Russ shows precisely how such spreadsheets are used to manipulate compensation data, cites available spreadsheet software and functions, and points to survey results showing the many ways in which personal computers are being used by the compensation departments of major consumer product companies.


Strategies for successful interpersonal negotiating. Human resources managers frequently find themselves in positions in which they must negotiate--with applicants, employees, subordinates, superiors, or peers. It is important, therefore, that they know the techniques that will enable them to wind up in an win/win situation. Authors Colette A. Frayne, doctoral candidate at the University of Washington, and Phillip L. Hunsaker, professor of management and director of management programs at the University of San Diego, spell out techniques to be used before, during, and after negotiations to reach the best possible solution for both sides.


Sociologist Paul Starr warns of bad business-medicine mix.


Move over CT and PET scans--make some room for BEAM.


Incidence of violent patient admissions apparently stabilized at 37 percent.


Information technology: 1. Planning and developing a human resources information system. for the unwary, planning and implementing an HRIS can present a variety of pitfalls. Author Albert L. Lederer, who spent ten years installing such systems before joining the faculty of the University of Pittsburgh (as assistant professor of business administration), is fully cognizant of the pitfalls involved and the problems that personnel departments encounter in the process. After discussing what an HRIS can accomplish, he gives a thoroughgoing, detailed approach to developing such a system--from cost justification, to the personnel department's relationship with the data-processing department at each step, to deciding between buying a packaged system and developing a new system internally. Most important, he emphasizes, is to define requirements precisely and completely at the outset--those who don't are in for a lot of costly headaches. Much more is covered in this comprehensive approach--not the least of which is (for packaged systems) vendor analysis and contract negotiation (the contract stipulates the vendor's responsibilities in terms of software, installation service, maintenance, training, and documentation). One popular strategy for negotiating a contract is to choose the best two vendors and compare their offers throughout the negotiation; this results in a contract with excellent leverage for the buyer.


Cooperation needed between universities, state institutions. Part I.


Bias against women persists in medicine.


Are you making the most of your crises?

Are you making the most of your crises?


What's ahead for special events.

What's ahead for special events.


The youthful suicide epidemic.

The youthful suicide epidemic.


X-ray report turnaround studies.

X-ray report turnaround studies. In the attempt to meet the diagnostic requirements of patients, satisfy referring physicians, respond to the mandates of hospital administration and conform to the cost-efficiency commandments of the federal government, most radiology managers realize that expediting the x-ray reporting process is fundamental. Turnaround, or time measurement, surveys are the mechanism by which a radiology manager documents the department's efficiency in producing the typewritten x-ray report. Such surveys measure the time lapse between when a radiographic examination is performed and when the typewritten report is received by physician or nursing station. Turnaround studies reveal the reasons for poor reporting, whether originating from personnel inadequacies or organizational pitfalls. Equal in importance to the gathering of time flow statistics are the problem-solving methods which follow.


Monitoring the iodine dose.

Monitoring the iodine dose. The administration of large amounts of iodinated contrast media can result in acute renal failure. Many diagnostic examinations, including pyelography, computed tomography and digital vascular imaging, require the injection of significant amounts of contrast media. Additionally, these examinations may be performed within 24-48 hours of each other, increasing the likelihood of a dose-induced acute renal failure. To avoid this complication, we have developed and implemented a system to monitor and control the patient's dose of iodine. This system effectively alerts individuals to the iodine dose the patient has received within the last 48 hours. The information is being used to compile a study concerning the relationship between iodine dose and the occurrence of acute renal failure.


Theory Z: a review of management styles and a proposal for change. Japanese management techniques have been the subject of much interest over the past few years. However, American culture does not lend itself to strict adherence to Japanese practices. Theory Z is a management philosophy that blends Japanese and American techniques and is currently being practiced in many areas of the business world. With some work, Theory Z can be incorporated into health care organizations in general,and radiology departments in particular.


Policies for managing the pregnant employee.


Learning to work with cliques in your department. The supervisor/manager deals with people every day. The basis for most worker behavior comes from interaction with their peers on the job. The effective manager must learn to understand and work with the various informal groups that form in the organization. He or she must understand how and why these groups form and how they are perpetuated. The effective manager can learn to use these cliques in the department to establish a spirit of cooperation and maintain the goals of the institution.


MR regulation: opportunity, risk and the freedom to fail.


Teleradiology: the use of slow-scan television in hospitals. Telemedicine has been practiced since the advent of the telephone, and the first video telemedicine applications were initiated in the late 1960s. With the proliferation of video screens being used as diagnostic aids, and as medical professionals seek ways to maximize their professional effectiveness, the technology of Slow-Scan Television has been adopted for routine use by radiology departments of hospitals throughout the United States and Canada. This article briefly describes the technology and diversity of current applications.


Management of the pregnant employee and pregnant patient.


NMR contrast media.

NMR contrast media.


The health planners dilemma and the problem of aggregation bias--an irresolvable conflict. This study examines the potential biases that may exist when data which are collected at one level of aggregation (e.g., the United States) are extrapolated to a smaller area of aggregation (e.g., a census region consisting of several states). Theory would predict that there would be inaccuracies resulting from such extrapolation but does not suggest whether the error would be of sufficient size as to have practical significance for a planner. This study clearly shows that attempting to predict smaller area hospitalizations with large area data is highly inaccurate. It is not only consistent with theory but also shows that the theory has practical value in assessing approaches to estimating hospitalization data. Faced with a need for diagnosis-specific data and the inability to directly acquire such data, health planners have been encouraged to use the approach of synthetic estimation.  This approach suggests that the planner can use disease-specific data collected for 1 area (e.g., United States), find correaltes of that data (e.g., age, race, sex) which are also available for a smaller area (e.g., a state) and then use the small area correlates to predict the disease-specific morbidity for the small area.  This study examines the potential biases that may exist in the stnthetic estimation of hospitalization and whether or not the degree of error that is introduced would have a significant impact on job decisions.  The general approach of the study is to form regression equations using relevant predicting variables at 1 ecological level, using several years of data at that level as the observations.  Then, the regression coefficients from these equations are applied to the corresponding predicting variables at an area of lower ecological level to develop a prediction of hospital discharges or admissions for the area of lower ecological level.  This prediction can then be verified against the actual of hospital discharges/admissions specific to the areas in question--Rhode Island is this study.  The findings show poor results of prediction when regional regression equation are applied to the Rhode Osland health service area.  It is argued that aggregation bias is the main reason for these poor results.  The loss of prediction accuracy due to the problem of aggregation bias approximately form 64.0%-84.3%.  This magnitude of error presents too great an impact on planning decisions to be of any use.  It is very difficult for local planners to estimate future hospital utilization by diagnosis for the purpose of health planning without primary data collection.  However, this is often impossible for competitive reasons or because it is discouraged by P.L. 93-641.  The authors argue that, because of the paucity of existing data about hospital utilization by diagnosis which palnners can use for health planning in their medical service areas, the efforts os systematic collection of such data in the private sector should be effectively encouraged by the Federal Government.


Nursing home residents mingle and chat over afternoon glass of wine.


West Park's elegance suits the elderly.

West Park's elegance suits the elderly.


Menu census 1984.

Menu census 1984.


Nutrition-education blitz: an idea whose time had come.


Menu combines patients' preferences with good nutrition.


Improving the productivity of service businesses. Service organizations account for over 60 percent of the GNP, yet management tools are less developed for this sector than for the manufacturing sector. This article describes a new approach to help evaluate and improve the productivity of many types of service organizations, identifies inefficiencies and ways to improve productivity, and provides examples of applications to hospitals and bank branches. These insights are not available from commonly used performance measures. The article presents procedures required to use this technique and discusses ways managers can assess its potential costs and benefits.


Contacting pregnant adolescents: are we missing cues?


Using peer support to prevent worker burnout.


Performance appraisal.

Performance appraisal.


A personalized approach to goal planning and evaluation in clinical settings. This article demonstrates a goal planning and evaluation method that focuses upon a client's behaviours or problem areas regardless of diagnosis or setting. Goal Attainment Scaling is described in terms of its procedures, scoring, advantages, precautions, and overall contribution to therapeutic recreation. Additionally, a case study is presented to demonstrate implementation of Goal Attainment Scaling.


Peer program review: a model for implementation of standards. Peer program review is examined as a method of program evaluation which utilizes established professional standards and, in turn, facilitates making these standards a pattern of practice. The relevance and implications of peer program review as well as a model for peer program review through a state therapeutic recreation society are discussed.


Does anybody have an extra hour I could borrow?. Interview by Wendy Francik.


James Farnsworth: a man of integrity. Interview by Wendy Francik.


Health promotion or regulation compliance? Smoking policies in Texas hospitals.


An interface between quality assurance and infection control.


The nurse-patient relationship. Legal liability v. professional responsibilities.


Setting up a quality control program for DLco.


Pediatric respiratory therapy beyond the neonatal ICU. This article is intended to generate interest in respiratory therapy for older infants and children by pointing out the special requirements and these patients and emphasizing the important role that respiratory therapists can have in their management.


Facility report. Division of Pulmonary and Critical Care Medicine, University of California, San Diego, School of Medicine. Activities and interests of this large division extend from conventional diagnostic procedures to sophisticated newer techniques and from teaching programs to research in collaboration with other regional medical facilities.


The Dialogue Cancer Support Group: learning to deal with the trauma of cancer.


Marketing: a survival strategy.

Marketing: a survival strategy.


From a birth amid cuts, HRSA growing stronger.


Organ shortage seen increasing.

Organ shortage seen increasing.


Advertising prescription drugs direct to the public. What are the issues?


Beliefs of service providers about abused women and abusing men.


How much are volunteers worth?

How much are volunteers worth?


Thoughts on the supervision of volunteers.


The no-apologies budget. How to justify the financial support a volunteer program deserves.


The quality of life of mentally retarded people in residential care.


More on cost containment. Part I.

More on cost containment. Part I.


TV's 'St. Elsewhere': a mirror to medicine?


Managers must meet to share ideas.

Managers must meet to share ideas.


Transplant legislation poses tough questions for Congress.


ACP opposes prescription drug ads for public.


Physicians and Madison Avenue--an alliance fraught with danger.


Guidelines for care of hopelessly ill patients....


Consumerism in hospitals--hospitals are, or should be, for people. The factory situation: are people seen as number patients or are they handled with care and compassion? Hospital care should aim at treatment of the whole person--role of non clinical services within hospitals, partnership with community--role of parents; better communication needed between treating professionals and patients--would reduce complaints and possible litigation; people wish to be partners with health professionals in their own treatment and recovery not articles on an assembly line; rights of patients to be given full facts of their illness and prospects for recovery. Who "pays the piper"? Medical audit, accountability, peer review; iatrogenesis or "doctor induced" illness e.g. adverse reaction to prescribed drugs, hospital induced infections, malnutrition, faulty diagnosis or failure to diagnose. Who motivates the provider and support personnel and how? Institutionalisation and its effects on treatment and recovery, attitudes by providers and receptors. New trends in treatment patterns and delivery facilities: high technology, birthing centers, is there a role for alternative professions within hospitals? Who looks after the consumer? Ombudsman , medical boards, licensing authorities, Australian Council on Hospital Standards.


Traditional versus technological care: future issues for nursing.


Smoker seg.

Smoker seg.


The hospital half hour.

The hospital half hour.


The challenge of new clinical developments. Developments arising from new discoveries already made and new technologies already developed will pose great challenges en route to the year 2000. Given the accelerating rate of change it is likely that new discoveries not yet contemplated will present even greater problems not just to the health professions but to the community and to our governments. The difficulties will lie equally in the clinical area and in social, financial, and ethical domains. One example which is worth addressing arises from the discovery of DNA which has led to new technologies with major implications in all these areas today, and a second one arises from the transformation in the care and survival of newborn babies.


Doctors, disease and demography--changing patterns. Over the past century major shifts have occurred in causes of morbidity and mortality in the population. Improved environmental conditions and control of infectious diseases have led to the emergence of the "new epidemics" of the so-called societal diseases. At the same time, the population has aged significantly in demographic terms. The major challenges facing health care services now require significant reorientation in thinking, especially in terms of objectives, definition of roles, allocation of resources and planning for the future. This paper explores some of the challenges, the competing interests involved, and the economic, social and political context in which these issues have emerged proposes a model for seeking resolution.


Investing for efficiency.

Investing for efficiency. The French Revolution set out to abolish hospitals but in fact strengthened them, made them the core of medicine and improved their effectiveness. Mortality rates more than halved between 1789 and 1850. This reduction was bought about by improvement and investment in old hospitals, appropriate separation of institutions and new administrative organisations. Our modern hospitals and institutions started with the French Revolution and have been going through similar cycles of neglect and abolition or concern and investment. This paper will look at the effects of investments, neglect and "pork- barrelling " by successive governments which has led to inappropriate locations of hospitals, sub-standard facilities, inefficient location of facilities within hospitals, outdated equipment, insufficient maintenance and dangers to public health and human safety. Operating costs, consequences of inefficient layout, buildings and sites within a number of Australian hospitals are then analysed. It is then suggested that orderly capital funding on a triennium basis be established in a similar way to university capital funding.


Surfeit of hyperbole and doctors.

Surfeit of hyperbole and doctors.


AMA rushing headlong into defeat.

AMA rushing headlong into defeat.


Visits to family planning service sites: United States, 1978.


Stroke survivors among the noninstitutionalized population 20 years of age and over: United States, 1977.


Employee health data and the law.

Employee health data and the law.


Patient profile, National Reporting System for Family Planning Services: United States, 1978.


Controls on the bidding process.

Controls on the bidding process.


The ten steps to smarter food buying.

The ten steps to smarter food buying.


Griffiths Report. How far down the road?


Securing your patients.

Securing your patients.


Grants help communities attack health costs.


New product development: can technique substitute for technology?


The future of U.S. participation in UNESCO.


Physician reimbursement reform. ACS Surgical Practice Department.


Science and technology programs in UNESCO. Summary of a Congressional Research Service Report.


Recognizing new specialists.

Recognizing new specialists.


The importance of general surgery to surgical specialists.


Defining the surgical oncologist.

Defining the surgical oncologist.


For-profit health care.

For-profit health care.


Technology in a changing environment.

Technology in a changing environment.


The hidden cost of "little ticket" advances.


An intervention strategy for controlling costly care.


Ethylene oxide; certain pesticide products registered for the sterilization of equipment and supplies in hospitals and health care facilities; withdrawal of revised labeling notice--EPA. Withdrawal of notice. EPA issued a notice requesting registrants of pesticide products containing ethylene oxide (EtO) registered for certain uses in hospitals and health care facilities to submit applications to amend approved labeling. Elsewhere in this issue of the Federal Register, the Occupational Safety and Health Administration (OSHA) has promulgated comprehensive exposure standards for all occupational uses of EtO. Therefore, EPA has decided to withdraw the original notice in recognition of concerns regarding the potential preemption of the OSHA standards.


Focus on the strengths of an aging work force, says Butler. Interview by Jane Stein.


Sizing up new technologies in Central Arizona.


Provider data and other criteria ADS selection.


Occupational exposure to ethylene oxide--OSHA. Final standard. In this Final Standard, the Occupational Safety and Health Administration (OSHA) establishes a permissible exposure limit for occupational exposure to ethylene oxide (EtO) of 1 part EtO per million parts of air (1 ppm) determined as an 8-hour time-weighted average concentration. The basis for this action is a determination by the Assistant Secretary, based on animal and human data, that exposure to EtO presents a carcinogenic, mutagenic, genotoxic, reproductive, neurologic and sensitization hazard to workers. The standard provides for, among other requirements, methods of exposure control, personal protective equipment, measurement of employee exposures, training, medical surveillance, signs and labels, regulated areas, emergency procedures and recordkeeping. An "action level" of 0.5 ppm as an 8-hour time-weighted average is established as the level above which employers must initiate certain compliance activities such as periodic employee exposure monitoring and medical surveillance. In instances where the employer can demonstrate that employee exposures are below the action level, the employer is not obligated to comply with most of the requirements set forth in this final rule. The 1 ppm 8-hour limit reduces significant risk from exposure to EtO and is considered by OSHA to be the lowest levels feasible.


Privacy Act of 1974: amendment of existing system of records--HHS. The Department of Health and Human Services proposes to amend system of records 09-90-0024. The specific changes to the notice are set forth below; and the system of records, as amended, is printed in its entirety.


Businesses drive to curb medical costs without much help from government.


High-tech miscreants beware: Congress is moving against computer crime.


Hospital finds cure for high-price projects.


Liability and societal obligation are bases for fetal protection laws.


Computing contingency plans. Emergency measures reduce the risks for EDP systems.


Coalition opens door to competition.

Coalition opens door to competition.


Do you have what it takes to be a great leader?


Meyer vs Gordon: a case study of obstetrical negligence.


The transplant debate continues: can we balance supply and demand?


States turning to public/private options to control health costs.


How you can participate in your hospital's accreditation process.


"Quality assurance in the laboratory".

"Quality assurance in the laboratory".


Organization is the key to cutting your costs.


Nurse practitioners in the medical group setting. To be at the leading edge in today's rapidly changing world of health care and respond to increasing consumer demands, medical groups must be willing to implement new concepts. The utilization of nurse practitioners is one such concept. Before implementation, however, the idea should be thoroughly reviewed from all standpoints, including role of the practitioner, education and training, scope and areas of practice, legalities, billing, third-party reimbursement, record documentation, income distribution, and control of practice. Nurse practitioners in the medical group setting can be helpful in increasing patient satisfaction and improving quality of care.


The conception and development of a clinical laboratory in the group practice setting. During the course of daily patient care, the need for clinical laboratory facilities presents itself over and over again. Many advantages can be realized by developing an in-house laboratory in the group practice setting: rapid test results, patient convenience, improved patient care, increased revenue, physician convenience, physician management, and prestige. An in-house clinical laboratory that is staffed by competent technicians, has a thorough quality control program, and is responsive to technological changes can play a very important role in the effective delivery of health care.


Employees take the lead and use quality circles to develop wellness programs.


Leadership demands a servant heart.

Leadership demands a servant heart. It takes much more than knowledge to become an outstanding leader today. Authoritative, moral, and sacrificial leadership must be evident in performance, and although increasingly uncommon in our society, involvement with our fellow human beings must go far beyond getting along with others. The true leader must have faith in the unlimited capacities of man, and be loyal, enthusiastic, and absolutely honest. Perhaps above all, he must be willing to pay the price of his position: he must serve his employees, not rule.


Psychological aspects of pain management of the burned child. Health professionals involved in the care of burned children frequently request assistance in the psychological aspects of pain management. In response to such requests, specific suggestions were developed based on the very limited fund of knowledge about pain in children.


Character and personality assessment in physician recruiting. The success of a medical group practice is dependent upon smooth communications between the group's physicians. By placing emphasis on compatibility during the hiring process, the administrator can improve his group's chances for success. Although it is impossible to reveal all potential problems beforehand, careful assessment of character and personality will lead to a more smoothly functioning clinic atmosphere.


Workers and companies benefit from phased retirement in Europe.


A preliminary evaluation of hospital preparation for nonpatient children: primary prevention in a "let's pretend hospital". This study evaluated the effectiveness of an innovative program about hospitalization presented to nonpatient children on a community-wide basis. The "Let's Pretend Hospital" (LPH) is an experiential and informational program wherein a mock hospital is set up for children to visit. The present study compared the self-reported medical fears and amount of medical knowledge for two groups of children--one that went through the LPH program and one that did not. The results provide preliminary evidence of LPH effectiveness in that children who participated in the program reported fewer medical fears and greater medical knowledge than children who did not participate. The potential benefits of this innovative program are demonstrated.


Reassuring and talking with hospitalized children. Some concepts and techniques have been organized into a flexible, sequential approach to discussing highly emotional topics with ill/hospitalized children and adolescents. The process is based on an eclectic, theoretical model that has been easily accepted and utilized by health care professionals. It includes identification of affect, rapport building, opening channels for socialized communication of emotions, and reassurance.


Policy and procedure manual. Drug recall program.


Awareness of Hispanic cultural issues in the health care setting. In view of the increasing numbers of Hispanics in this country, American health care professionals need to be aware of cultural differences between themselves and their Hispanic patients, especially where health practices are concerned. This paper deals with some of the health-related traditions, values, and beliefs held by various groups of Hispanic extraction in this country. A number of culture-specific disease entities and treatment modes are discussed, with special reference to patient behaviors and attitudes. Implications for health care delivery to Hispanic individuals and families are outlined, and suggestions for service providers are put forth.


New considerations for discharge planning.


Hospital-administered HHAs form state group.


DME contracting with hospitals.

DME contracting with hospitals.


What hospital administrators think of home care.


Referral arrangements revisited: the impact of the Hyde decision.


Home care plays a big role in the changing hospital industry.


Options for hospital/HHA arrangements.

Options for hospital/HHA arrangements.


Hospital and home care joint ventures.

Hospital and home care joint ventures.


Creative ventures in the home care market.


Hospital/HHA cooperative delivery models.


South Hills Health System/Home Health Agency.


Technology assessment.

Technology assessment.


Creighton University School of Nursing runs home health agency.


The Memphis VNA: from crisis--to conquest.


Home care: the answer to tomorrow's health care needs.


Gaining the competitive edge.

Gaining the competitive edge.


Determining the need for home health services.


Multiple employer trust guidelines stress careful selection, vigilance.


A description of the nuclear medicine service at the VAMC in Wood, Wisconsin. It is rare for a Nuclear Medicine Service to replace or add four gamma cameras within six months; it is more unusual for a Service to move to a totally renovated facility. And even more remarkable for a Service to add a large sophisticated imaging computer system, which converts the entire Service to an "all digital" image acquisition, interpretation and archiving (PACS) oriented service. At this Medical Center, we have had all three events occur simultaneously in the past year.


Computers in pharmacy: improve efficiency and productivity. In 1975, when most hospitals were still relegating computers to front-office use, John C. Lincoln Hospital, of Phoenix, Arizona recognized the need for better management of its pharmacy services. That "better way" was the use of a computer system to standardize routine manual procedures.


Additional revenues recoup automated pharmacy cost. The installation of a computerized pharmacy system at Cape Fear Valley Medical Center's pharmacy has improved revenues +5.50 per patient day--a 10% increase over like figures for the previous 5 months. A system that paid for itself in just fifteen days.


A computer system brings new efficiency to outpatient pharmacy.


Computerized materials management system aids cost control.


The case for sequential numbers. The KISS theory applied to identification--keep it sequentially simple.


"Compatibility and integration ...".

"Compatibility and integration ...".


Impact of maintenance insurance.

Impact of maintenance insurance.


Ten ways to provide technician training.


Computerized medical management system improves collections, increases efficiency.


"It's not the change that we fear ...".

"It's not the change that we fear ...".


How to prepare for your hospital information system. Part I.


The importance of software modularity.

The importance of software modularity.


Proposed shared service regulations published.


Study of 26 biomedical engineering programs.


Medical equipment insurance coverage.

Medical equipment insurance coverage.


Fetal monitoring problems during labor associated with most serious ob claims.


Hospital information systems: a key to profitability.


Antitrust considerations in hospital/home health agency relations.


'Don't worry, we can handle it'. A clinic administrator shares his experiences with computer companies.


The pharmacist in home health care: Part III--Safety, optimum use, and accountability of drugs.


Hospital/HHA relations--overview.

Hospital/HHA relations--overview.


The time has come for debating technology and rationing questions.


A primer for the new computer buyer trying to cure business growth problems.


The proliferation of standalones!! An interfacing dilemma.


Save 30 percent to 50 percent on your data processing costs?


Medical student education in the emergency department.


Organizational defenses against the anxiety of terminal illness: a case study. Working with the dying is a task which generates enormous anxiety in the caregiver as well as the entire organization which has taken on this assignment. This case study deals with a chronic care hospital and the organizational defense mechanisms observed by a consultant hired to do staff training and development. Further, there is a discussion of the training model devised to provide a facilitative means of tapping those defenses and working through the anxiety.


FCC regulation of EMS telecommunications.


Should EMTs be required to attend refresher courses for recertification?


Regulations and standards for emergency medical dispatchers: a model for state or region.


Inservice education--this is show biz.

Inservice education--this is show biz.


Aeromedical transport of the high-risk obstetrical patient.


Medical and dental staffing prospects in the NHS in England and Wales, 1983.


Orthopaedic audit: a comprehensive system for in-patients. Problem Oriented Summary, Audit, Discharge (POSAD) is presented as a system which permits auditing of in-patient admissions. It is prospective, comprehensive, simple to operate and generates an immediate discharge summary. it has replaced the conventional hospital discharge summary and therefore does not increase secretarial or medical workload. It can be run either as a paper-based system or computerized. The work profile and quality control information that has resulted from the 1982 auditing of the Hollywood Orthopaedic Service is presented. This service involves eight consultant orthopaedic staff who dealt with 2,322 hospital patient admissions in that year. Auditing/peer review has shown up wide variations in surgical behaviour and the workload undertaken by individuals. The information that has been produced has enabled the surgeons of this service to put into effect three significant innovations. These are: (a) Regular analysis of complications. (b) Rank ordering (comparison) of individual surgeons. (c) Ready access to current statistics.


Non-consultant peripheral clinics: a new approach to diabetic care. A system of non-consultant peripheral clinics (NCPCs) established on the Isle of Wight is described. For the first phase of the study 182 diabetics attending the consultant clinic were allocated to the appropriate peripheral clinic (group 1). In the second phase, 152 new referrals were prospectively allocated between the consultant and appropriate peripheral clinics (group 2). Evaluation was made of the patients' random blood sugar and glycosylated haemoglobin. The savings in cost and time to patients resulted in over 90% of patients preferring the peripheral clinics. NCPCs are discussed in relation to hospital-based clinics and to other alternative systems of care. It is concluded that NCPCs could be incorporated into the diabetic service in other regions in the United Kingdom with advantages to diabetics and hospital services alike. These peripheral clinics are suited to all types of diabetics and perhaps the only clinical restriction is the desirability for metabolic deterioration to be managed by a consultant clinic until the patient is satisfactory.


Hepatitis B immunization: experience in a provincial centre. A programme for identifying medical and para-medical personnel in a large provincial city at risk for hepatitis B with a view to immunization is described. 177 individuals were offered vaccine, but this was accepted by only 56%. The reasons for the low acceptance rate are discussed.


Spiritual emergencies. Chaplaincy program comforts hospital patients.


The initial hospital discharge note: send out with the patient or post?


EMS in the Soviet Union. Interview by Carl J. Post.


Patient satisfaction as related to selected nursing care activities in the emergency department.


The design of a new physician licensure examination. Many health professions include written examinations among their licensing procedures, and constructing these examinations poses special difficulties. For physician licensure the central dilemma is manifested by the longstanding tradition of undifferentiated licensure contrasting with the strong specialty orientation of contemporary physician training. This article details the authors' response to this problem and describes the resulting design of a new physician licensure examination. Using a combination of empirical data and expert judgment, descriptions of selected clinical encounters have been assembled as a practice model of a physician licensed for the delivery of general health care of patients. Application of an explicitly situational framework to the design of a physician licensure examination is unusual, and the approach is advocated for use with other health professions.


Factor-implied scales of ward atmosphere. Evaluation of environments in hospital settings with regard to their therapeutic qualities has been a problem for clinicians and evaluation specialists for sometime. The present project examined the Ward Atmosphere Scale (WAS) factor-analytically and derived second-order factors inconsistent with those proposed by the authors of the scale. Items of the WAS were arranged psychometrically into three scales as implied by the factor analysis. Results suggest that interpretation of the WAS can be simplified considerably if these three super-ordinate dimensions are used to organize item-level data.


Physicians' attitudes toward breast self-examination: a pilot study. Recent case control studies suggest that breast self-examination (BSE) is efficacious in the early clinical diagnosis of breast cancer. Population studies also indicate that adoption of this behavior depends largely on physicians. This pilot study was designed to determine whether physicians' attitudes on this subject could be obtained through a mail questionnaire. The results show that a self-administered mail questionnaire can be used successfully in physician studies. Although questionnaire length does affect response rates (78% one page, 69% four page, and 57% eight page), it does not affect either respondent characteristics or question response.


A deterministic theory of clinical performance rating: promising early results. The proposed theory provides a basis for both measuring and correcting rater stringency error in some grossly incomplete rating data matrices. The theoretical model fit (R = .92, .85, .82; joint p less than .000001) ratings made by faculty and resident physicians (n = 47, 31, and 29) of student clinical performance in each of three junior year medical student cohorts (n = 29, 30, and 35) better than alternative models. In these data the percentage of variation attributable to stringency and ability was about 35 and 40, respectively. Three-month test-retest reliability for rater stringencies was .16 less than r less than .29 (joint p less than .04). Cross-validation supported the proposed model (r = .61) over the conventional alternative (r = .41; z = 2.62, p less than .004). Both reliability and convergent validity of the ability construct were .20 greater for one corrected rating than for one observed (uncorrected) rating.


Needs assessment and hospice planning in a rural setting. A needs assessment is a research and planning activity designed to determine a community's service needs and utilization patterns. One of the most practical ways to plan services is to gather information accurately about a defined population and use that information to revise existing programs or develop new ones. Unfortunately, needs assessment findings often go unused. This article describes how a needs assessment was designed to assess the need for hospice services in a rural Pennsylvania county and how the results of this assessment were useful in determining priorities for program planning and service development. The implications of a model needs assessment such as the one proposed are discussed.


Similarities and differences between mental health and health care evaluation studies assessing consumer satisfaction. This paper compares the literatures assessing consumer satisfaction with health care and mental health treatment. Similarities and differences in the quantity, origins, quality, methodology, results, and utilization of findings are examined. The similarities identified far outweigh the differences. The trend toward carefully constructed high quality studies in the health care field is seen as suggesting a promising direction for future research.


Patient satisfaction with mental health services: a meta-analysis to establish norms. Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.


Defining and measuring patient satisfaction with medical care. This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.


Conceptual and methodologic issues in the evaluation of children's satisfaction with their mental health care. The assessment of client satisfaction has become an important aspect of evaluation research in the adult mental health field, but there has been relatively little extension of that approach to the child client population. This is due to the lack of adequate methodologies for assessing treatment satisfaction in children and to the overriding conceptual issues which make it difficult to develop such measures. Further information is needed to clarify developmental differences in the way both healthy as well as medically and psychiatrically ill children conceptualize illness and treatment. The authors suggest that specific methodologies for assessing child satisfaction with treatment can be systematically developed once a more explicit developmental framework has been delineated in the area of children's understanding of medical and psychiatric disorders and their treatments.