Marketing health services: the engineering of satisfaction. Service marketing is the engineering of satisfaction, and the key to success is to identify and influence potential customers' expectations and then to fulfill those expectations. Patient satisfaction largely determines both a program's revenues and expenditures and the effectiveness of care received by patients. A program's ability to satisfy patients rests upon three basic elements: research, design, and communication. Research should be on two levels. The first is basic market assessment and analysis, and should reveal overall market potential by focusing on consumers' expectations, unmet needs, and level of satisfaction. From this stage of research, the organization should be able to identify current programs that are secure and stable, those which have significant growth potential, those which are threatened by competition, and those which have little future. This research also should indicate the potential for new programs and for new markets for existing programs. The second level of research focuses on a specific program (whether current or proposed) and is the basis for program design. The organization can tailor the program to consumers' expectations in everything from services provided to price of parking and other amenities. Research also provides a basis for communications. Not only can communications influence a potential customer to try a provider, but also care providers can use communications during and after the service experience to reinforce what might have been a casual decision. Ideally, all communication that occurs between patients and providers should serve marketing as well as diagnostic and therapeutic purposes. It can shape patients' expectations, reinforce satisfaction when those expectations have been fulfilled, and convey the provider's caring and concern.


Industry notes.

Industry notes.


When values compete: ethics committees and consensus. When conflict arises between physicians's commitments to prolong life and to relieve suffering, health care providers must assess the purpose of medical practice. Concepts that must be clarified and translated into action are "quality of life," "relief of suffering," "inevitable death," and "normal care." A multidisciplinary ethics committee brings together individuals with varied backgrounds: those with philosophic or religious training, physicians, nurses, administrators, attorneys, and others. Consultation among these persons representing the intellectual cultures in the health care structure can benefit the quest for the "right" decision. In a similar way, an ad hoc coalition of representatives from various groups, including The Catholic Health Association, agreed on the language of an amendment to SB 1003, which mandates ethics committees to recommend guidelines for treating handicapped newborns. In addition to examining scientific issues (e.g., brain damage, permanent unconsciousness) and humanistic concerns (e.g., the guidance provided by religious beliefs, incompetent patients), the committee would on occasion sponsor a subcommittee to deal with a specific patient problem in which preservation of privacy precludes large-group discussion. Such a subcommittee could also approach a range of questions beyond the use of life-sustaining treatment, such as consultative practices and physician and hospital fees. To be effective in improving quality and appropriateness of health care, ethics committees must relentlessly deal in a frank manner with the problems of contemporary medical practice. They must not avoid contentious problems or protect hospitals and physicians rather than patients.


Developing a PPO: challenges and benefits. When deciding upon which kind of alternative delivery system to develop, Saint Vincent Charity Hospital and Health Center, Cleveland, selected the preferred provider organization (PPO) mode because of four basic advantages: (1) the health care consumer's freedom to choose providers; (2) effective cost containment; (3) coordination of services among allied providers; and (4) health promotion programs. More specifically, the Ohio Health Choice Plan (OHCP) benefits hospitals by assisting to maintain or increase market share, facilitating prompt claims payments, and improving financial mix. Physicians benefit not only because they receive prompt payment and are not a risk but also because the fee-for-service system is retained and their market shares can also be preserved or enhanced. Employers' advantages include savings through controlled utilization, positive employee relations, and improved management information. Employees' benefits include lower out-of-pocket costs and freedom of choice. As a full-service PPO, the organization provides benefits plans designed to meet each employer's needs as well as actuary services, claims screening and processing, benefits coordination, utilization control, management reporting, health promotion activities, and networking capabilities. Four major challenges do confront PPOs: 1. Start-up and operating costs can be significant; 2. The administrative skills required are different from those used in traditional health care systems; 3. The commitment in implementing and operating a PPO; and 4. All participating providers must genuinely accept the PPO. A PPO's success also can be measured in three ways: the development of a strong network; size of enrollment; and effectiveness in utilization control.(ABSTRACT TRUNCATED AT 250 WORDS)


Pain and plenty. Income polarization and health in the '80's.


Anointing of the sick: community celebration. With the recent more celebrative attitude toward the sacraments comes the concern that people will not recognize the ceremonies' call to conversion and to the sharing in Christ's mystery--experiences that occur during life's crises, such as serious illness. The Anointing of the Sick permits the recipient to witness Christ's own suffering and thus is much more than a "blessing" for individuals. It is a rite that must be celebrated in the context of the community's total pastoral life as part of an overall program of care of the sick. This community attention to the sick encourages anointing as soon as serious sickness is apparent, when the recipient can enter the ceremony consciously. The sacrament can be fruitfully celebrated with unconscious persons, however. With friends and relatives present, the event can minister to the community as well as to the sick person. Sickness should not be too narrowly defined. Elderly, suicidal, or alcoholic persons who wish to relate their conditions with Christ's sufferings can benefit from this sacrament. The need for anointing is often greatest in the health care setting, where time may be lacking for proper catechesis or celebration. To remedy this, pastoral care personnel can prepare a brochure explaining to patients and families the facility's sacramental practice and can encourage family and staff members to be present at the rite. They can avoid administering the sacrament hurriedly. These actions focus on the purpose of the anointing: to provide an opportunity for people to join in a celebration of their faith.


Communicating hospitals' concerns to legislators and the community. The time is past when voluntary hospitals could afford to be uninformed and inactive in public affairs. As decisions in the public sector increasingly threaten not-for-profit institutions, Catholic hospitals particularly must pursue an action-oriented program of communication with legislators and the community. At Carney Hospital, Boston, an especially effective forum for the past eight years has been buffet dinners held on a quarterly basis with state and congressional legislators and representatives of the hospital's management team, board of trustees, associate board, and medical staff. These dinner meetings provide a singular opportunity for law-makers to learn hospitals' perspective on key issues such as the effect of tightened reimbursement on care of the poor. The dinners not only have enhanced relations with legislators but also raised the consciousness of the business community, consumers, and the general public. Frequent mailings to legislators and members of the board of trustees and the associate board also have beeN helpful. The associate board was formed to augment the expertise of the board to trustees and to increase lay participation in the hospital's affairs. Composed of 20 lay leaders representing a diversity of disciplines, the associate board provides a strong base for influencing public policy and community action. Moreover, the hospital's various constituencies--physicians, employees, volunteers, and auxilians-are recruited as appropriate to contact legislators, write letters to the editor, and give media interviews. Also important in the facility's public affairs efforts have been timely responses to requests for action from The Catholic Health Association, the American Hospital Association, and the state hospital association.


Congregation's new ministry provides housing for poor.


At home on Golden Hill.

At home on Golden Hill.


Center provides research, treatment for Hansen's disease. The National Hansen's Disease Center is a unique research, training, and treatment complex at Carville, LA, for Hansen's disease (leprosy), a chronic illness affecting an estimated 15 million people worldwide. The Daughters of Charity of St. Vincent de Paul helped establish it in 1896, and in 1921 the center became a federally funded institution. SUlfone drug treatment, a major advance, was begun there. Scientists at Carville study the disease's unknown mode of transmission; training administrators conduct learning seminars; and laboratory researchers produce bacteria samples to be distributed as possible vaccines. Some patients receive treatment and leave, whereas others reside at the self-contained community. Reconstructive surgery is performed there, and special footwear is made. Some patients work on The Star, a magazine dedicated to correcting misconceptions about the disease and its communicability. The center includes a school and a pool and golf course. Hansen's disease care programs are available in many states and are expanding to other areas.


May a Catholic hospital allow drugs that accelerate abortion?


Improved medical care for the elderly: intervening in medical education. It is the premise of this paper that certain instructional interventions in the medical school behavioral science curriculum will eventually improve the health care received by elderly patients. Four content areas for such intervention are reviewed: patient adherence to medication regimens, risk and management of psychosocial stress, responses to chronic illness, and doctor-patient communication patterns. The final section describes research that supports the long-term efficacy of such curricular interventions.


Pre-admission education brings early involvement.


Working with the family council.

Working with the family council.


Community mental health and the elderly: service and training approaches. There is a growing gap between needed and available mental health services for older adults. This article discusses the training needs, personnel shortages, and lack of effective service programs and proposes some strategies for dealing with the problems. There is a lack of adequate methods for identifying and referring frail elderly persons in need of mental health services. Services that are currently available to the elderly are identified along with factors that may influence their use by older adults and other service personnel. There are shortages of mental health professionals with special training and experience in gerontology and geriatrics, and clinical geropsychologists. An innovative and practical service model that was developed to coordinate and integrate the identification and treatment of frail, community-dwelling elderly is presented. Various aspects of the program that include outreach and case management approaches, the integration of student volunteer activities with those of special volunteer corps within public housing and specially trained paraprofessionals, telephone reassurance programs, and a system of layered supervision are described. Comparisons are made between this Coordinated Agency Resources for Elderly Services (CARES) model and existing service delivery programs. A three-tiered approach to training and coordinating the activities of trained mental health personnel: (a) paraprofessionals and volunteers, (b) middle-level professionals and (c) supervisory professionals within an integrated system is proposed. Specific roles and functions of personnel at each level are described. The summary discusses the potential of the proposed strategies for dealing with the problems created by the shortage of personnel and services. It suggests some time frames within which the strategies could be operationalized.


Family life at Bryans.

Family life at Bryans.


In West Virginia it's family style.

In West Virginia it's family style.


Fitness is a family affair.

Fitness is a family affair.


Go fishing and hook a visitor.

Go fishing and hook a visitor.


Turning transfer trauma to triumph.

Turning transfer trauma to triumph.


Start-up analysis for marketing strategy. The complex start-up effect on utilization of health care services is too often overlooked or underestimated by marketing planners, leading to a range of negative consequences for both the users of services and the provider organization. Start-up analysis allows accurate estimation of these utilization effects for coordinated strategic planning among marketing finance, and operations.


Decision-making in long term care facilities--the role of the family.


Family-centered care begins with staff.

Family-centered care begins with staff.


Marketing the Health Protection Plan.

Marketing the Health Protection Plan.


Role of referent selection in primary care provider choice and satisfaction. This study reports the results of a large scale mail survey designed to identify and assess the sources of influence used in choosing primary medical care providers. Distinctive referent utilization patterns were identified for particular demographically defined market segments. Additionally, patient satisfaction with primary care providers was shown to be related to referent selection preferences.


The medical staff and the development of hospital marketing programs.


Evaluating a marketing consultant: a consultant's viewpoint.


Six challenges for the future.

Six challenges for the future.


International health administration experiences: issues for sponsors and participants.


Factors affecting rural consumers' satisfaction with medical care. This study examines various factors which influence consumer satisfaction with medical care at a family practice office of a randomly generated sample of 259 rural households. Consumer perceptions regarding physician competence, seeing the same doctor on successive visits, and whether the physician's office is meeting the general medical needs of the community were important predictors of satisfaction. Marketing implications are suggested to increase the economic and professional viability of medical practice.


On using workforce characteristics to prepare and counsel students for hospice administration.


Career preparation for leadership in the university teaching hospital.


Whither the master's thesis? One program's approach.


A new educational program in the Netherlands: health care administration.


Shared progress, issues, and responsibilities.


Quality circle in a rural mental health center?


Administration/consultation: the staff interview.


Ethics and administration.

Ethics and administration.


Monitoring mental health contract services: a management approach.


Issues of accountability in mental health administration. The issue of accountability in state hospitals and state schools-hospitals can be expected to remain paramount in the future. Almost all areas of mental health services are being scrutinized by consumers who are demanding more for their money. From the Perspective of the mental administrator consumers will have to become a more meaningful part of the decision making process to produce productive changes in these human service fields. Thus, to this end, human service institutions must have the ability to function as open systems and must develop a sense of responsiveness to their consumers' needs.


The incompatibility between psychiatrists' expectations and organizational needs of community mental health centers.


The left hand finally meets the right: development of linkages between a state hospital and community mental health centers--why it worked and continues to work. In January, 1981, Central State Hospital and eight Community Mental Health Centers within the Hospital's Service Area formed a Task Force for the purpose of strengthening linkages. Several concrete accomplishments have resulted and continue to result due to the efforts of this Task Force. The Authors describe why they believe the Task Force has been so successful. (This article was part of a presentation made at the 1983 Annual Meeting of the Association of Mental Health Administrators in San Antonio).


Psychiatrists and the private psychiatric hospital. "Closed staff model vs. open staff model".


Delineating management authority in community mental health centers.


Improving the record-keeping performance of direct service personnel. Record review procedures and contingent performance feedback were used to monitor and improve the record-keeping performance of human service staff in a behavioral residential treatment setting. A multiple baseline design was employed across three groups of B.A.-level human service personnel. The study consisted of five conditions: (1) Baseline 1; (2) Written Instructions (memoranda); (3) Written Performance Feedback; (4) Verbal Performance Feedback; and (5) Baseline 2 (return to the Baseline 1 condition). Dependent measures included highly reliable ratings by independent observers of the (1) essential documents present in case records, (2) documents approximately located/organized in case records, and (3) an overall rating of documents present, correctly organized, signed and dated, and not duplicated in the records. Results indicated that the procedures most frequently used to provide feedback to human services personnel--meetings, policy and procedure manuals, and/or written memoranda--were not as effective as verbal feedback sessions in prompting staff participation in case record maintenance. Findings were interpreted to suggest that, with adequate training, supervision, and performance appraisal, direct service personnel in residential treatment settings can effectively manage clients' case records and become more involved in, and committed to, accountability and quality control.


Resident advocates: a mechanism for protecting the rights of institutionalized mentally retarded.


General hospital psychiatry in the 1980's. There has been an increasing amount of attention being given to the role of community hospital based inpatient psychiatric services in the face of changing utilization patterns, state hospital deinstitutionalization and cutbacks in community support programs. These trends have converged over recent years to reshape the nature of psychiatric practice in the general hospital setting. It is likely that these trends will continue throughout the 80's and that general hospital based services will become increasingly pivotal in the care of mental illness at the community level. The challenge facing such programs will be adapt creatively to the changing demands of the market environment while maintaining the integrity of existing programs and coping with the pressures that these changes place on staff.


The Oklahoma experience: a systems approach to budget cuts in community mental health.


Designing an incentive plan for outpatient therapists.


The evaluation of bedpan washer/disinfectors.


The use of music with hospitalized infants and toddlers: a descriptive study. This clinical study was conducted to examine the effectiveness of music in decreasing stress behaviors exhibited by hospitalized infants and toddlers. The sample consisted of 27 hospitalized infants and toddlers, ages 5 weeks to 36 months, who had demonstrated stress behaviors (defined as crying, throwing objects, absence of vocalization, lethargy, and/or body tension) during 15-minute observation sessions. Each subject was assigned to a music program implemented by a Registered Music Therapist (RMT) on the Child Life staff. Programming included relaxation, didactic games, movement, and songs. Sessions lasted from 15 minutes to 1 hour. During the sessions, the subjects were observed and their behaviors were recorded on a checklist. Results of the study indicated that music plus interaction with a music therapist effectively reduced stress-related behaviors.


Hospital acquired infection--the role of the World Health Organisation.


The present state of medical records library and education of medical records administration in Japan.


Gastrointestinal endoscopy--the hazards of infection.


Decontamination of fibrescopes--recent developments.


A unique approach to performance standards for clinicians in a CMHC. Performance standards were developed for clinicians of a large comprehensive mental health center. Clinicians were required to provide a minimum average of 20 hours of face-to-face service per week. Credit values, ranging from .5 to 3.0, were assigned for each hour of service provided based on the difficulty of the service to deliver and the amount of paperwork required. Total credits were considered as an extra accomplishment and utilized as a criterion for determining merit increases. The results indicated an increase in the utilization of family and group therapy as well as a more equitable system for evaluating widely differing services.


Emergency medicine and trauma care in Japan.


Quality assurance programs in Japan.

Quality assurance programs in Japan.


The plan of medical treatment in the Senri area and its development.


Japanese medical system and regional medical treatment.


International Hospital Federation Regional Conference, Seoul Korea, 1984. Hospitals and primary health care in achieving for all by the year 2000. Future role of hospitals in Japan.


An analytical study in the use of space in Japanese hospitals.


Do quality-of-work-life programs violate Section 8(a)(2)?


I've got something stronger than malpractice insurance.


If I join a PPO, will it respect me in the morning?


Is the fee scale tipping toward cognitive services?


Look who's helping build practices now! Hospitals have discovered that it makes good business sense to give attendings a boost.


Medical instrument reliability. Designing reliable microprocessor-based monitoring instruments.


Sensor performance evaluation.

Sensor performance evaluation.


Who is working for whom?

Who is working for whom? A recent trend in many medical groups toward management aiding in "employee self-fulfillment" leads to the question, "Who is working for whom?" The author of this article firmly believes that a manager's expectations, encouragement, and support of his employees must be used to balance his own personal intelligence, knowledge, and skills if he is to be successful in his job. A manager's strong desire and commitment to becoming involved in his employees' lives will bring many benefits to all involved--management, employees, and most importantly, the patients.


The numbers game. Introducing a cost-reduction program. When cost-reduction programs based on theory are introduced, they invariably trigger opposition. It is hard to object, however, to a program based on solid statistical data. A new statistical tool is now available which allows medical group managers to focus on the impact of change: the Group Practice Performance Evaluator (GPPE). Based on GPPE data, the possibilities for cost reduction in one significant area, human resources, are examined.


Exploring new frontiers in advertising.

Exploring new frontiers in advertising. What will be the next stage in the on-going healthcare services marketing revolution? The city of Madison, Wisconsin has hosted a preview of the new frontier. According to a media spending report, the area's six HMOs, an insurance carrier, and local hospitals spent over $500,000 in one month on media advertising expenditures in a battle to enroll patients in prepaid health plans. Despite initial physician reluctance, the scramble for healthcare dollars has made the packaging and sale of medical services a reality of today.


Collection time again.

Collection time again. Looking forward to your next round of collection calls? Few of us do, yet collections play a vital role in every group practice, large or small. This crop of practical collection tips is guaranteed to boost the morale of everyone involved in the collection process. Not only are the basics of a good collection call set down, but result-getting responses to frequent debtor excuses are provided. Telephoning the debtor patient need not be a dreaded task. Just have confidence, keep in mind that the patient does owe you for services rendered in good faith, and pick up the phone--it's a snap!


Annual buyers guide surveys: biofeedback, catheters/cath systems, electrodes--ECG, EEG, etc., patient monitors, stimulators, defibrillators.


What is reasonable care in design?

What is reasonable care in design?


Medical records--value for money.

Medical records--value for money.


Power supplies: voltage regulator or dedicated line?


'83 hospital spending by department.

'83 hospital spending by department.


"The N.H.S. in the next decade--development of data and information".


Patient support groups: a natural resource for physicians.


Streamlining blood counts with a microcomputer.


Treatment alternatives for public mental health clients.


The key to predicting laboratory workload.


An in-house proficiency survey for WBC differentials.


The key to a successful psychiatric program.


Size considerations in the psych unit.

Size considerations in the psych unit.


The evolution in alcoholism services.

The evolution in alcoholism services.


A consultation-liaison team in the general hospital.


Assisting the victim: one innovative alternative.


Mental health scenery: MHAM perspectives.


Severity, frequency of claims push hospitals' insurance rates skyward.


Surgical center chain sells stock, plans to use $6.8 million to expand.


Technology, demographics to bring variety of changes in 21st century.


Hospitals overcoming roadblocks to use variable-rate bond financing.


Staff conferences can help promote good relations, better management.


Hospital testing PPO on its own employees.


NME selecting business strategies that help boost hospital admissions.


Nursing home crunch to hit hospitals soon.


Legal guidelines for blood banking and transfusions. Part II.


HMOs advertising heavily to sign up government workers in Madison, WI.


Adventists see national network of diverse healthcare services.


Catholic providers undaunted in wake of Saint Joseph sale.


Protestant networks seek to preserve religious heritage.


Effectively employing support services the key for increasing nursing personnel productivity.


Frugal hospitals are looking outside for laundry services.


Nursing home stocks star as other healthcare stocks lose their glitter.


Board must remember fiduciary duty in negotiating insurance coverage.


Outside directors bring experience, ideas to Holy Cross Health System.


Outcome of November vote: industry competition probably will continue.


Physicians, Rochester, NY, hospital enter joint venture to protect market.


Home care leads rising trend of new services.


Ambulatory centers try to broaden appeal by shifting to primary care.


HCA, Intermountain deal offers glimpse of "giants' in action.


Improving care while limiting costs.

Improving care while limiting costs.


Opting for deals a growing trend.

Opting for deals a growing trend.


Declining occupancy, bad debts put Austin, TX, public hospital in the red.


Teaching hospitals seek new funds, new roles in education.


Big 3 hospital supply companies trim employee health benefit plans to ease the bite on their bottom lines.


Hospital commits itself to fresh, new look at care delivery.


Consortium makes effort to surmount difficulties, aid university hospitals.


Education bill may stir debate.

Education bill may stir debate.


Firings, unhappiness main reasons for job shifts by nurse heads.


State legislatures considering ways to finance medical care for indigent.


Credit markets forecast: 1985.

Credit markets forecast: 1985.


Multis 'import' business talent.

Multis 'import' business talent.


Tax reforms.

Tax reforms.


Humana's goal. Centers of Excellence draw exceptional physicians, and the patients follow.


Growing with the business. At Basic American Medical, Brady Justice is managing for change. Interview by Jo Ellen Mistarz.


Reps must weigh words under final MDR rule.


An export in demand. International hospitals, joint ventures, and HMOs attract multis.


MM alertness key to new reporting rule.

MM alertness key to new reporting rule.


Group purchasing commitment: once the exception, it is fast becoming the rule.


Hospitals review options for home care involvement.


Hospital market update: groups still seen groping for contract compliance.


Hospital buyers' sweet dreams of automation.


Bringing corporate culture to the bottom line. Up to now managers could find little evidence to support the idea that the organization's culture has an impact on its bottom-line performance. To remedy this, Denison draws on survey and performance data from 34 large corporations to show that those that have participative cultures experience better performance than those that do not. This difference in performance appears to have widened over the five years that these firms were studied. The results also hold up when the performance measures for each firm (return on investment and return on sales) are compared with those of their competitors. Denison suggests that this comparative approach to the study of organizational culture provides a way to capture the impact that culture has on organizational performance. This strategy, he argues, also provides a way of diagnosing organizations and measuring the ways in which human resources management, organizational culture, and management practices do, in fact, contribute to the success of business organizations.


'Wellness' helps public and industry.

'Wellness' helps public and industry.


Career transitions within organizations: an exploratory study of work, nonwork, and coping strategies. This paper examines career transitions within organizations. An integrative model was developed and evaluated which views career transitions as a stress-coping process influenced by work and nonwork factors. Data supported the model in that individuals experiencing a large number of personal life transitions were more likely to adopt a symptom-management coping strategy (as contrasted with a situation-focused strategy) for dealing with job stress during the transition. However, neither the magnitude of the career transition nor intervening role variables in the model contributed to explanation of the career transition process. Major career transitions were associated with major transitions in personal life and data suggested that a career transition could act as a "trigger" event for personal life instability. Implications of both supportive and disconfirming findings are discussed. Future directions are suggested for research on careers and for career management in organizations.


Making a choice: seven specialties up close. Psychiatry, Family Practice, Internal Medicine, Pediatrics, General Surgery, Obstetrics/Gynecology, and Emergency Medicine.


Uncompensated care, payment delays top list of main concerns.


The National Health Service Corps: policies and prospects.


Cutting laboratory costs: where we are most likely to succeed.


Prescriptive chemical urinalysis can reduce your laboratory's workload.


Six strategies for providing hospital laboratory services.


Boosting your laboratory's productivity.


Organ transplant law includes grants, computerized network.


"People are talking about the importance of evaluating patient education. But where do I start?".


Patient advisory council cuts malpractice costs.


Patient education challenges in home health care.


Patient education: whose territory is it?


A three-tier plan for cafeteria benefits.


Is your organization ready for no-fault absenteeism?


Every bunny benefits.

Every bunny benefits.


Health care cost containment and its impact on employee relations.


Preferred provider organizations.

Preferred provider organizations.


Guarding the health care dollar. A systematic approach to choosing from today's cost containment options.


Worksite health promotion. An overview of programs and practices.


Medical benefit plan costs.

Medical benefit plan costs.


Corporate physical fitness programs: the role of the personnel department.


A business coalition overcomes its suburban isolation.


The computerized job seeker.

The computerized job seeker.


Shiftwork, stress and wellbeing. How workers and their families cope with shiftwork.


Low-priced automation for personnel management functions. The microcomputer market.


Human resource management systems.

Human resource management systems.


Why your hospital may go out of business.


For-profit hospitals: a boom or bust for health care?


Will the courts blow PPOs out of the water?


Respite care for the frail or disabled elderly.


Cool treatment for patient food.

Cool treatment for patient food.


Hospitals train employees to be nice.

Hospitals train employees to be nice.


Creative financing methods in the acquisition of medical imaging equipment.


Using film librarians to increase productivity. This article presents an approach to increasing the efficiency and productivity of radiology departments by having film librarians review, select and place films on multiviewers prior to the radiologist's interpretation.


Occupational injuries in radiology: strategies for cost containment. Occupational injuries represent a measurable part of the operating costs in the health care environment. Injury rates in hospitals have been documented to be higher than those in industry; one possible cause may be the cost-based reimbursement setting which provides no incentive to reduce occupational injuries. With the advent of prospective payment, the costs associated with occupational injuries must be reduced. This paper will discuss the common hazards in radiology, as well as action that can potentially reduce these costs. Prospective payment has given a new meaning to cost containment, forcing the radiology administrator to seek all possible means to contain costs.


Estimating the financial impact of computed tomography acquisition on the 50- to 200-bed community hospital.


Keeping healthcare costs down, employee spirits up.


Laundry joint venture.

Laundry joint venture. Many hospitals are concerned about the loss of control which is associated with contracting for linen service. On the the hand, many laundries do not have the resources or experience to serve hospitals in a comprehensive and trouble-free manner. In many communities a joint venture, such as the one described here, can successfully combine the interests of the hospital and laundry communities without causing the hospitals to lose control of the service and without requiring the laundry operator to have detailed knowledge of hospital operations. As more hospitals opt for contract service, and if this service is to be provided at the lowest total cost, the hospitals and the laundries must come to grips with the problems surrounding the laundry-hospital interface. A joint venture, such as that described here, is one way to accomplish this.


Successfully marketing education programs.


The Deficit Reduction Act of 1984: some implications for employers.


The marketing audit: the first step.

The marketing audit: the first step.


Community involvement as a marketing strategy.


The nurse expert witness.

The nurse expert witness.


A new identity for a new era.

A new identity for a new era.


Financing building and equipment through UDAG.


Bahrain emphasizes health care development.


Case study: St. David's Community Hospital.


Hospital advertising: a sign of the times.


The importance of caring.

The importance of caring.


Fundamentals of terminating.

Fundamentals of terminating.


Medical records and the terminally sick patient.


Hazardous waste management.

Hazardous waste management.


Purchase of goods and services.

Purchase of goods and services.


An approach to estimating future manpower requirements in physical and occupational therapy. This paper reports the approach used in a physical therapy (PT) and occupational therapy (OT) manpower requirements study conducted in British Columbia, Canada. A total of 426 questionnaires were mailed to likely employers of PTs and OTs, and to PTs in private practice. After telephone reminders and a second mailing, the overall response rate was 83.3%. The results of the survey indicated that, by 1986, respective PT and OT department heads were anticipating a 60% increase in demand for PTs and a 102% increase for OTs, while agency administrators were suggesting a 76% increase for PTs and a 142% increase for OTs. Although a variety of factors--all largely beyond the control of both respondents and researchers--will determine the degree to which these estimates actually reflect the future demand for these manpower groups, it should be noted that, for both disciplines, the anticipated increase was substantially greater than the level experienced in the five years preceding the survey. The estimation approach used in this study considers nonrespondents; it is a procedure which permits investigators to offer a more accurate picture of the current manpower situation while using a more realistic base on which to estimate future requirements. The development of the requirement side in the supply/requirement equations of manpower studies may be well served in the future with this approach.


Attendance.

Attendance.


Dental care for the AIDs patient: the infection control practitioner's perspective.


The changing context of human services administration. In response to economic, political, and other changes in their environment, human service agencies undergo a financial and ideological crisis. This crisis leads to major transitions in the administration of agencies that are expressed by degovernmentalization (the shift to nongovernmental jurisdiction over human services), privatization, and cutback management. This article explores the implications of these transitions for both the delivery and the future character of human services.


Purchase of social services: another look. Purchase of social services is an integral part of many social service delivery systems. Its advent was heralded by some as the fiscal salvation of hard-pressed social service agencies. This article reviews the problems of purchase of social services. It then discusses some of the literature and the research on the subject, including the author's own study in Utah, that are directly concerned with the variables of cost and quality. The author adds recommendations based on the findings presented.


Financing innovations for capital expenses.


The Deficit Reduction Act of 1984.

The Deficit Reduction Act of 1984.


How to read a financial statement.

How to read a financial statement.


Recent legal decisions and the implications for governance. What major legal precedents were considered in the past year that affect hospital governance? The assistant general counsel of the American Hospital Association examines three particular areas of concern: the composition of hospital boards, trustee liability for federal taxes, and antitrust analysis of exclusive contracts.


Hughston Sports Medicine Hospital and Campus.


Congress orders feasibility study for National Bone Marrow Registry.


Cost containment of health care. The responsibility of employers and doctors.


Perspectives. Congress reconsiders block grants.


Perspectives. Malpractice insurance: affordability crisis?


Mission possible: survival of personalized medical care.


The impact of corporate restructuring of inner-city hospital charges: a comparative analysis.


Ethical issues in the cost-containment of modern medicine.


Health care blow-outs hit rubber city.

Health care blow-outs hit rubber city.


The public's perception of hospital trustees. A member of the board of directors of the Arizona Hospital Association takes a candid look at the pressures that are affecting the public's perception of not-for-profit hospitals, and the actions trustees must take to preserve public confidence in our health care system.


Hospitals' leading edge: telecommunications.


The role of a free clinic in the mid eighties.


Hospitals' legal responsibility for trainees.


Technology and interorganizational activity as predictors of client referrals. The client referral activity of 41 human service agencies operating within the same community was examined using recently collected data. Hypotheses were developed focusing on agency service technology and interagency activity as predictors of referrals from and to other organizations. The hypothesis for technology was supported; hypotheses for interagency activity received mixed support. Additional analysis revealed an agency's service orientation to be a strong predictor of referral inflows.


The effects of full-time versus part-time employment status on attitudes toward specific organizational characteristics and overall job satisfaction.


The moderating role of work context in job design research: a test of competing models.


The Chinese view of health education.

The Chinese view of health education.


Peer review in medical publishing--how to streamline the system.


What's new in transplantation.

What's new in transplantation.


Diversification of nursing home services evaluated.


Sicker patients trigger staff alterations.


Wanted: CEOs and trustees with a business perspective.


As controversy mounts over hospitals-for-profit.


Still too many cesareans?

Still too many cesareans?


Beware 'sick-building syndrome'. The deadliest pollutants of all may be the ones you breathe at home or at work.


Child abuse and neglect prevention and treatment program--HHS. Notice of proposed rulemaking. This rule proposes a new basic State grant requirement to implement the Child Abuse Amendments of 1984 (Pub. L. 98-457). As a condition of receiving State grants under the Child Abuse Prevention and Treatment Act, States must establish programs and/or procedures within the State's child protective service system to respond to reports of medical neglect, including reports of the withholding of medically indicated treatment for disabled infants with life-threatening conditions. Other changes in regulations required by these Amendments will be published as a separate NPRM at a later date.


Services and treatment for disabled infants; interim model guidelines for health care providers to establish infant care review committees--HHS. Notice of opportunity to comment. These are interim model guidelines to encourage the establishment within health care facilities, especially facilities with tertiary level neonatal care units, of committees for the purposes of educating hospital personnel and families of disabled infants with life-threatening conditions, recommending institutional policies and guidelines concerning the withholding of medically indicated treatment (including appropriate nutrition, hydration, and medication) from such infants, and offering counsel and review in cases involving disabled infants with life-threatening conditions. The publication of these interim model guidelines for public comment is required by section 124(b) of the Child Abuse Amendments of 1984, Pub. L. 98-457.


Cooperative agreements to support national health promotion programs--PHS.


NIH center grants--PHS. Notice of proposed rulemaking. This Notice sets forth proposed regulations covering grants by the National Institutes of Health for the support of research and demonstration centers. These regulations would replace existing regulations covering just centers supported by the National Heart, Lung, and Blood Institute.


Medical Radiation Advisory Committee; request for nominations for membership--FDA. Notice. The Food and Drug Administration (FDA) is requesting nominations for membership on the Medical Radiation Advisory Committee. There is currently one vacancy on the committee and there will be three additional vacancies on June 30, 1985.


Occupational exposure to ethylene oxide--OSHA. Final rule: supplemental statement of reasons. On June 22, 1984, the Occupational Safety and Health Administration (OSHA) published a final standard for ethylene oxide (EtO) that established a permissible exposure limit of 1 part EtO per million parts of air determined as an 8-hour time--weighted average (TWA) concentration (29 CFR 1910.1047, 49 FR 25734). The standard also includes provisions for methods of exposure control, personal protective equipment, measurement of employee exposure, training, signs, and labels, medical surveillance, regulated areas, emergencies and recordkeeping. The basis for this action was a determination by OSHA, based on human and animal data, that exposure to EtO presents a carcinogenic, mutagenic, genotoxic, reproductive, neurologic, and sensitization hazard to workers. During the rulemaking proceedings that led to the establishment of the 1 ppm TWA, the issue of whether there was a need for a short-term exposure limit (STEL) for workers protection from EtO was raised. OSHA reserved decision on the adoption of a STEL at the conclusion of the rulemaking in order to permit peer review of the available evidence and to review more fully the arguments and pertinent data regarding the STEL issue. Upon receipt of the analyses from most of the peer reviewers, OSHA published a notice to that effect on September 19, 1984 (49 FR 36659) and invited public comment on the pertinent issues addressed in the peer reviews. Based on the entire rulemaking record, including the peer reviews and public comments received since June 22, the Assistant Secretary has determined that adoption of a STEL for EtO is not warranted by the available health evidence, and that a STEL is not reasonably necessary or appropriate for inclusion in the final EtO standard. OSHA has also asked that NIOSH fund certain additional studies related to whether a dose-rate relationship can be established for EtO, and OSHA will review the results of those studies when they become available.


Employer considers refund of health plan contributions.


When religious faith dictates treatment.


Another side of DRG's.

Another side of DRG's.


Arguing the right to die.

Arguing the right to die.


Moving south: from the frying pan and into the fire?


Brand name vs generic: the drug wars rage on.


Healing--through the eyes of traditional cultures.


Insurers predict lower health care rate hikes.


Employer actions help hold the line.

Employer actions help hold the line.


Employers hope for savings from home care.


Home practice: is the neighborhood doctor extinct?


Mandatory rate setting still studied by states.


Prevocational exploration and vocational rehabilitation of the psychiatric client. The primary objective of this paper is to survey current trends in the United States in the use of vocational rehabilitation services for the psychiatric client in relation to occupational therapy. In assessing the techniques and services that can be employed by occupational therapists working in psychiatric rehabilitation centers, nine vocational rehabilitation prototypes have been identified, i.e., evaluation of skills and aptitudes, occupational information groups, individual counseling, vocational training, pre-employment group counseling, transitional volunteer work, sheltered work, temporary tryout work, and special placement. Based on a number of descriptive clinical studies, it can be concluded that vocational rehabilitation serves as a key factor in a comprehensive psychiatric treatment program located in the community. In general, work provides the psychiatric client with opportunities to be in the mainstream of life and to attain the psychological satisfactions that are derived from being employed.


Substitutability of work and the professionalization of occupational therapists. This paper examines the status of occupational therapy as a profession. Achievement of status as a full-fledged profession will depend on the success with which this group convinces members of society that the work it does is non-substitutable. It is difficult for occupational therapists to prove there is no legal substitute for the services they offer. This factor will likely limit attainment of status as a full-fledged profession.


Report on the Canadian Association of Occupational Therapists' manpower survey: 1981. The following report outlines the findings of the CAOT Task Force established in 1980 to undertake a national manpower survey. With the assistance of Statistics Canada a survey was designed and through CAOT, it was distributed in the Fall of 1981. Although a completed methodology and tabulation were sent to the CAOT Executive in March 1982, an analysis was not completed until November 1982. This report is to inform all participants of the findings, implications and future considerations. The objectives, methodology and problems encountered are described. Unfortunately, most of the objectives were not met. The task of developing an effective survey tool and the process of collecting meaningful data was far greater than anticipated. Such a massive project, which entails money and time, requires professional assistance to reduce ambiguities in the survey forms and computerization to correlate the information. Much of the information received could not be used nor correlated; however, the results do give a brief description of the profile of an occupational therapist to build on in the future. In addition, the experience gained will facilitate future survey development and distribution.


Sexual harassment on the job: psychological, social and economic repercussions. This article is an effort to shed new light on what has been commonly termed sexual harassment, to identify its forms and, most importantly, to explore its effect upon those who have been subjected to it. The author's hypothesis is that sexual harassment in the workplace is more a social phenomenon than a personal problem, and that it is the cause of lasting psychological, social and economic after-effects among its victims. Combatting sexual harassment is only part of the solution; we must look beyond its legal aspects to find ways of changing male-female occupational relationships, and we must provide support to victims of sexual harassment.


Women and technology.

Women and technology. The introduction of microtechnology (in particular, word processing and data processing instruments and other computer-controlled equipment) has had dramatic effects on the nature, organization and rhythm of work in settings traditionally occupied by female workers (offices, service industries, telecommunications, etc.). This article describes some of these effects, with particular reference to organizational issues within the office setting. Symptoms of excessive stress among office workers are described; the motives for technological change and resistance to change are examined; and some suggestions for procedural reform are offered in the interest of safeguarding the mental health of female workers.


A survey to determine how occupational therapists in Ontario rehabilitation units are using microcomputers for patient treatment in clinical programs. Thirty four Ontario Rehabilitation units were surveyed to determine how occupational therapists use microcomputers for patient treatment. Twelve rehabilitation units (35.3% of the sample) presently have microcomputers and 11 of these units have recently purchased the microcomputer for clinical use. Stroke, head injury and spinal cord injury patients were identified as the population that use the microcomputer. The APPLE 11 microcomputer was the most popular type chosen by rehabilitation units. Commercially available software programs are used for cognitive, perceptual, educational and recreational purposes. Satisfaction level with the quality of the software, however, was only 42.8%. Finally, it was noted that the speech therapist was the primary professional who liaised with the occupational therapist.


Employee assistance programs: an alternative resource for mental health service delivery. The purpose of this article is to provide a very brief introduction to employee assistance programs (EAPs) and their role in the mental health delivery system. In addition, some consideration will be given to the opportunity these programs offer for making a significant impact on both the mental health of Canadians and the productivity of Canadian business.


Double work and women's health.

Double work and women's health. In Canada, a high percentage of wives and mothers have full time or part time paid employment outside the home; yet the expectation that they will assume primary responsibility for domestic work persists. As a result, women who work outside the home experience cumulative stress: too many physical and emotional demands to meet, too many hours of work, and a continuous struggle to reconcile the demands of the two work settings. The author considers double work from a socioeconomic, structural viewpoint, and from the perspective of increased psychosocial and health risks. She calls on professionals to address the complex and controversial issues raised by the identification of double work as a risk factor.


The role of pastoral care in home health services.


Diagnosis-specific home care: a model for the future.


Innovative technologies for healthcare enhancement.


Homemaker-home health aide supervisors' knowledge about older families: a study.


The post 1984 in-house vs. out-of-house decision.


An evaluation of a pharmacy based aminoglycoside monitoring service. The impact of a pharmacy based aminoglycoside serum concentration monitoring service is reported. Physician responses to serum concentrations were assessed before and after the introduction of the service and the results compared. Eighty-four percent of recommendations made by pharmacists to physicians were totally accepted and the response to serum concentrations significantly improved after the introduction of the clinical pharmacokinetic service. Such a service provides a valuable function and is well accepted by the physicians.


Guidelines for phenytoin infusions.

Guidelines for phenytoin infusions. Until recently, phenytoin sodium injection was not recommended for dilution in intravenous fluids because insolubility results in precipitation of phenytoin acid. The formation of rod-shaped crystals primarily reflects the failure to maintain the pH of the admixture above 9.5 to 10. Investigations have clarified this problem and point out that stable solutions of phenytoin sodium can be prepared which are safe for intravenous infusion provided the injection is diluted in small volumes of 0.9 percent sodium chloride or Ringer's. Lactate injection and administered freshly prepared. Specific guidelines are suggested for the preparation and administration of phenytoin sodium infusions.


Consultants perspective on medical office computerization.


Fear of individuality displacement.

Fear of individuality displacement.


A responsible industry.

A responsible industry.


Thoughts about thinking from the President-elect of HISSG.


Selecting whether to die at home or in a hospital setting. Data from a 1978 health care study in rural North Carolina were analyzed to investigate whether people prefer to die at home rather than in a hospital setting and the reasons for their preference. Medical, financial, personal and family-related reasons were investigated as possible explanations for selecting a preferred site of death. Differences between respondents in demographic, socioeconomic, and health-related variables were analyzed to determine their possible effects on where an individual preferred to die. The results indicate that financial reasons were most likely to be given for preferring to die at home followed closely by individual reasons and then by family and health considerations. Statistically significant differences indicated that those who preferred to die at home were younger, white, more educated, were not satisfied with the quality of medical services, considered their health as excellent and were afraid of hospitals. The implications of these results were considered.


Hospice program integration: an issue for policymakers. As the number of hospice programs in the United States expands, policymakers face a variety of issues concerning the care of the terminally ill. Do hospice programs offer a truly unique approach in caring for the dying? Are hospice services cost effective? Should hospice programs become integrated into the mainstream of medical care service delivery? Based on data from hospice programs in an industrialized Midwestern state, this paper explores the strategies employed by hospice programs to become integrated, the conflicts that have arisen among providers of hospice care, and the impact of hospice program integration on patient care. Results show that as hospice programs become more integrated, they have lost some of the idealism on which they were founded, have altered organizational structures, and have changed certain patient services. However, there is no evidence to suggest that integration of hospice programs into the medical mainstream has decreased the quality of patient care or patient satisfaction for hospice services.


A general framework for evaluating the reliability of medical measurement systems. Measurements of physical and social phenomena are often used in the decision-making process despite the error introduced by human and context variation. It would be advantageous to a decision maker to know the sources and magnitudes of such errors in using a measurement system or in choosing among alternative measurement systems. This paper describes an approach to determining the reliability of a measurement procedure called generalizability (G) theory. G theory uses the results of a random-effects analysis of variance to estimate the magnitude of error variability associated with each of several potential sources. These estimates can then be used to calculate a number of indices which typify the amount of precision provided by a measurement system in a particular context of usage. The major concepts of G theory are described and illustrated in the context of evaluating a radiologic total lung capacity measurement system.


Research approaches in health manpower development. Some alternatives. Traditional scientific research approaches have contributed only minimally to the resolution of problems related to the educational aspects of health manpower development. It has been suggested that this lack of impact has been due mainly to the incompatibility of the traditional approaches with the phenomena of concern--naturally occurring educational, human, and social events. The problem has been addressed in considerable detail in the literature that relates to the more general view of education, and the alternative research approaches described in this article are derived from this broader-based literature.


A comparison of knowledge, synthesis, and clinical judgment. Multiple-choice questions in the assessment of physician competence. This study compares the reliability, validity, and efficiency of three multiple-choice question (MCQs) ability scales with patient management problems (PMPs). Data are from the 1980, 1981, and 1982 American Board of Internal Medicine Certifying Examinations. The MCQ ability scales were constructed by classifying the one best answer and multiple-true/false questions in each examination as measuring predominantly clinical judgment, synthesis, or knowledge. Clinical judgment items require prioritizing or weighing management decisions; synthesis items require the integration of findings into a diagnostic decision; and knowledge items stress recall of factual information. Analyses indicate that the MCQ ability scales are more reliable and valid per unit of testing time than are PMPs and that clinical judgment and synthesis scales are slightly more correlated with PMPs than is the knowledge scale. Additionally, all MCQ ability scales seem to be measuring the same aspects of competence as PMPs.


A Bayesian aggregate meta-analytic evaluation approach. The Bayesian inferential process is modified to be used as an approach to an aggregate meta-analytic evaluation. Comparisons of the Bayesian approach with the traditional average effect size meta-analytic approach indicated that the Bayesian approach was more sensitive to differences between studies. The approaches to derive descriptive and inferential statistics were more consistent in the Bayesian approach. Because of its ability to account for all available information, the Bayesian approach was statistically more powerful. It is recommended that this approach be used for combining evaluation results when primary data are not available and when all evaluations involve comparisons of two independent samples.


Defining the severely mentally disabled. A definition of the "known target population of severely mentally disabled" in community mental health centers is examined. Criteria include intensive treatment contact and persistent, severe disability, but not diagnosis. Feasible and reliable screening procedures are demonstrated. In the identified population, most subjects at some time had received a diagnosis of schizophrenia and had been on public assistance. These criteria apply to catchmented treatment systems and should be useful in services research.


Are validity and reliability "relevant" in qualitative evaluation research? Interest in and use of qualitative methodological strategies in evaluating research have increased considerably in the last few years. Many of the recent evaluation frameworks or models are entirely or partly oriented toward use of qualitative methods. A number of methodological issues and concerns have been raised, including the appropriateness of validity and reliability estimation for the measurement strategies employed in qualitative evaluations becoming more common in health and other fields. In this article, the views of prominent qualitative methodologists on this topic are briefly summarized; a case is made for the relevance of validity and reliability estimation; definitions of validity and reliability for qualitative measurement are presented; and appropriate estimation techniques are suggested. It is hoped that discussions such as this will promote increased attention to validity and reliability concerns in qualitative evaluations and thus help improve the quality of those evaluations.


Physician expectations and the changing culture of medical practice: can we adapt?


Physicians' attitudes toward an expanded role for pharmacists in an HMO. The study examines the attitudes of physicians in a large HMO toward expanded activities for pharmacists and attempts to determine the physicians and their practice characteristics that account for these attitudes. The setting was the Oregon Region of the Kaiser-Permanente Medical Care Program. The data were obtained from a survey of the physicians serving the membership. The findings indicated that about two of every three physicians favored expanded activities for pharmacists. The specific activities most favored were those least threatening to physicians' roles. Their attitudes were most strongly related to whether they favored prescribing privileges for physician assistants and nurse practitioners. The physicians and their practice characteristics accounted for a small amount of the variation in physicians' attitudes. Large HMOs may be favorable settings for expanding the activities of pharmacists.


Age-based transition periods and the outcome of mental health treatment. Do people ever get too old to change? Studies of the influence of the age of adult patients on the outcome of mental health treatment have led to inconsistent results. Design characteristics of such studies have limited our understanding of the relationship between age and outcome. Over 300 male veterans undergoing brief inpatient psychiatric treatment were categorized according to their age-based, adult developmental period (Levinson, Darrow, Klein, Levinson, & McKee, 1978). Improvement during treatment was found to be significantly related to the patient's developmental stage (r = .25, p less than .01). These results wee cross-validated and replicated using three different techniques for measuring improvement. Patients treated during transition periods, whether young or old, improved most. These results were not limited to wartime veterans. Apparently, adult males are more responsive to mental health treatment during transition periods than at other times.


Perceived access to care and patient satisfaction in a prepaid group practice HMO.


Phasing-in mental health services in a health maintenance organization: problems and issues.


Radical surgery at the Red Cross.

Radical surgery at the Red Cross.


Library of Congress complex fire protected.


The role and development of marketing in today's health care institution.


Hospital image quiz.

Hospital image quiz.


A survey on the current status of health care marketing. This article presents the results of a survey, conducted by Market-PULSE Measurement Systems, reflecting the growth of health care marketing and the marketing perspectives of health care professionals. The survey results echo the opinions of two groups of professionals: chief executive officers of hospitals over 100 beds; and administrators as well as directors of marketing, planning, and public relations who attended a recent health services marketing conference. The survey, a telephone interview, was conducted to determine: The degree to which hospitals are market oriented. The degree to which hospitals use survey research. The following is an analysis of what the surveyors found.


Selecting an image maker for your health care facility. In this era of increased competition for patients and increased health care consumer sophistication, hospitals and other health care facilities are coming to terms with the need to market their services and assess their true image in the marketplace. This article provides a professional look at the field of image building in the health care industry, and offers some solid guidelines with which to create a strong, professional, and financially healthy hospital.


Dealing decently with death.

Dealing decently with death.


Administering death.

Administering death.


Nursing costs. Tokens: a simple way to monitoring an expensive resource.


Estate management. The commercial incentive.


Case in point. Providence Hospital.

Case in point. Providence Hospital.


Special needs which Sweden tries to meet.


Mental handicap. Seeking the best of both worlds.


Why governments want comprehensive health care.


Financial advisers. Poachers or gamekeepers?


Keeping costs in the pipeline.

Keeping costs in the pipeline.


Hospital catering. Currying favour with the Asian vegetarians.


Appraising your suture distribution system. Devoting study to a minute part of its supply system has paid off in big dividends for Hutchison Hospital, an acute care hospital in central Kansas with 230 beds and an occupancy rate of 71%. In this article the author explains why other hospitals may find it profitable to take a close look at their suture distribution systems.


Purchase law clinic. Supplier's firm offer.


Select and save on works contracts.

Select and save on works contracts.


Manufacturer's liability to patient for injuries from defective equipment.


Central laundries: only as good as their management.


Looking at today's x-ray film market. Part II.


Logistics management: a timely management tool.


Marketing research for better planning: surveys.


Delegation--its dilemmas.

Delegation--its dilemmas.


An interview with Dr. Robert J. Rubin. Interview by Walter R. Nathan.


Business in Richmond attacks health care costs. Like a fever that will not break, health care premiums continue to climb relentlessly, yet remedies have been hard to come by. Employers, for the most part, have accepted ever-rising expenditures as the price of good employee relations. And federal regulations designed to control medical costs have proven weak. The road to recovery begins, this author tells us, when a health maintenance organization, or HMO, enters a community, because its prepayment approach upsets the medical profession's conventional fee-for-service rules. Thus it quickly evokes competitive responses from other health care providers, who must become equally cost-conscious or lose their market share. HMOs need advocates, however, to spread as rapidly as their potential warrants. Drawing on recent events in Richmond, Virginia, the author shows how a city's business leadership can become the catalyst for changing the health care system.


Recognizing union organizing activity. Part II.


Morale in the lab can affect patient care.


Manpower shortage in hospital labs? Warning flags are flying.


Certified agencies' growth dramatic.

Certified agencies' growth dramatic.


Quality circles after the fad.

Quality circles after the fad. On the face of it, it makes sense, If you want to involve your employees more in decision making and shift the organization toward a more participative culture, starting suggestion groups called quality circles seems to be a risk-free way to begin. Having studied many quality circles in different organizations, the authors of this article conclude that quality circles have their distinct advantages but that they have inherent in their design numbers of factors that often lead them to self-destruct. Quality circles are also said to be a poor forerunner for more participative approaches to management. Changing a quality circle into an institutionalized participative structure involves making many changes in important features of the organization that do not naturally flow from the implementation of a circle program. The authors describe the stages that quality circles go through, discuss the various threats they must survive, and then outline the most effective uses that managers can make of them.


Not the National Health Service. The Canadian Health Care System.


Winning greater employee involvement in security.


Competitive tendering--the need for a systematic approach.


IHSA Presidential Address 1984.

IHSA Presidential Address 1984.


Management budgeting.

Management budgeting.


Outcome measures and health care planning.


The hidden soul of harmony.

The hidden soul of harmony.


The general manager: who fits the description?


The management budgeting experiment.

The management budgeting experiment.


Health care for the elderly--the next twenty years.


Race relations.

Race relations.


Current themes in the care of the elderly.


Staff homes.

Staff homes.


The Japanese health system--another success story?


Care in the community: the administrator and the management of change.


Equal opportunities in the NHS--a challenge for personnel management.


How far can management influence NHS industrial relations?


The use of management development in developing a training strategy.


Freedom and constraint in unit management.


The Health Service Commissioner.

The Health Service Commissioner.


Progress of the government's liberalisation policy.


New exchanges.

New exchanges.


Telecommunications in the health service.


Why do the majority of marketing programs in hospitals fail?


Electronic energy management progress.

Electronic energy management progress.


Using marketing research to estimate market potential and feasibility: the case of hospital child care centers as a nurse recruiting tool.


Segmentation bases of the elderly health care consumer.


Benefit segmentation: a marketing tool for enhancing the physician recruitment process for hospitals.


Product integrity: the missing link in a hospital's marketing process.


How to choose and use microcomputers.

How to choose and use microcomputers.


Public policy and hospital marketing.

Public policy and hospital marketing.


Price--a primer on the 2nd "P" for hospital marketers.


Environment design can strengthen a hospital's marketing campaign.


Beyond the carrot and the stick.

Beyond the carrot and the stick.


The emerging hospital/employee relationship.


Renovated hospital building provides housing alternative for the elderly.


The making of a logo: Scott and White develops a new look.


The bottom line on advertising.

The bottom line on advertising.


Does your customer relations program have what it takes?


Maricopa aftermath: what is required for a physician group to achieve integration?


Medical malpractice crisis continuing; now hospitals may be liable with physicians.


How to stimulate innovation.

How to stimulate innovation.


Action, not theory, key to productivity.


Don't work harder, work smarter!

Don't work harder, work smarter!


1984 annual tax wrap-up.

1984 annual tax wrap-up.


Putting patients at the center of admission process. Interview by Nancy Evans.


Carner's codes. You (the best of all worlds).


Work-study provides strategy for health care recruitment.


Spotlight. Wanda McKnight, ART.

Spotlight. Wanda McKnight, ART.


Health care values redefined.

Health care values redefined.


Barriers to adult women students returning to college in a nontraditional MRA program.


Outcome of a cooperatively funded children's day-treatment program. Emotionally disturbed children participated in a cooperatively funded day-treatment program. The philosophy of the program, designed to facilitate understanding and cooperation among the three funding agencies, the parents, and interdisciplinary team members, was a variant of social learning theory. In this article the program is described, as well as the results of a follow-up study which indicated successful therapeutic intervention. Finally, a discussion of the success, problems, and dissolution of the program is presented. A suggestion is made that future programs which are funded cooperatively include a buffer fund to allow the program to survive temporary financial shortfalls.


The implementation of a program innovation in a community mental-health center: theory and practice. This paper describes the innovation of a partial-hospital program into an ongoing community mental-health center which is under the auspices of the department of psychiatry housed in a city general hospital. The role of the environment and structure of this mental health system in facilitating and hindering implementation is discussed. Resistance from within the program and problems associated with institutionalization of the implementation are noted. The experience of innovation is linked with theory.


Method for the study of the effectiveness of attendance in the multiple-family group on overall client treatment in a day-hospital setting. Client satisfaction in a specific day-hospital session was demonstrated using an evolving questionnaire process. This process consists of phases in which the questionnaire is systematically revised based upon significant findings from the previous questionnaire, further client input, and the application of pertinent theoretical frameworks. In the present study, two phases of revision are described to determine specific aspects of client satisfaction from attendance in a multiple-family group (MFG). Mahler's theory of separation-individuation and Russell's circumplex model were used in the revision of critical items from Questionnaire 1 used in Questionnaire 2. Results of Questionnaire 2 yielded more refined data of discrete aspects of client satisfaction from attendance in the MFG. Thus, these results will be used to devise Questionnaire 3 in the next phase of the questionnaire evolution process.


Mental patients in nursing homes: their characteristics and treatment. Nursing homes have become a primary care site for chronic mental patients. The present study reports an empirical investigation of the characteristics of 163 mental patients in nursing homes in a large midwestern city and of the treatment they receive. These mental patients tended to be chronic schizophrenics with an established history of poor social coping. Their average age was 48 years, and they had no obvious physical ailments that would account for their nursing-home placements. These patients received an average of three or four medications each, a figure that tended to increase over a 1-year period. Conversely, relatively little psychosocial treatment is provided these patients, and such treatment tends to decrease over a year. Results are discussed in terms of the relative emphasis in nursing homes on custodial care versus active psychosocial treatment.


The rights of passage: hospice care in the 1980s.


"Selling" your hospital: public relations is essential.


Involuntary treatment: the issue of consent.


The People's Republic of China: impressions from a recent visit.


Alberta redesigns its home care information system.


Hospital nursing practice in the year 2000.


Evaluation of amitriptyline use for depression when prescribed by internists and psychiatrists. The efforts involved in structuring and implementing a drug utilization review (DUR) program that was designed to assess the use of amitriptyline for depression when prescribed by internists and psychiatrists is described. In-depth audit criteria were used to identify deviations from the criteria for each group. An immediate goal of this amitriptyline DUR program is to apply the results of the study toward the implementation of a targeted, multifaceted educational program. The design of the DUR program should emphasize the individual needs of each of the two study groups.


The P&T committee: Clinical Hospital Center, Zagreb, Yugoslavia. A P&T Committee was recently founded and organized by clinical pharmacologists at the Clinical Hospital Center in Zagreb, Yugoslavia. Although subtle differences are evident, the responsibilities of the Yugoslav P&T Committee parallel those of the P&T Committees in hospitals in this country. A hospital formulary has been established in Zagreb's Clinical Hospital Center, resulting in more rational prescribing of drugs. The criteria for formulary inclusion and protocol for submission are provided. Other responsibilities of the Yugoslav P&T Committee in Zagreb are discussed.


Transferring a national information system from the public sector to the private sector--how the Administration on Aging did it. The Administration on Aging (AoA) sponsored a national information system known as the SCAN system. The SCAN bibliographic database went on-line in March 1982. Congress, however, had repealed the authority for the clearinghouse, so the Government let all of the services of SCAN expire by September 1982. The Government then tried to keep the SCAN information accessible by offering it to the private sector. The Government solicited applicants through both the Federal Register and the Commerce Business Daily. As a result, the American Association of Retired Persons (AARP) and AoA signed an agreement calling for AARP to make such of the SCAN information accessible on-line and to update it.


Dollars and sense: the economics of personal health decision-making. The economic consequences of personal health care decision-making have received relatively little attention in the United States. The majority of the American public is shielded from an awareness of the cost impact of health services by first dollar health insurance coverage and modest out-of-pocket personal payments. As the various current structural changes in the reimbursement system for health care begin to manifest themselves in terms of mandating individual responsibility for paying a significant portion of health care, Americans will require and demand a deeper understanding of how much their health is costing them. In addition, as individuals realize that up to 50% of disability and death can be attributed to negative lifestyle health behaviors, the interrelationship of personal economic status and health status will create a new consciousness of the value of preventive health practices and health education. This article provides an in-depth analysis of the social forces in America compelling individual health decision-making in economic terms, barriers to informed health decision-making, a suggested matrix for making quality-vested health decisions (with case examples) and a discussion of available resources for assisting in the decision-making process.


Raising money from members: who needs what you do?


Response to Relman.

Response to Relman.


For-profit hospitals for Europe: the case of Britain and France. The paper first describes the structural characteristics of the for-profit private sector in Britain and in France. In Britain, the recent growth of the for-profit private hospital's sector, although still a small sector, is related to the growth of private insurance. Cost-containment however coupled to rapid increases in premiums is slowing down the momentum. Moreover, the NHS starts charging private hospitals for such services like blood banks. In France the private sector has always been strong, although living in a highly regulated and dependent symbiosis with the public sector. In a second part, speculations are made on the crucial question whether for-profit hospitals are a legitimate alternative for Europe. In the end, an in-between solution is opted for by which the public sector would sub-contract certain functions like data processing, management and others, from the commercial sector.


Adequacy of a health program for the Nigerian population: a critique of the free health scheme in Oyo state 1979-1982.


The community residential treatment service: developing a continuum of prosthetic environments for the chronically disabled. Among the many issues regarding the care of chronic mental patients, none is more pressing than the need for administrative and clinical models designed to organize and systematize the efforts of diverse community service providers. This paper describes the functioning of the Community Residential Treatment Service of the South Beach Psychiatric Center, a large-scale project of a state facility created to respond to this tissue. By blending sophisticated clinical and administrative technology, programs operated by the state, voluntary, and proprietary health care sectors have been integrated to form a balanced service delivery system. This system provides a broad continuum of inpatient and outpatient residential settings developed in accordance with social learning principles. The components of the system, with the Community Residential Treatment Service as the major integrative force, are linked together by detailed contracts as well as common behavioral clinical and behavioral administrative language. The treatment successes f this system have been significant enough to suggest that a positive synergistic effect is generated by this programming combination.


The future of the nonprofit sector.

The future of the nonprofit sector.


Emphasize steering instead of the brake.


Ambulance maintenance.

Ambulance maintenance.


1985 salary survey.

1985 salary survey.


Medicine, society & the dying patient: the case of Granny Doe.


The new era of negotiations: conflict or cooperation.


Clinical need variations of disabled persons residing in group homes. Group home research has generally entailed comparison of these settings and their residents to institutions and their residents. Group home residents have frequently been treated as a homogeneous cohort of individuals. When group home development began, initial residents--usually individuals recently deinstitutionalized--were probably relatively homogeneous in regard to functional abilities and service needs, and generally similar to other disabled persons living in the community. Today, the residents of one group home may bear little resemblance to those of another. This report presents information about the types of group homes within a state system based upon the characteristics and service needs of 1,050 persons in 118 group homes and questions the role of community mental health centers in addressing certain service needs of group home residents.


Protecting personal information: what every nonprofit should know.


Trauma care. Child of the sixties, man of the eighties.


Continuing education.

Continuing education. With increasing demands being placed on limited resources, hospitals are drastically cutting back or eliminating entirely funds for employee continuing education. Considering the advances in technology, the changing regulatory and legislative climates, and the growing need for expertise in handling DRGs and case mixes, more funds should be allocated for continuing education, not less. Agree: 87%, Disagree: 9%, No opinion: 3%.


Santa Barbara Cottage Hospital.

Santa Barbara Cottage Hospital. The 465-bed Santa Barbara Cottage Hospital is the largest medical facility on the California coast between Los Angeles and the San Francisco bay area. The hospital dates back to 1888, when a group of local citizens began raising funds to build a "cottage-style" hospital for the growing community. Their original plans called for a complex in which each medical specialty would be housed in a separate bungalow. Even then, however, such a decentralized plan was too costly, so work began instead on a single cottage for all hospital departments. The first Cottage Hospital opened in 1891, with 25 beds housed in a two story Victorian building. Now a hugh medical complex employing some 1,500 people, the hospital continues to be called "Cottage" after the original home-like building. Rodney J. Lamb has been Hospital Administrator for the last 30 years.


A total waste management system for hospitals.


Sterile shelf life and expiration dating. When products are packaged so that they remain sterile, the archaic practice of outdating is no longer necessary. Instead, expiration dates can be used as a tool for controlling the hospital's inventory. In this article, the Journal's publisher explains how products become contaminated and outlines steps CS professionals can take to guard against contamination.


Indefinite shelf life...amen!

Indefinite shelf life...amen!


Steam penetration in fabric packs--gravity displacement sterilizers.


Implementation of health facilities in a new city. A new city is under construction in a developing country. The town will be organized in modules, and the population projection is established till the 90s. The ratio of medical personnel to inhabitants is fixed according to health policy criteria. The primary care system should be composed of a set of health centres which are identical with regard to equipment and personnel. The problem is to determine the number--and thus the size--of the health centres, and their location. The solution depends on two opposing factors: the total construction cost, which is increasing with the number of centres, and the walking distance for the patient, which is decreasing with the number of centres. For a given critical distance, we find--using techniques of location theory in network--the smallest number of centres that will ensure that all inhabitants are located within the critical distance. A Fortran program in which the sensitivity of the solution is studied as a function of the given critical distance is developed.


The marketing of pastoral care and counseling, chaplaincy, and clinical pastoral education. Offers ten approaches pastoral care persons might use to confront the growing health care crises facing the United States. As a response, the Executive Director of the Association for Clinical Pastoral Education outlines alternatives to traditional CPE settings which could be utilized to address creatively the many changes in health care delivery systems.


Sarawak General Hospital--Kuching, Malaysia.


Marketing pastoral counseling.

Marketing pastoral counseling. Identifies, suggests understandings, and illustrates applications of marketing principles as they relate to pastoral counseling services. Describes four approaches to marketing pastoral counseling--traditional, educational, marketing, and fund raising--and gives illustrations of each. A director of an established pastoral counseling center responds to the article in terms of "high density" and "low density" principles and suggests that strategies which emulate the medical model may need to be re-examined by contemporary pastoral counselors.


Custom procedure trays. An overview.

Custom procedure trays. An overview. A new service industry has emerged to assemble and sterilize custom procedure trays for use in the hospital. CS and materials managers, OR supervisors, infection control practitioners and other hospital personnel are being asked to make a selection among many competing vendors. A methodology is needed to assist these managers in the decision making process. This article will define custom procedure trays and suggest criteria by which the selection process may be assisted.


Public relations for pastoral counseling centers. Outlines a public relations program in terms of setting objectives, developing programs, and evaluating effectiveness. Details an example of a PR campaign for a Samaritan Center. Notes ways in which a well-planned PR program can increase a pastoral counseling center's effectiveness and visibility.


A mini course in uniform buying techniques.


West Midland Regional Health Authority regional training scheme in sterile service management.


Getting the most out of performance appraisals.


Should you...lease your staff to cut costs?


New center built for medical complex. Administration wants efficient laundry.


Hospital redevelopment plan excludes laundry. Closed in-house facility won't reopen.


Goals enhance job security.

Goals enhance job security.


Medical device reporting. Hospitals play a major role.


Compliance programs for the new EtO standard.


Interpersonal communications.

Interpersonal communications.


Regulation vs. competition.

Regulation vs. competition. Must we choose between regulation and competition as the remedy to today's skyrocketing healthcare costs? These two options are not necessarily mutually exclusive, and neither alone can best serve the needs of both the public and the profession. The heart of the current healthcare debate can be more accurately described as a system of individual restraint via the market versus a system of collective restraint arrived at through fixed budgets. Upon close examination of both viewpoints, it becomes apparent that a system in which regulation and competition coexist may be the best alternative in the long run for containing and redirecting total national healthcare expenditures.


The changing healthcare consumer.

The changing healthcare consumer.


Competitive marketing strategies. A challenge for academic practices. A special challenge has been presented to academic medical practices by the new healthcare environment. While increased competition for patients and resources affects all medical groups, it is the academic practices who are responsible for training the physicians of tomorrow. Not only must they sharpen their students' awareness of the new environment and teach them to incorporate effective management strategies into their practices, but they must set an example in effective management as well. The basic concepts of competitive marketing strategy, along with helpful exhibits, are presented here, and strategies for effectively maximizing position are discussed from the viewpoints of product mix, process market, and financing.


Public interest be damned. Our patients come first.


Achieving effective cost control while decreasing regulation. A response to Dr. Fein. While Dr. Rubin and Dr. Fein agree that we must achieve effective healthcare cost control while decreasing regulation, they do not agree on the means to this end. Drawing on his years as assistant secretary for planning and evaluation at the Department of Health and Human Services, Dr. Rubin presents his views on regulation, competition, PPOs and HMOs, and prospective budgets. The real issue that emerges is whether or not our society is willing to spend millions and millions of dollars for a slight prolongation of life, and at what level this type of decision should be made.


A $2.2 million lesson in the perils of peer review.


Can previous malpractice charges be held against you?


Four visions of health care beyond the millennium.


Cost containment factors will dictate promotional changes.


Allocating overhead hours with a spreadsheet.


Keeping the lab out of court.

Keeping the lab out of court.


An inventory control and money management system that works.


Developing practice plans in a public hospital. As funding sources outside of tight state and local budgets are being explored by public institutions, there is increasing interest in practice plan arrangements at public hospitals. The efforts of the New York City Health and Hospitals Corporation (HHC) in developing and implementing practice plan policies and programs in a diverse system of healthcare centers are documented here. These efforts were initiated in conjunction with a review of HHC's contracts with major medical schools, and their success has proven to be largely due to the plan's built-in flexibility and strong administrative and medical leadership.


Projecting a favorable personal image.

Projecting a favorable personal image.


Job satisfaction: the possible dream.

Job satisfaction: the possible dream.


Financial reporting.

Financial reporting. "How are we doing?" Financial reports must provide the answer to this all-important question for every medical group. Although there are some key differences between academic practices and private group practices, good financial reports and statements of activity are essential in all situations. Examples are provided here of how financial information can be communicated to the several organizational levels that need the information, as well as how financial planning, measurement, and control are part of this communication process. Sample formats outline the important ingredients for making your group's reports more useful.


A physician profile system.

A physician profile system. The need for effective management information systems is now evident. No longer is pertinent and timely information merely something desirable to group practice; it is essential for management control and even survival in today's healthcare environment. Most of the management information systems currently in use are designed for controlling line-item budget categories and not the key professionals whose actions determine the fate of the practice. A physician practice profile system was developed at the Cornell Medical Practice and implemented in July 1982. This tiered reporting system is described in detail, including its ancillary service utilization and quality audit profiles, and the results of the system are presented.


Hospital layoffs: the Michigan experience.


Layoffs hit small, rural hospital.

Layoffs hit small, rural hospital.


Dynamics of a staff reduction.

Dynamics of a staff reduction.


Program aids displaced health care workers.


Outplacement counseling proves cost effective, compassionate.


The legal implications of layoffs.

The legal implications of layoffs.


Current happenings--Michigan Department of Public Health.


Middleton Trustee of the Year. Alliance's E. George Middleton Jr.


California hospitals talk to medical society about medical staff bylaws.


More not-for-profits mull sellouts to form 'new breed' of foundation.


HHS 'Baby Doe' proposals draws fire.

HHS 'Baby Doe' proposals draws fire.


Boards consider several factors in trading hospital for foundation.


New sales strategy puts AHSC executives near major customers.


Boards must approve medical staff bylaws.


Modified heart-lung machine may cut cost of treating severely ill newborns.


Hospital group rebates under federal scrutiny.


Company puts MD groups into home care business.


Eleven cost containment tools.

Eleven cost containment tools.


First full-service hospice for children opens.


The health lobby: making private interest public law. Part II.


Pathology has been an invisible specialty too long! It is time for pathologists to tell patients and the public who they are and what they do, the author insists. Here are tips that will make your interviews with television and newspaper reporters more comfortable and more productive. This article is adapted from Mr. Zeitlin's presentation at the CAP seminar "Communicating With the Public: The Pathologist and the Media," during the 1984 CAP/ASCP Spring Meeting. The seminar will be repeated at the 1985 Fall Meeting, Nov. 2-8.


Effective supervisory training and development, Part 2: In-house approaches and techniques.


Collecting pituitaries: why the program continues to need your help. The human pituitary collection program provides hormone for thousands of hypopituitary dwarfs each year. Though the past two decades have been years of great progress, the need for your dedication and assistance in years to come is more acute than ever.


Decisions, decisions: which approach to take? After examining four basic decision processes, and the kinds of problems they are designed to solve, the author explains how to use each according to the situation at hand. Examples illustrate each.


Beyond quality circles: self-managing teams. A more extreme form of change than QCs, self-managing teams are informally estimated to have evolved in more than 200 U.S. plants. Indications are, however, that this is but the beginning--despite middle managers' fears that such teams will erode their power.


Encouraging patients to use the hospital library.


Stage negotiation: the best route to agreement.


A prescription for lower health care costs.


Current methods, problems and future trends. The merit of merit pay.