Searching for new directions in mental health services...for new times. The mental health system as we know it today is essentially a linear extension of the system in place thirty years ago. "System lethargy" results from planning which has relied excessively on past models and has emphasized "facts" over principles rather than taking advantage of changing values and societal trends. This paper identifies major environmental changes likely to influence the health field, including changes in technology, scale of organization, and leadership style. Vibrant mental health services of the future are likely to be less exclusively based in the health care system, with greater emphasis on initiatives in the workplace, more use of electronic media, development of new professional roles and more intensive client-focused programming.


Maintenance as treatment: the Fennell Program Day Centre. After discussing maintenance as an appropriate treatment philosophy for treating the long-term chronically mentally disabled, the authors describe a day centre based on this approach. Resources and costs, the target population, clients and their needs, activities, and referral and back-up procedures are reviewed. The article concludes with a look at some of the problem areas and benefits involved in a program using a maintenance approach.


Semi-independent living for the long-term mentally ill. This article describes a program developed in Burnaby, British Columbia in early 1981 to provide former boarding home clients with placements in unsupervised group home settings. The article also demonstrates how the mentally ill can foster solutions to their housing problems by means of participation in a special needs housing society.


The breakup of a giant. How will the divestiture of AT&T affect hospital phone service and costs?


Corporate reorganization. Promise and problems of hospital 'businessification'.


Management's perspective on medical office computerization. Part I.


Hospital information systems: a marketing resource.


Employee accountability--are you getting what you pay for?


The elusive hospital information system.


A new approach to medical practice computers and the conversion process.


Discharge planning in a primary nursing system.


Head nurses become effective managers in the discharge planning process.


Discharge planning models. Models revisited.


Hospice care: a challenge and an opportunity for discharge planners.


'Networking' offers advantages when EDs and FECs cooperate.


IPM, the Methodist Hospital, Houston.

IPM, the Methodist Hospital, Houston. The cardiac rehabilitation department at this institute combines three separate programs into a complete rehabilitation facility. The sequence of programs is designed to provide optimum conditions for maximum physiologic as well as psychologic improvement.


Hospitals report maintenance savings with flame-resistant glass fiber draperies.


Work controls for housekeeping.

Work controls for housekeeping.


An equation that works. Education and in-service + frequent reinforcement = pride, confidence, positive attitude, teamwork and professionalism.


Conference with audio, but send video ahead.


The need for an operational definition of burnout.


Professional roles at risk for burnout.

Professional roles at risk for burnout.


Assessing burnout: the organizational and individual perspective.


Prevention and self-care for professional burnout.


Organizational strategies: promoting retention and job satisfaction.


Viewpoint: the role of the educational setting in preventing burnout.


Preventing burnout: coordinating the employee health function.


Applying quality circles in healthcare.

Applying quality circles in healthcare.


Expectations in relation to disciplinary functions of state medical boards. The perspective of a medical administrator.


Consultants.

Consultants.


Communications: How ECFMG was formed.

Communications: How ECFMG was formed.


Principles of accounting and finance for the nonaccountant.


Involving employees in change, productivity and the future.


Needed now: a hospital partnership for patient care.


Should your hospital have a department of education?


Controlling overtime.

Controlling overtime.


From idea to print: writing and publishing a journal article.


Performance auditing for health care supervisors.


Market-based planning for a successful PPO. The preferred provider organization (PPO) is rapidly evolving as an innovative, cost-reducing alternative to traditional provider modalities. Literature to date, however, has devoted little attention to opportunities and risks associated with PPO development. The authors address PPO development strategy, recommending a market-based planning approach which matches hospital resources with market demand and other environmental forces.


Ten reasons not to reorganize (revisited)


Case in point. Metropolitan Charity Medical Center.


Case in point--the answer. Seever Osteopathic Hospital.


Politics of the purse strings.

Politics of the purse strings.


College of Health. Consumers unite.

College of Health. Consumers unite.


Alberta's brave, new glass-domed world.

Alberta's brave, new glass-domed world.


Friends of the NHS fight it out.

Friends of the NHS fight it out.


Blood money problems.

Blood money problems.


Clean bill of health for module.

Clean bill of health for module.


Consultants face the figures.

Consultants face the figures.


Health equality. Raising the race issue.


Roll call for transport.

Roll call for transport.


A year in the life of a budget.

A year in the life of a budget.


Management.

Management.


Resource allocation. The Oxford experiment.


Nucleus extension.

Nucleus extension.


Are efficiency measures effective?

Are efficiency measures effective?


Warning lights?

Warning lights?


Staff development. Tough in the middle.

Staff development. Tough in the middle.


Effective reporting from materials management.


Vaccination. When the damage done is doubled.


When and how to use consultants.

When and how to use consultants.


What top administration expects from materials management.


Reporting materials management results.

Reporting materials management results.


Dissatisfaction with health-care costs is centered on hospitalization.


Dealing with the impaired physician.

Dealing with the impaired physician.


Managing the hospital's political environment.


Coping with arson: an update.

Coping with arson: an update.


An interview with James G. Fasone.

An interview with James G. Fasone.


Financial planning and computer modelling in a Middle Eastern hospital.


Private and public responsibility for health and health care.


The role of the preceptor in the National Administrative Training Scheme.


What's the difference? Grievance or dispute?


Computing development and education for management in the NHS.


Planning--the Lothian approach.

Planning--the Lothian approach.


Cometh the NHS chief executive?

Cometh the NHS chief executive?


Prevention of hospital infection--the role of hospital engineering.


Biosafety for hospital engineers.

Biosafety for hospital engineers.


Natural lighting in hospital design.

Natural lighting in hospital design.


BSN offered at hospital nursing school through consortium agreement.


Clinic's multilingual staff helps Indo-Chinese refugees.


Emergicenters' uncertain legal status raises treatment, liability questions.


Hospital-physician joint ventures: some crucial considerations.


Care givers must incorporate spiritual values in daily work.


Physician budget committee helps control capital equipment costs.


In-house hospice design reflects providers' priorities.


Hospital has right to set visiting rules to serve patient's best interests.


Government-funded hospital may require physician to accept indigent patients.


Funding pastoral care: are we committed to the Catholic care mission?


Planning for and implementing an automated inventory control system.


Computerization: a necessity for materiel management.


The use of microcomputers in materiel management.


A minicomputer system for materiel management.


Planning guidelines for automating a pharmacy department.


Development of a computerized property assets management program.


Multidisciplinary computer inventory controls.


Reimbursement of depreciation costs based on computer-assisted replacement cost appraisals.


Exchange cart information system: the computer connection.


Increased revenues through improved charge recovery.


Materiel management systems: a means toward significant hospital cost containment.


Hospital pharmacy inventory management: economic order quantity model with space limitation.


Microcomputers and hospital materiel management: improving the likelihood of successful selection.


Management tools for the modern day health administrator. Part 5. Setting standards and motivating tools.


How hospitals can respond to changing values. To accomplish the intended results, hospital administrators must develop a new perspective on problem-solving as it relates to changing individual values. Administrators must progress toward solutions that acknowledge the presence of shifting values in the hospital environment.


How to train unit managers.

How to train unit managers. Unit managers do need formal supervisory training. Training should focus on their approach to the decision making process as well as their performance within it. Quality circle training was deemed most appropriate, because it focuses on team management and the development of skills needed to handle interactions in team settings.


A medical staff credentialing information system.


Job stress on an oncology nursing unit: an attitudinal survey.


How to deliver comprehensive rehabilitation using a matrix organizational model.


Hospitals and communities: bridging the gap.


IRS issues proposed regulations on shared service organizations.


Arkansas court halts construction, upholds state health plan in CON proceeding.


WV court invalidates freeze on rates for hospital services; freeze violates Medicare, Medicaid regulations.


Missouri appeals court overturns public hospital board decision on suspension of staff privileges to a medical staff member.


Private interview rooms can improve the overall quality of psychotherapy in inpatient hospital settings.


Volunteers can be problem solvers.

Volunteers can be problem solvers.


Results of a survey of interorganizational linkages in hospital administration.


On re-sterilizing disposables.

On re-sterilizing disposables.


"Green dot program".

"Green dot program".


Minnesota Supreme Court restricts disclosures of group therapy sessions as evidence in child abuse prosecutions.


California court refuses to grant woman's request for injunction to stop hospital intervention in her decision to starve.


Review of one year of drug prescribing for the elderly in a hospital clinic.


A successful affiliation with an academic medical center can put your hospital in a better financial position and create a regional market for its medical services. Part I.


A patient and employee advocacy program--how to get productivity and harmony.


Negotiating a successful affiliation agreement between a hospital and a university, Part II. Part I in the January/February 1984 issue of HOSPITAL TOPICS discussed how such an affiliation can help solve the DRG problem and improve the cost benefit of your capital and operating programs. Part 1 also included an up-to-date list of references on all phases of the subject. Part II takes up the interests of the University, the Hospital Board, the Physician, the Patient, the Third Party Payor and the costs of the affiliation. It will detail entering into a memorandum of agreement between the Hospital and University and the text of such an agreement is given.


Central supply. A new ball game between disposables and reusables.


Feasibility of review of emergency room drug prescribing for patients 75 years or older.


CEOs looking toward health care tomorrow.


"Our goal is prevention". An interview with Nicaragua's Director of Health and Safety Programs.


Buying: learning the ropes.

Buying: learning the ropes.


Doing it all for them--with style.

Doing it all for them--with style.


Those loveable impossible-to-do-without volunteers.


Buying strategies for chocolate.

Buying strategies for chocolate.


Back to the patients: process vs. outcome for hospital managers.


It can be done!

It can be done!


Hospitals and business: a viable partnership for innovation in healthcare delivery.


Fixturing with glass.

Fixturing with glass.


Financial flexibility: a measure of financial position for hospital managers.


Planning shop layout.

Planning shop layout.


The organizational climate audit ... or how healthy is your hospital.


Who will your customers be?

Who will your customers be?


Keeping a finger on inventory.

Keeping a finger on inventory.


Team work: a commitment to cooperation.

Team work: a commitment to cooperation.


Promotion + service = sales.

Promotion + service = sales.


Ringing up holiday sales.

Ringing up holiday sales.


Space, fixtures and layout.

Space, fixtures and layout.


Light fingers = heavy losses again!

Light fingers = heavy losses again!


Value analysis.

Value analysis.


Catering to your clientele.

Catering to your clientele.


The financial roller coaster: planning for the big dip.


What is your uniform saying?

What is your uniform saying?


Expansion and innovation equal $.

Expansion and innovation equal $.


Decorating the shop.

Decorating the shop.


The asset of inaccessibility.

The asset of inaccessibility.


Specialty foods ...

Specialty foods ...


The Atrium Shoppe more than just another pretty place.


On the question of finances and figures ...


Hospital administrations: how supportive are they?


Tax-exempt status. What does it mean?

Tax-exempt status. What does it mean?


When and why we lose volunteers.

When and why we lose volunteers.


Some tips on energy management.

Some tips on energy management.


Employee payroll deduction programs.

Employee payroll deduction programs.


Children's hospital gift shops.

Children's hospital gift shops.


Big isn't everything, Part 2.

Big isn't everything, Part 2.


Communications between the P & T chairman and other medical staff committees.


P & T Committee roundtable discussion: Great Lakes region. Part II. A series of regional roundtable discussions regarding the successful operation of Pharmacy and Therapeutic (P & T) Committees has been conducted by Hospital Formulary. Representation from private hospitals, university and teaching hospitals, as well as Veterans Administration Medical Centers has been achieved to ensure that different aspects of P & T Committee performance are demonstrated. Issues such as committee profile, constituency, function, and mechanics are discussed, as are criteria for establishing a successful formulary within an institution. The sessions were taped and the edited transcription is provided in the following article.


Drug utilization review of nifedipine.

Drug utilization review of nifedipine.


Utilizing the computer for a hospital bid program. The goals of a computerized bid program include acquisition of pharmaceuticals at lowest possible cost, guaranteeing prices for a fixed period of time, having the ability to provide budget and patient charge information, decreased payroll hours and expenses vs. a manual system, and having the ability to retrieve data for accounting and purchasing procedures. These goals can be obtained by separating the bid procedure into five operations, which are identifying the pharmaceuticals to bid, preparing a vendor bid list, tabulating the bids received, selection of awarded bids, and vendor notification of awarded bids.


Consultant pharmacist impact on antihypertensive therapy in a geriatric long-term care facility. Antihypertensive therapy of a group of elderly patients in a long-term care facility was compared before and after the addition of a consultant pharmacist to the health care team. Criterion variables were systolic and diastolic pressure and drug cost and use. Consultant pharmacist protocol included drug history and monthly use review and pertinent communications regarding problems. Statistical analysis employed a t test with two-tailed probability. Both systolic (128.5 to 135 mm Hg) and diastolic pressure (68.9 to 72.3 mm Hg) were increased after 1 year, the number of patients with hypotensive readings decreased, and the average antihypertensive drug cost was decreased. The cost of potassium supplements was increased, however, fewer patients had abnormal potassium levels.


Pharmacy generated on-line cancer chemotherapy information system. Described is an on-line Cancer Chemotherapy Information System developed to supplement a pharmacy's dose verification capability when dealing with these agents. MANTIS, an interactive programming language designed by IBM, was utilized for the creation of this program. The two major components of the system are the protocol summaries and the individual drug monographs. The protocol summaries are accessible from the main menu through three separate indexes: (1) Investigational Group Index, (2) Primary Site/Lesion Index, and (3) Drug Index. The drug monographs are accessible either from the main menu or directly from the protocol summary being reviewed. The protocol summary allows for dosage and administration verification of the entire regimen at optimal conditions. The drug monographs outline necessary dose adjustments for specific organ compromise as well as side-effect, interaction, and handling information.


A strategy to reduce drug expenditures with a drug utilization review program. This paper describes a potential strategy for implementing a Drug Utilization Review (DUR) program aimed at reducing hospital drug expenditures. The importance of this type of program is underscored by the spiraling rise in health care expenditures and the influence of a new drug technology on this rise. The program described here consists of a utilization review program for high cost drugs for which a lower cost alternative exists. An initial retrospective usage and cost analysis must be undertaken to identify those drugs which should be reviewed initially. As the DUR program progresses, additional drugs can be added to the review program. Once the drugs to be reviewed are identified, the first step is to develop usage criteria. This can be accomplished through a review of the literature and consultation with medical and other specialists. Appropriate medical administrative staff approval and endorsement of the criteria should be obtained utilizing various committee structures and other input. The pharmacy staff must also be inserviced on the approved drug usage criteria. After the criteria are finalized, staff pharmacists will contact a DUR pharmacist daily upon receipt of any physician orders for the review drugs. This pharmacist will then compare the prescribed drug use to the approved criteria and contact the prescriber when the usage appears questionable. A lower cost therapy will then be recommended when appropriate. In order to assess the impact of this intervention strategy on drug expenditures, the cost of the initially prescribed therapies must be compared to the recommended therapies. Data should also be obtained on overall drug usage and expenditures to detect shifts in therapy and drug costs. The success or failure of this concurrent DUR program will be highly dependent upon a team approach and cooperation. A program of this type could have a significant impact on hospital drug expenditures in those hospitals where it can be successfully implemented.


Involving your staff in committees and meetings. Committees serve as an ideal forum for members of an organizaton to exchange views and information. If managed effectively, they can be utilized to generate ideas and to provide sound recommendations to the pharmacy manager. This article describes a personnel management program in which all levels of pharmacy personnel are provided with several opportunities to actively participate and contribute to the establishment and attainment of departmental objectives. The involvement of the staff in serving on committees and attending meetings is outlined. Various intradepartmental and interdepartmental committees as well as continuing education conferences are described. The comprehensive program permits each member of the pharmacist staff to spend approximately 5-10% of their time participating in the three above-mentioned activities. This personnel management approach has had a positive effect on the role of the entire staff and has enabled all levels of employees to get involved and contribute to departmental services and hospital issues. Most importantly, it has successfully provided a stimulus to the staff to pursue avenues of professional specialization.


Not quite traditional: obstetrics/gynecology office.


Color abets the cure: Vista Hill Hospital.


Color and psychotherapy.

Color and psychotherapy.


Unifying elements: gastro-enterologist office.


The transformation of a general pediatric clinic to a physician-directed practice.


Management issues in an ambulatory care consortium.


Hospital-based versus free-standing ambulatory care costs: a comparison.


An episode approach to the care and costs of obesity.


Hospice: life to its fullest.

Hospice: life to its fullest.


National Nursing Home Week. Planning guide.


Diversified living arrangements mean having a choice. Heritage Village residential care.


Diversified living arrangements mean having a choice. Cokesbury Village life care.


The challenge of treating post head trauma patients.


Legal currents: questions raised in making certain treatment decisions.


Architecture and long term care.

Architecture and long term care.


Stochastic modeling of consumer preferences for health care institutions. This paper proposes a stochastic procedure for modeling consumer preferences via LOGIT analysis. First, a simple, non-technical exposition of the use of a stochastic approach in health care marketing is presented. Second, a study illustrating the application of the LOGIT model in assessing consumer preferences for hospitals is given. The paper concludes with several implications of the proposed approach.


Brands or generics: the dilemma of pharmaceutical marketing in a developing country. A significant issue in pharmaceutical marketing in many developing countries is whether drugs should be sold by generic or by brand names. In Pakistan, legislation prohibited the sale of brand name drugs in order to increase price competition, and strengthen the market position of indigenous manufacturers to compete against multinationals. However, the government's objectives were not achieved for reasons discussed in the article. The Pakistan case has implications for multinational firms and for other developing countries in similar situations.


Diversified living arrangements mean having a choice. Good Samaritan Village continuum of care.


Community services reach out to elders in need.


Home delivery of quality care: a winning practice.


Pioneering respiratory care in the nursing home.


The community survey and the health services provider.


Marketing: (how) is it working?

Marketing: (how) is it working? This editorial examines possible reasons why marketing has not worked as well as originally projected in the nonprofit and public sectors.  4 possible barriers to effective marketing are proposed.  1st, marketing may not be an appropriate discipline for full implementation in the social sector.  This may be why nonprofit managers adopt only fragments of the marketing model.  2nd, ideologically, nonprofit people tend not to be market-oriented.  3rd, nonprofit organizations often lack the financial resources for fully implemented, data based marketing, and 4th, social and nonprofit organizations' structures are not conducive to marketing.  Marketing functions are often housed in public relations or communications departments of nonprofit organizations, and thus are not in a position to have a significant impact on the institution's operations.  Of value would be a study team, composed of academicians and practitioners, to assess the situation and offer some solutions.  The following 4 questions should be addressed:  What is the general state of nonprofit/social marketing?  Are there any organizations in which marketing is being fully implemented, with documented results?  Are there any elements that are common to successful nonprofit marketing efforts?  Can these common elements be exported so that other organizations can apply them?


Marketing study interviews: a case study.


Improving health care strategy planning through assessment of perceptions of consumers, providers and administrators. Perceptions of consumers, health care administrators, and physicians regarding health care providers are analyzed. Ratings on 26 dimensions of health care services were obtained from members of the three participant groups using measures of image and satisfaction of both physicians in general, and of specific physicians. Discriminant analysis reveals significantly different perceptions of the health care system among the three groups of respondents. These differences suggest some changes in health care administration which could lead to increased consumer satisfaction and competitive advantages for physicians and health care institutions.


Potential liability in corporate medical programs.


Occupational health information systems.


The future of corporate health initiatives.


Issues of mission, structure, and domain.


The medical department and pressures for change.


Dilemmas in the company response to health risk.


Physicians' frustrations with management.


Microcomputers--the information and records managers newest file, storage & retrieval tool.


Management issues in information management.


Olympic EMS...another game?

Olympic EMS...another game?


Carry-in equipment. Part 2: Soft packs and rescue packs.


Trauma Center--ABC style.

Trauma Center--ABC style.


Monthly performance reports: management's tools for control.


The decision to establish a closed psychiatric unit: some ethical and administrative considerations.


Nursing home placement for beginning baccalaureate nursing students--why not?


Eleven years of experience with capitation reimbursement for pharmacy services. Pharmacy services encompass more than dispensing medications. However, traditional pharmacy reimbursement methods are based heavily on the dispensing of medications--i.e., on selling a commodity rather than providing a service. The capitation reimbursement method described provides the pharmacist with a means of reimbursement for professional services independent of the number of medications consumed by the patient. The pharmacist is thus free to encourage reductions in the consumption of medications without incurring an economic penalty. Such reductions are not only of potential benefit to the patient but can also reduce the workload of the nursing home staff. The feasibility of this capitation system is demonstrated by the successful pharmacy practice described.


Stability in the Federal Employees Health Benefits Program. Recently the Federal Employees Health Benefits Program has been the subject of much discussion in Washington as a result of the rather large premium increases in 1982 and 1983, the delayed open season of 1981, and the benefit reductions. Enrollees responded in May 1982 to the changes; a record number switched plans. It appears that enrollees were simply responding to the new premiums and benefits. In this paper we describe the economic incentives faced by enrollees in the FEHBP. We find that, due to the strong incentives for enrollees to leave certain high-cost plans, continued instability should be expected. In fact, the disparity between expected benefits and premium is so great for some plans (e.g. the Blue Cross high-option) that their survival is questionable. This lack of stability raises important questions about the viability of some pro-competition proposals involving multiple-insurer systems.


Children's Hospital and Health Center, San Diego, California.


Computerized exchange cart processing.

Computerized exchange cart processing.


Competition between non-profit and for-profit health insurers. This study investigates the effects of tax, regulatory, and reimbursement policies and other factors exogenous to the health insurance market on the relative price (to commercial insurers) paid by Blue Cross plans for hospital care, their administrative expense and accounting profits, premiums, and ultimately Blue Cross market share. We specify and estimate a simultaneous equation model to assess interrelationships among these variables. We conclude that premium tax advantages enjoyed by the Blues have virtually no effect on the Blues' premiums or their market shares. A Blue Cross plans' market share has a positive effect on the discount it obtains from hospitals as does coverage of Blue Shield charges by a state-mandated rate-setting plan. An upper bound on the effect on the Blue Cross market share of covering Blue Cross under rate-setting but excluding the commercials from such coverage is seven percentage points. Tests for administrative slack in the operation of Blue Cross plans yield mixed results.


Solving wet pack problems.

Solving wet pack problems.


A model of physicians' practice attributes determination. This paper presents a conceptual framework for modelling physicians' styles of practice. It also develops and estimates a causal model of practice style determination. The method allows simultaneous analysis of different practice styles and their determinants. The paper provides new insights into physician decision-making and, in particular, the positive relationship between fees and the number of physicians.


Eliminating stained instruments by controlling steam quality.


Large laundries face rapid changes most of them due to rising utility costs.


Keeping up with cost data.

Keeping up with cost data.


Economic or medical criteria, or both, in policy decisions about medicines?


Health-care infection control. The laundry's role in infection control.


Establishing a cart exchange program.

Establishing a cart exchange program.


Infection control comprises physical and operational.


Hospital study reveals switch to disposables in operating room packs would inflate costs.


Cost reduction programs in health-care field provide opportunity for LM's, says executive.


Policlinico Gemelli, Rome, Italy.

Policlinico Gemelli, Rome, Italy.


Heat sealing.

Heat sealing.


Liability of hospitals toward occupationally injured employees: ethylene oxide: a case in point.


Taking the clinic to the patient. Starting a satellite operation. Triggered by a decreasing patient base and slow new patient growth, one medical group reached the decision to start a satellite clinic. This case report outlines the major areas of concern in starting a satellite operation, including choosing a location and office, staffing medical records, and projecting expenses and revenues. Though the results of this undertaking proved to be disappointing (the satellite is due to be closed), several critical success factors have emerged.


Prepaid plans re-established in a fee-for-service group. A negative past experience in contracting with an HMO had soured a small fee-for-service group's taste for this type of organization. A change in management led to an objective evaluation of the situation and, as a result, a renewal of negotiations with the HMO. Outlined in this article are the planning premises, objectives, and major steps undertaken to make a prepaid plan work within a fee-for-service setting.


Respect life: care of the terminally ill.


Communicating the value of fringe benefits to employees. In a city where competition for employees was extremely high, one clinic kept its edge by offering a generous benefits package. Problems arose, though, because the employees did not fully appreciate the value of their fringe benefits. A concise and effective written communication tool was therefore developed, informing each employee of the cost and value of his personal fringe benefits. The figures accompanying this article offer every administrator not only an example of benefits analysis, but also a valuable basis for comparison.


Through the eyes of the consumer. A look at marketing group practice. The marketing concept should be understood and practiced in varying degrees by all medical groups; otherwise, growth is left to chance. Operating on this premise, the author has set forth a very clearly written description of the key components and general considerations of a long-range marketing plan. The managerial functions of a plan are presented, as well as controllable and uncontrollable factors, and the needs and associated risks of various marketing growth strategies. Within this discussion, the administrator will find a framework for evaluating his particular situation and planning for the future.


An integrated medical record system.

An integrated medical record system. Clear, well-organized, thorough medical records are fundamental to the success of a quality healthcare organization. This article specifically addresses the problem of integrating multiple records from several group and individual practices into a single common medical record for each patient. All aspects of the record system are described--from initial development, record protocol, and start-up and operational costs, to implementation, quality control, and results of the new system. The information set forth is valuable to all healthcare administrations interested in establishing or maintaining integrated medical record systems in their group practices.


Design. A successful waiting room.

Design. A successful waiting room. Often, the waiting room is the source for the patient's initial impression of the medical group. Much time and money is spent on designing attractive, efficient waiting rooms. A professional designer offers some insights into the planning that must go into designing a waiting room for a medical group, including the functional aspects of the design and the image the group is trying to communicate through its waiting room.


Right-to-die issue takes new twist in Bouvia case.


Drugs and the elderly: when, why, how much?


MAHA: we've come a long way.

MAHA: we've come a long way.


Health promotion: Michigan hospitals move forward.


MHA policy statement on health education.


A model for chronic disease management.

A model for chronic disease management.


Continuing health education: its strengths, its weaknesses, and its future.


Paying for the message.

Paying for the message.


AHSC bringing hospitals 'continuity of care'.


China to Chelsea: a nursing exchange program.


Can't laugh at the 'enemy?' My foot! Says Sen. Proxmire.


Preferred supplier to the preferred provider?


Health care and mega-trends, Part I.

Health care and mega-trends, Part I.


Most hospital buying still not computerized.


Hospital repositioning really works.

Hospital repositioning really works.


Education as a problem solver.

Education as a problem solver.


Hospital wins big in "Let's Make a Deal'.


Crisis management of receivables.

Crisis management of receivables.


How to prepare for an inspection.

How to prepare for an inspection.


How and when the accreditation program began, and where it is today.


Guidelines for high risk or potentially high risk autopsy cases. These excellent procedures are in use at the author's institution, and are published here for the benefit of those who have not instituted their own, which is a deficiency found frequently at CAP inspections. The CAP is in the process of developing formal recommendations which will be published at a later date.


Microcomputer basics. Part II. Software. Microcomputers are invading every aspect of life including the practice of pathology. This second in a series of articles is designed to help neophytes make effective use of these new tools. A list of references, providing readers with more information on the subject of microcomputers and their applications to pathology, will be furnished at the conclusion of the series.


CAP accreditation is laboratory improvement.


How the pain clinics manage pain.

How the pain clinics manage pain.


How your APA works.

How your APA works.


The Baroness Munchausen's syndrome.

The Baroness Munchausen's syndrome.


Contracting with nonprofits.

Contracting with nonprofits.


Knowledge gap effects in a health information campaign. The evaluation of a campaign to increase cardiovascular health knowledge indicates that within the treatment community, education was a significant predictor of knowledge before the campaign but was not a significant predictor after the campaign. Two variables related to motivation to acquire information about cardiovascular health (age and perceived threat of heart attack) were not significant predictors of knowledge before the campaign but were significant predictors afterwards. These results suggest that the infusion of information into a social system via the mass media can close as well as open knowledge gaps and that motivation to acquire information in a specific knowledge domain is a factor controlling gap effects.


Outcome evaluation findings: a decade of experience. Using the experience and findings of the McLean Hospital Evaluative Service Unit as a framework, this report presents an overview of outcome evaluation during the last decade and outlines some directions for future work in the field. Evaluation techniques and criteria are discussed, with particular emphasis on the effectiveness of the problem-focused approach, using patient and family perceptions of treatment and outcome. Various factors relating to successful post-hospital adjustment are enumerated, with adherence to aftercare and the presence of a strong social support system emerging as significant. In our own work, patient characteristics found to be correlated with good outcome are being older, married, or diagnosed with an affective disorder. Of the problems and symptoms explored, improvement in depression emerges as the best indicator of good mental health at follow-up.


Understanding & responding to the terminal patient. The past ten years have seen a change in the attitudes of informing patients of the diagnosis of a terminal illness. An understanding of the psychological response to physical illness and impending death is required when discussing death and dying with terminal patients. In this article, the authors present generic concepts in understanding the terminal patient, as well as suggested guidelines for the treating physician.


Telling patients they are mentally ill.

Telling patients they are mentally ill. Telling a patient that he is mentally ill is a frequently encountered but rarely simple task. Because a diagnostic disclosure could have a deleterious effect, the decision to inform a patient of his psychiatric illness must be based on whether the patient will utilize the knowledge in a constructive or self-destructive manner. In this article, the author discusses when and how to tell a patient he has a psychological disorder, along with areas of caution and recommended guidelines.


A quiet revolution comes to Iowa.

A quiet revolution comes to Iowa.


Compensation schemes and the labor supply of dentists.


Patient flow and scheduling.

Patient flow and scheduling.


Sex counseling with groups in a general hospital.


The problem of resistance in nursing home consultation.


The pattern of demand in the United States. The objective of this paper is to examine the demand for goods and services in the United States using the Almost Ideal Demand System (AIDS). The focus is on testing the theoretical properties of demand. The model fits the data well. The suggestion is that food, clothing, housing and transportation are necessities while medical care and recreation are luxuries. The notion of homogeneity is generally accepted while symmetry is soundly rejected. Finally, negativity is shown to hold.


A chance-constrained multiobjective model for mental health services planning. Mental health services planning, and particularly the planning for deinstitutionalization, is a very complex problem. This paper suggests a chance-constrained goal programming (CCGP) approach to mental health services planning. The CCGP approach is based on the sequential solution of a linear programming formulation, allowing efficient solution of large-scale planning problems using commercially available linear programming computer codes. The procedure is demonstrated with a case example and implementation of the approach is discussed.


A proposed method for the analysis of public health policy in less developed countries. The study of public health policy in the less developed countries (LDCs) is handicapped by both lack of adequate data and gaps in conceptual apparatus. A new conceptual model is proposed that would be used for future policy analyses to assess what changes in health status of populations in LDCs can be expected as direct functions of increased health service resources, and of improved environmental and econosociocultural conditions. While direct policy analysis is ill-advised at this time due to data inadequacy, the model is illustrated using data presently available for twenty-five relatively homogeneous sub-Sahara African countries. Within the limitations of available data, the findings suggest that reductions in mortality in the region might best be achieved by making appropriate health resources available to the populations. Study findings also suggest that physicians contributed more during the study period to the variance in physical health status than did medical assistants.


Procreative liberty and the control of conception, pregnancy, and childbirth.


Strategic issues in performance appraisal: theory and practice. Performance appraisal systems have tremendous strategic potential for governing employee behavior and thus corporate direction through their links to selection, training and career planning, and reward systems. Authors Charles J. Fombrun, assistant professor of management at the University of Pennsylvania's Wharton School, and Robert P. Laud, senior vice-president of Drake Beam Morin, Inc., surveyed appraisal systems of Fortune 1300 corporations to find out how well companies are realizing this potential. Among their conclusions: (1) In most organizations, the typical performance appraisal system is focused on short-term goals. Strengthening the linkage between the appraisal system and the long-term implications of strategic planning could improve organizational effectiveness in the future. (2) The performance appraisal system's most prevalent use is as a feedback mechanism rather than as a management tool. Thus, the authors conclude, the role of the performance appraisal system as a strategic organizational tool is largely unappreciated by U.S. organizations.


When older patients don't learn. Adapting educational efforts to age. A common frustration experienced by respiratory care practitioners is a seeming unwillingness or inability of some patients, particularly elderly ones, to comply with instructions or derive any apparent benefit from efforts to educate them concerning their disease. It is helpful to consider why these patients may not learn. Awareness of age-related biologic, physiologic, psychologic, and social changes should allow for modification of education attempts to maximize understanding and compliance.


The comprehensive home visit.

The comprehensive home visit. There is increasing awareness of the benefits of home care for respiratory patients. This care is best given by skilled health care professionals whose goal is to meet patients' needs. What are the skills that a respiratory home care specialist must have? What are the activities that should be included in a comprehensive home visit? How can home care be evaluated? These and other questions are addressed in this article.


Building a healthy relationship. Customer and supplier viewpoints.


Bridging the gap between O.R. and laundry.


Converting from OPL to contract service.


Ohio company expands to serve hospitals.


A hospital administrator looks at contract services.


Analyzing an in-house hospital laundry.

Analyzing an in-house hospital laundry.


Respiratory therapy in small-town USA.

Respiratory therapy in small-town USA. Respiratory therapists who regard work in a rural community hospital as a bleak and unpromising career step may be overlooking opportunities not available in a big-city medical center.


Computers in... logistics management.

Computers in... logistics management.


Staff development and the personal computer.


Why we use reusable surgical packs.

Why we use reusable surgical packs.


The paperless claims program at Blue Cross and Blue Shield of Texas.


Getting there.

Getting there.


Rational use of drugs should be emphasized in utilization review.


Microcomputers in nursing administration.


A surgical data system.

A surgical data system.


Establishing a "cooperative friendship" between employees and your new computer system.


Specialty units-the Touro experience.

Specialty units-the Touro experience.


Charlotte Eye, Ear and Throat Hospital: adaptability means progress.


The freestanding cancer center: focal point for cancer management.


Making the board more effective.

Making the board more effective.


Pain management: a day program.

Pain management: a day program.


Encroaching hospital liability: the nurse's role.


Should you join a multi-hospital system?


Computers in health care.

Computers in health care.


Discretionary authority in the selection of medical staff members.


Agreements. Today's executive contracts: who needs them and why.


New logo presents positive outlook.

New logo presents positive outlook.


Managing the cost of change.

Managing the cost of change.


CEO contracts from a trustee's point of view.


CEO contracts.

CEO contracts.


Designing a career ladder for the professional nurse.


Stability and status. A need for job security.


CEO contracts from a CEO's point of view.


Interviewing potential employees.

Interviewing potential employees.


The forgotten victims. Treating the alcoholic's family.


Art therapy. A creative approach to alcoholism treatment.


Employee assistance programs. An old idea getting new attention.


A framework for evaluating nursing care.


Informed consent revisited.

Informed consent revisited.


QA assessment: structure, process, outcome.


PR practitioners: a hospital asset.

PR practitioners: a hospital asset.


The pulse of design and construction in health care.


Growing pains. Ideas for coping with hospital expansion.


Surgery in the sky.

Surgery in the sky.


ICU design: many hands make right work.

ICU design: many hands make right work.


Applying management information systems to staffing.


Creating a noteworthy newsletter.

Creating a noteworthy newsletter.


Renovating? Take a look at the new short-term paths to financing. A hospital's renovation project can be financed through a diversity of financing techniques. Although the traditional vehicle for hospital capital financing is long-term, fixed-rate debt, there are a growing number of short-term financing alternatives that can provide greater flexibility and generate debt service savings. The author describes some of the new short-term financing techniques, as well as the advantages and disadvantages of short- versus long-term financing.


Contractors with consultant's hats.

Contractors with consultant's hats.


Hospital breaks new ground with hybrid financing package. By applying financial management techniques that are more traditionally associated with corporate businesses, an Illinois hospital was able to generate the funds needed for a new replacement facility at a time when the money market was especially tight. The authors explain the structure of the hybrid financing package they used, and how such a strategy enabled the hospital to generate $61 million in capital at an interest rate almost 5 percent below prime.


More administrators' views on top planning challenges of 1984. Part 2. This is the second of three articles in which a cross-section of administrators from teaching, community, freestanding, multi, and specialty hospitals have been asked to share their views on what will be the top three planning issues of 1984.


Hospital safeguards capital program through private sector partnership. As access to capital tightens, more hospitals are exploring the benefits of partnerships with private companies. A California hospital, burdened by the long-term debt it incurred for a medical office building, worked together with its medical staff and an outside real estate developer. By selling the building to the developer, not only was the hospital able to finance a much-needed expansion and reconstruction project, but the hospital's medical staff had an opportunity to become limited partners in the ownership of the building.


Labor costs pivotal in hospitals' battles with 1984 inflation targets.


As I see it: some people profess to like surprises.


New medical arena forseen by AMA.

New medical arena forseen by AMA.


Expert outlines strategy to prevent union elections.


Behind swelling ranks of America's street people.


FDA unveils clues into AIDS therapy.

FDA unveils clues into AIDS therapy.


NIH reemphasizes vital research role.

NIH reemphasizes vital research role.


NHLBI maintains research balance.

NHLBI maintains research balance.


Creating persuasive fund raising documents.


HHS investigations centered on AIDS.

HHS investigations centered on AIDS.


Two CVAs and how they feel about...volunteer administration as a career.


Perspectives. Health planning looks to the future.


Evaluating volunteer motivation and satisfaction.


Perspectives. The corporatization of American health care.


Perspectives. Where we are, where we're going.


The seductive silver lining.

The seductive silver lining.


Perspectives. Access to health care: who are the underserved?


Perspectives. Federal policy and infant health: a debate.


Perspectives. Hospital linkages: horizontal integration.


Perspectives. Reagan budget: what's new?


Perspectives. Access to capital: equity markets.


1982 summary: National Hospital Discharge Survey.


Workshops--a real world performance evaluation setting. Workshop clients have been identified as those having potential for employment. They now have a specially focused vocational rehabilitation program; including a treatment plan with an uninterrupted workshop evaluation period. The clients' involvement must be understood and supported by other rehabilitation and hospital services since their support is essential for client success. Workshop performance evaluation is a long-term assessment. First, it provides for an assessment to determine the strengths of the client, secondly, it is a selective process which provides for emphasis and for exploration and/or development of those strengths. Assessment in a workshop addresses the sustained characteristics of good work performance, as well as the critical values requiring development to ensure acquisition of good worker traits, work personality and work intelligence.


Pet therapy.

Pet therapy.


Independent living: a successful concept. The Independent Living Program at the Little Rock Veterans Administration Medical Center is providing an invaluable service to disabled veterans. Since activation 2 1/2 years ago, it was proven to be a strong, viable program which fills a previous gap in the discharge plans of the medically stable but physically disabled veteran. Without a successful transition into the community, many are susceptible to failure, which then results in hospital readmission or nursing home placement. These veterans, having suffered a severe disability, cannot be expected to return to the mainstream of life solely on the basis of having received medical treatment and therapy. The utilization of available resources and expertise of professionals, combined with the constructive input and determination of the veteran will significantly enhance the potential of a smooth transition into the community. The veteran's satisfaction and pleasure of living independently, despite his disability, is immeasurable. Independent living should be the ultimate goal for health care providers of the disabled.


'Angel' network gives wings to nation's cancer patients.


Transplant successes stir debate on coverage.


VA findings say water temperature irrelevant.


Payroll cuts and higher productivity reduced costs at Michigan plant.


Latest HAS figures: laundry and linen costs slightly more than 1%.


It's better to give....

It's better to give....


Ten years experience with a regional health information system--the Stockholm County health care information system.


A computerised resident medical officer rostering system. A computerised Resident Medical Officer (RMO) rostering system was developed by the authors over a period of two years to aid in the preparation of yearly and daily rosters for RMOs. The main aim of the system is to save the time required for repetitive rostering activities, such as preparing the weekly rosters and pay sheets. No new philosophies of resident rostering have been introduced and the program simply does more quickly what used to be done under the manual system. As an example, in preparing the weekly rosters and pay sheets, the program does in approximately 10 minutes what used to take about two hours. A secondary bonus of the system is that distribution of the costs to specific cost centres is now possible and it is hoped that this may lead to greater control over the utilisation of this rather expensive resource.


A hospital energy audit project.

A hospital energy audit project. The project was carried out under the auspices of the Research Sub-Committee of the Victorian Branch of the Australian College of Health Service Administrators. It illustrates the way in which remedial action based on a thorough, systematic audit of energy losses can yield savings which are conservatively estimated to be worth tens of thousands of dollars per annum. While many of the energy saving functions proposed can be implemented at little or no cost, it is concluded that energy audits must be thoroughly and competently undertaken and the use of consultants is considered to have been well justified in this case.


The medical common-whose responsibility?


Copyright can survive the new technologies.


Choice, costs and competition.

Choice, costs and competition.


The bubble boy's lost battle.

The bubble boy's lost battle.


Time limits for patients. Insurance firms cut costs by monitoring therapies.


The ethics of worksite screening.

The ethics of worksite screening.


Designing a successful hypertension control program.


Private sector initiatives: what makes them work?


Drug revolution places prescribing practices in question.


Drug purchasing: an evolutionary blueprint.


Fitness becomes a way of life for Canadians. Interview by Jane Stein.


Hospital privileges for allied health professionals covered in landmark case.


Assessing health: what can employers do?


Medicine: a brave new world.

Medicine: a brave new world.


Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); certified clinical social workers--Office of the Secretary, DoD. Amendment of final rule. This final rule amends DoD Regulation 6010.8-R (32 CFR 199) which implements the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). This amendment implements language contained in the Department of Defense Appropriation Act, 1983, Pub. L. 97-377, which authorizes CHAMPUS payments to certified clinical social workers who practice independent of physician referral and supervision.


Administration of grants to states other than block grants or open-end grants--HHS. Proposed rule. For most of its categorical grants to States, HHS proposes to replace its general grants administration regulations (45 CFR Part 74) by reduced and simplified regulations. This proposal is part of the Department's efforts to provide regulatory relief to States and to place greater reliance on States to administer their Federally-assisted programs.


A hospital fails a checkup.

A hospital fails a checkup.


Grants for residency training in general internal medicine or general pediatrics--PHS. Amendments to final regulations. This rule amends the regulations implementing grants for residency training programs in general internal medicine or general pediatrics to conform with statutory changes made by the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35) and the Commonwealth-Covenant to Establish-Northern Mariana Islands (Pub. L. 94-241). These changes are nondiscretionary in nature. Additional amendments are for clarification.


Low-level waste sites: states juggling a hot potato.


Consultations with state and local officials prior to awarding community health center grants--HRSA. Notice. Section 1923 of the Public Health Service (PHS) Act (42 U.S.C. 300y-2) requires that if a State does not apply for a Primary Care Block Grant under section 1924 of the PHS Act (42 U.S.C. 300y-3), or does not qualify for such a grant, a Secretary of Health and Human Services will use those funds not allotted to States participating in the block grant to make grants under section 330 of the PHS Act (42 U.S.C. 254c) to individual community health centers (CHCs). Section 1923 also requires that the Secretary consult with the chief executive officer of the State and with appropriate local officials before making such grants for community health centers in a State. This notice describes the manner in which the Health Resources and Services Administration (HRSA) will fulfill the requirement for consultation. In addition, it solicits comments from local officials regarding CHCs in their areas. A State may elect to supply comments under the system established in accordance with 45 CFR Part 100, "Intergovernmental Review of the Department of Health and Human Services Programs and Activities." (See 48 FR 29188, June 24, 1983.)


Privacy Act of 1974; notice of new system of records--HHS. Notice of new system of records. In accordance with the Privacy Act of 1974 (Pub. L. 93-5790, as amended, the Office of Human Development Services is proposing to establish a new system of records, Records Maintained on Individuals for Program Evaluation Purposes Under Contracts, HHS, HDS No. 09-80-0100. We have provided background information about the proposed system in the "SUPPLEMENTARY INFORMATION" section below. HDS invites public comments by April 19, 1984 on the proposed routine uses of the system.


Privacy Act of 1974; report of new system--HCFA. Notice of new system of records. In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records. Evaluation of the HCFA Alcoholism Services Demonstration, HHS/HCFA/ORD No. 09-70-0031. We have provided background information about the proposed system in the "Supplementary Information" section below. HCFA invites public comments by April 12, 1984, with respect to routine uses of the system.


Coalition sponsoring data collection.

Coalition sponsoring data collection.


Revision of income criteria for eligibility for uncompensated services--HRA. Notice. This notice announces the applicability of the recent revision of the Poverty Income Guidelines to uncompensated services programs administered by health care facilities pursuant to Titles VI and XVI of the Public Health Service Act.


Claims automation. New breed of computers can aid health cost containment.


Controlling costs. Monitoring hospital care reaps big savings.


What is your staff really worth?

What is your staff really worth?


Reagan budget urges tax on health insurance.


Health claims audits. Reviews can turn up errors and, sometimes, savings.


Force-feeding decisions bring medicine and the law into conflict.


In the hands of Jesus: trauma takes its toll.


Take steps to reduce the risks of a malpractice crisis.


Cardiac patients benefit from home-care program.


Canadian Journal of Occupational Therapy: a reflection of professional growth. The Canadian Journal of Occupational therapy (CJOT) is the only Canadian refereed professional publication reflecting the views and professional development of occupational therapists in Canada. A study of all issues of CJOT published during three five-year periods was carried out to see if CJOT could be said to be improving in terms of reflecting professional trends. Some areas examined were quantity of articles, type of articles, references, authors and citations. It was found that although CJOT did reflect professional growth in many areas, there were a number of areas needing improvement before CJOT could be considered to be the primary professional publication for occupational therapists in Canada.


Improved legislation required for treatment of incapable patients.


Documentation of occupational therapy services: a process model. This paper describes a process model of occupational therapy and the Occupational Therapy Sequential Client Care Record (OTSCCR). The OTSCCR incorporates the model and provides comprehensive documentation of occupational therapy services from referral through outcome of intervention.


Quality control report, 1981-82: nine months of operation.


Group life review and denial of death.

Group life review and denial of death. In order to assess the utility of structured reminiscing with the elderly a series of five Life Review Workshops (LRW) were offered. Sixty-three seniors participated in the treatment or no-treatment conditions and were administered four attitude measures pre- and post-treatment. Workshop participants also filled out a Workshop Evaluation Form. Analyses showed that the treatment group significantly decreased in denial of death (t = 2.66, p = less than .01) while the control group did not. There were also moderate but significant correlations between age, education, religiosity, and health measures and the perceived benefit accrued from the workshop, the amount of reminiscing which participants reported after completing the workshop, and the number of functions which reminiscing served for LRW members.


The clinical use of pets with the aged.

The clinical use of pets with the aged.


Plush animals as therapy in a nursing home.


ICU syndrome: onset, manifestations, treatment, stressors, and prevention.


The patient in the ICU: a family experience.


Childhood coping: adaptive behavior during intensive care hospitalization.


Sensory overload and noise in the ICU: sources of environmental stress.


Healing the person in a consumer society. Keynote address--CHAC 1983 Annual Convention.


The sanctity of life.

The sanctity of life.


Using creative arts to help children cope with altered body image. A specific aspect of development to be considered when planning expressive activities for hospitalized children is the potential and actual effects of hospitalization and illness on their developing body image. Therapeutic activities which address this stressful issue can be an integral part of the care of pediatric patients. This manuscript highlights several categories of expressive activities to help illustrate the way in which these activities can be used individually and with groups of children for therapeutic intervention when dealing with body image issues. Case studies are presented.


The work of chronically ill children on a hospital unit. A nurse watches chronically ill children at work on a hospital unit. Food procurement work, body work, composure work, work during an IV procedure, resisting work, personal relations work, sick role work, and information work are among the extensive kinds of work children are observed carrying out. However, the child's work is seldom recognized or valued. Nurses need to evaluate how their own work facilitates or impedes the work of the child.


A cognitive-affective approach to child life programming for young children. A comprehensive model for child life programming for young children integrating cognitive and affective theories is described. Continual assessment of the cognitive and affective states of children provides the basis for programming. Degree of structure facilitated by the child life worker through his or her physical and/or verbal interaction and type of activities selected and implemented varies with children's cognitive-affective states.


Child life intervention in the emergency department. Since 1979, the Child Life Department of the Children's Hospital of Eastern Ontario has provided 75 hours per week of Child Life intervention for children and parents in the emergency department. Factors that would influence a child's ability to master an emergency experience have been identified through a review of the literature. The protocol for Child Life intervention in frequent emergency situations is described. Practical approaches to Child Life programs in Emergency and evaluation of effects of Child Life intervention are discussed.


Training child life students: guidelines for hospital supervisors. The majority of child life programs offer some type of student practicum experience. At present there are no programmatic guidelines for hospital supervisors to follow in their task of training professionals. There is growing concern within the child life profession that students are being trained in field programs that have widely divergent content, objectives, expectations, supervisory methods, and evaluation criteria. There is a need to establish some commonly endorsed standards for clinical supervision within the hospital. In the spring of 1982, the Child Life Council appointed a committee for this specific purpose. This paper represents the beginning of that task. The guidelines put forth here have not yet been presented to the Council for endorsement.


Child life and children's dentistry: broadening our scope of concern. The Association for the Care of Children's Health has recently broadened its scope of psychosocial concern to include not only children and families in hospitals, but also those in any health care setting. Clinical dental treatment has long been recognized as capable of producing patient apprehension. This paper discusses possible philosophical differences between optimal psychosocial care of children and families and dentistry's current beliefs and practices concerning the proper treatment of child patients. Several areas of opportunity for research and for increased "humanization" in dentistry for children are presented.


New horizons: the changing world of television. These are just some of the new opportunities that television is opening up for nonprofits. I should mention that, there are also certain other implications, such as the fracturing of the mass TV audience into more fragmented markets. This means that nonprofit organizations will have to produce more PSA's to reach its audience. There'll also be more competition for available public service time. Finally, as pay TV grows, nonprofit organizations may have to produce special programming for this medium. There's several things we can comfortably predict for the future. One, television will continue to change. And two, the successful nonprofit organizations will be those who seriously explore the new opportunities today.


Communicator's checklist.

Communicator's checklist.


Visiting Nurse Association of Albany, Inc.


Operating as a nonprofit or for-profit home health agency.


Opportunities on the rise in home health care.


Agency of the month. Mid-South--a caring agency with experience.


An insider's view on lobbying Congressional staff.


The VNA of Dallas: how one agency is staffed for governmental affairs.


Political advocacy--one state's approach.


Passing home care legislation: the Ohio experience.


Free-standing emergency centers.

Free-standing emergency centers.


Voluntary active euthanasia for the terminally ill and the constitutional right to privacy.


Challenging hospital bills and services.


Institutional ethics committees. 'Recommended' now, but perhaps mandatory in the near future.


Clinical engineering trends for 1984.

Clinical engineering trends for 1984.


CHPRB Second Invitational Seminar residency programmes--where are they now? Where did they come from? Where are they going?


AIDS and the blood bank.

AIDS and the blood bank.


A nursing administration tool for the 80's.


The role of nursing in the acquisition of an HIS. As the use of computers to accomplish organizational objectives continues to grow, nurses need to examine the role they will play in this changing environment. This article discusses nursing's role from initial inquiry through the acquisition of a hospital information system.


Interfacing of systems: a major issue for the 1980s.


Who needs trustees?

Who needs trustees?


AHA meets the challenge of the 1980's.

AHA meets the challenge of the 1980's.


Healthcare fitness design to grow says IBD 'trends' forecast study.


Depositions and the health professional.


Evaluating computer systems--which approach, the RFP, the RFI or the NAR?


Key implementation issues for installing comprehensive hospital information systems.


Trusteeship: a successful tradition.

Trusteeship: a successful tradition.


Comprehensive audits: a methodology. Part 1.


Bright colors & artwork geared to pediatric patients.


Trustee authority and responsibility: sources revealed.


Hospital daycare center design attracts personnel.


Roles for an effective board: a five finger exercise. Part 1.


Soft, postmodernist pastels help planners revitalize healthcare design market.


Competitive hospitals plan for efficiency.


Home-like birthing room conceals medical equipment.


Luxury amenities at Nevada hospital attract patients, staff.


"Wellness" emphasis dictates Illinois hospital design.


The effects of a short-term death training program on nursing home nursing staff. This study examines the effects on nursing home nurses of a two-day training program concerned with nurses and their response to the dying patient. Utilizing the Solomon four-group design, the study investigates whether exposure to information on death and dying (a) results in the acquisition of greater knowledge about death and dying, (b) is accompanied by a more positive attitude toward the elderly, and (c) is accompanied by a change in anxiety about death. Based on t tests and one-way analyses of covariance, the results point up the mixed nature of short-term training programs. It was found that there was a significant increase in the nurses' knowledge about death and dying, there was no change in their attitudes toward the elderly, and there was a significant increase among the nurses in the death anxiety experienced. This is not to suggest that training programs of this sort should not be conducted with nursing home staff. On the one hand such programs provide information useful for job performance. On the other hand they create some sensitization to death, which at the very least could give nurses greater insights into the concerns of the patients and perhaps stimulate empathetic responses.


Health care cost containment is the major goal of Morgan Guaranty's new cafeteria benefits plan.


Medical insurance, technological change, and welfare. Concerns have been expressed about the welfare effects of expensive innovations in medical care financed largely through medical insurance. This paper develops a model which considers such issues. It is shown that even if insurance is purchased optimally (subject to a plausible constraint on the form of the contract), innovations may be adopted that have the effect of reducing expected welfare. The question of how the benefits of medical innovations ought to be measured in the presence of insurance is also explored.


Nationwide utilization review groups get results.


Blues expand preadmission authorization plans.


Preferred provider concept gains support, but federal regulation of such groups is controversial.


Hospices substitute for more costly care and do not add expenses, asserts Ohio research.


Executive explains General Motors health benefits.


Ohio becomes first state to ban urgent care center construction.


Putting together a quality assurance program can solve problems, unite disparate interests.


More than one type of NMR scanner may be needed by different institutions.


An 'enlightened' view of employee committees under the Taft-Hartley Act. The Sixth Circuit Court of Appeals recently ruled, in NLRB v. Streamway Division of the Scott and Fetzer Co., that an in-plant representation committee, unilaterally established by the employer, was not a labor organization. Until 1959, when the Supreme Court decided NLRB v. Cabot Carbon. "labor organization" was narrowly construed, based on the traditional adversary model of labor relations. With Cabot Carbon, and some later Board decisions, the definition has broadened. Now, at a time when many employers are turning to employee committees, quality circles, etc., as ways of improving relations with employees, the Streamway decision takes on particular significance. In the following article, the author examines the statutory basis for determining whether an employee committee is a labor organization, within the meaning of the National Labor Relations Act. He also discusses the judicial and Board precedent for the more liberal definition of "labor organization" set forth in Streamway.


Interior plant care: an executive housekeeper's viewpoint.


Games employees play: tardiness and absenteeism.


Interior plant care: a contractor's viewpoint.


Certification of death and the clinician. Patterns of certification of death and the subsequent selection of an underlying cause of death are analysed. The need for awareness among certifying practitioners of the issues and the rules for the selection is demonstrated. There is scope for further improvement in certifying practice among medical practitioners and coroners.


Institutional care for the elderly: the impact and implications of the ageing population. Two cross-sectional studies three years apart assessed functional capacity in everyone aged 65 years and over in any ward, hospital, home or hostel in a defined geographical area. Comparison of the proportion of patients aged 65-74 years, 75-84 years and 85 years and over within these institutions showed that a higher proportion of the very elderly were in homes for the elderly and a lower proportion in National Health Service (NHS) geriatric hospital beds in the later time period. Greater proportions of all age groups of the elderly were in NHS acute hospital beds. Levels of incapacity in these people had increased between 1976 and 1979. In continuously resident people the proportion remaining unchanged fell and the extent of deterioration increased with greater age: among recent admissions significant increases in incapacity were only seen in patients in NHS geriatric hospitals. At present the demands of the ageing population are such that old people will be admitted where places are available even if the setting is not entirely appropriate to their needs. Restrictive admission policies on the part of residential homes will not reduce levels of incapacity if they continue to admit older residents.


Referrals to a British liaison psychiatry service. The first 300 referrals (excluding self-poisoning) to the newly established liaison psychiatry service at Leicester Royal Infirmary have been examined. One-third of the referrals were for psychological reactions to physical illness and another third for psychogenic illnesses. Physicians do not seem to require our help with the classic psychosomatic disorders. The vast majority of referrals were appropriate and there was only minimal abuse of the service.


The bells, lights and whistles syndrome. Part 3: the magic of software.


EMS at the 1984 Olympics.

EMS at the 1984 Olympics.


Manpower imbalance in oral surgery/oral medicine.


General medicine with special responsibility for care of the elderly.


Square pegs, round holes? The appropriateness of providing care for old people in residential settings.


Economies and the medical staff budget.

Economies and the medical staff budget.


Impact of death and dying on emergency care personnel.


End stage renal failure: coping with the demand.


UCLA's Medstar: care in the sky.

UCLA's Medstar: care in the sky.


Local authority social services in England--a personal retrospect on the Seebohm years.


Review of an orthopaedic in-patient waiting list. A review of 950 patients who had waited for more than one year for orthopaedic treatment at a large District General Hospital was undertaken. Searches of medical records eliminated 193 patients who had already had operations, but, whose names had not been removed from the list. Of the remaining 757 patients, 48% indicated their wish to remain on the list. This proportion was lowest for: the under 45 year old age group (43%), the over 75s (36%), patients awaiting less complex procedures (35%) and those with waiting times longer than five years (31%).


Presentation of statistical information on in-patient and out-patient activities to members of health authorities, consultants and general practitioners.


The elderly at home: health and social status. The health, social status and contacts with services of all people over the age of seventy-five living at home in and around Melton Mowbray was assessed by interview. Nearly half the sample (46%) lived alone, and just over a third (37%) were married. Most respondents were able to complete the basic activities of daily living without any assistance. The apparent prevalence of dementia at 1.6% was lower than had been found in previous population studies. The levels of social contact were similar to those reported previously. While service provision compared well with that found in other studies, only a relatively small proportion of the population were in receipt of nursing, paramedical and social services.


The validity of indices for rural health manpower needs assessment. Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.


The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. This study of chronically mentally disabled persons in community residences examined the discriminant validity of subjective quality of life indicators and self-report mental health indices to determine the potential confounding effects of psychopathology on the assessment of quality of life (QOL). Factor analyses and difference-score reliabilities identified a general QOL construct and a general mental health construct with 27% common variance. However, psychiatric symptoms did not significantly (p less than .05) alter the bivariate and multivariate relationships among the QOL ratings, except in the health domain in which the correlations of health-related QOL indicators with global QOL were significantly (p less than .05) attenuated after removing the effects of psychopathology. The results suggest that psychopathology does not introduce bias into the overall structure of QOL data, but they also indicate the importance of controlling for mental health effects in the assessment of patients' self-rated health and satisfaction with health care.


An organization-environment framework for assessing program implementation. Evaluations of health programs are typically conducted from a rational bureaucratic framework in which client change and client outcome are seen as logical outcomes of program activity. This paper proposes a theoretical framework for examining organizational consequences of program implementation. Factors in the internal environment (e.g., the hospital) and the external environment (e.g., the community) which contribute to the program's success or failure, are considered. Observational and structured interview data are used to compare two state funded perinatal projects, one an organizational "success" and the other a costly failure. Attributes of external environments which may be important to successful implementation include demand for services, provider competition, access to information, social beliefs, and professional commitment. Important features of the internal environment include host organization commitment and conflict, and structural attributes: complexity, formalization, centralization, and coordination. The paper concludes with theoretically-based questions which serve as guidelines for process evaluation.


Evaluating Reagan's block grants. Informed opinions on essential issues and needed information resources. In this paper a set of common issues has been proposed to provide a framework for evaluating the effects of current and future block grant programs. By using these issues to identify current information needs and resources, the author attempts to promote the wider use of the available evaluation information on the current block grants and budget reductions, and to identify information gaps in these data bases.


Malpractice crisis watch.

Malpractice crisis watch.


Community concern turns to involvement; unique hospital involves.


On the path to proactivity.

On the path to proactivity.


HMO income: what it takes to make it.

HMO income: what it takes to make it.


Michael Reese Hospital: the meeting place.


Paul Deignan, RD/ASHFSA.

Paul Deignan, RD/ASHFSA.


New York University Medical Center cooperative care unit: patient dining room.


Standardization, tangible benefits to be keys to future, suppliers told.


Nutrition programs for alcoholics.

Nutrition programs for alcoholics.


Business and the health marketplace: testing grounds for competition, cost containment.


Race horse helps scholarship fund, has hospital unit named for him.


Before & after: the decentralization of John J. Kane Hospital.


Interest in PPOs gains momentum but size and scope of movement still undetermined.


Robots in your foodservice?

Robots in your foodservice?


Giving and getting: the non-profit outlook 1983-88.


Building the case for solid gift support.


HMO enrollment rises as involvement in alternative delivery systems increases.


Policies clear up confusion for board, staff, committees.


A check list for hospital PPO contracts.


Business is advised to be a partner with health industry in curbing costs.


Advice to hospitals: treat coalitions as opportunity rather than a problem.


Fostering the voluntary spirit: motivating people to serve.


Business and providers make competition the name of the game in Richmond, Va.


The mechanics of assembling an international drug dossier. An international registration dossier is a comprehensive scientific document used to obtain worldwide licensing approval of a drug by diverse health authorities. Its creation, processing, compilation, and dispatch to the field by a regulatory affairs department of a major, US-based, multinational pharmaceutical company is dependent upon many interrelated activities beginning years prior to its physical assembly. The following activities are briefly discussed to show the magnitude of the task and the type of activities encountered: planning and scheduling; creating, organizing, and formatting; typing; copying and collating; working with extramural suppliers and services; and finally, shipping the document to the field. Suggestions for making the process more efficient are offered.


Regulation plus competition: an unwise compromise.


FDA approval of comparative claims for prescription drugs--the Moxam case. FDA allowance of comparative claims as part of the approved labeling for new prescription drugs creates special problems. Claims contained in prescription drug labeling are viewed by physicians as embodying not just the normal puffery of the manufacturer, but the considered views of government agency charged with protecting public health. Thus, labeling claims for prescription drugs have an impact and significance that promotional claims for other products do not. In the Moxam case--a dispute between Upjohn and Lilly over the FDA's approval of a comparative claim for a new Lilly antibiotic--the agency recognized this fundamental reality. Faced with the prospect of having to provide a procedure to permit competitors to challenge approval of comparative claims, the FDA has moved toward a policy of not permitting such claims in labeling, while allowing them in advertising.


Selection of scientific periodicals to monitor drug safety information using Excerpta Medica and Japicdoc in the post marketing surveillance of drugs. In order to select important journals to be monitored for efficient collection of literature information on drug safety, a retrospective search was made of the safety information in the Excerpta Medica (EM) database between 1979 and 1981. The search provided 54,005 references to drug safety, which were found in a total of 2,536 journals. Fifty percent of the references appeared in only 148 journals, or 6% of all journals surveyed. A similar search, carried out using the Japicdoc (JD) database, provided 9,268 references in 172 journals. To cover all the necessary information appearing in overseas journals, however, a retrospective search of a bibliographic database is required as a cost-effective means to improve the comprehensiveness of the collection of information. In domestic journals, because JD includes fewer journals than EM, all of the 172 journals can be monitored for the collection of drug safety information.


An antitrust exemption for commercial insurers? Answer: no.


A comparison of pharmaceutical manufacturers as a source of drug information to a telephone inquiry: generic vs brand. A telephone survey was conducted to evaluate and compare drug information received from the pharmaceutical manufacturer in response to a drug interaction question concerning concurrent administration of tetracycline and cimetidine. This study assumes that the pharmaceutical company may often be consulted by the hospital pharmacist seeking information about a particular medication. Forty-five pharmaceutical companies, all marketing tetracycline products, were selected for the study. A conversation protocol was utilized. It was designed to assure consistency and evaluate information received for accuracy, response time, clinical judgement offered, and referrals. Forty pharmaceutical manufacturers responded: 18 brand manufacturers and 22 generic companies. Eleven companies provided information on the interaction identified. Five manufacturers stated that there were no contraindications to concurrent administration of the drugs, one company identified a similar interaction, and five manufacturers successfully provided information identifying the interaction with supportive documentation. Two of the five companies offered clinical judgement as to the clinical significance of the interaction. Both reached different conclusions. The mean time of all phone calls was 4.29 minutes (range 0.39 to 15.41 minutes). The investigator was referred to outside sources by twelve companies. In this study, brand manufacturers performed better than generic companies. Results indicate that few manufacturers are organized to answer drug information requests involving current information sources in a response to a telephone request.


Development of a computerized drug interaction database (MEDICOM) for use in a patient specific environment. Drug Interactions are a clearly defined problem that we as health professionals must deal with on a day-by-day basis. It is by far the area of health care that demands more attention today and tomorrow than was possible in the past. The amount of reference sources and text material of drug interactions is growing at such a rate that it is almost impossible to recall essential information in a reasonable time frame. If the practitioner is to continue with an uninterrupted work flow and still maintain the best possible service for the patient, an immediate and accurate method is needed in the hands of the user ... a computerized drug interaction database. The community health care standards would be ultimately raised to a level never before attainable and efficiency would continue with full utilization of professional practice. Combine then, drug interaction data with ancillary benefits such as cost containment, third party accounting, inventory control, and a multitude of other operational functions into a computerized database and the end product results in an enhanced, controlled, professional operation.


Arizona legislature gets chance to try to settle hospital cost controversy.


International prescription drug labeling. Yesterday's therapeutic compounds were meticulously prepared, elegantly presented, and relatively innocuous (Dunlop). Today's powerful and complex drugs are manufactured with sophisticated technology and require clear, concise, and comprehensive information for the physicians throughout the world in order to provide maximum benefit for the patient. Our company, Merck & Co, Inc, has adhered for many years to strict requirements for full and balanced disclosure in all information disseminated to professionals about our products, including circulars, labeling, and advertising. Our practice is to provide complete information to physicians, pharmacists, and regulatory authorities, both on the recommended uses for our products and on their potential adverse effects. The cornerstone of our international disclosure system, the International Physicians Circular (IPC), is provided for each product and comprises part of the initial submission to each national health authority in connection with application for marketing approval. Each IPC sets forth the company's best scientific judgment with respect to both the positive and negative aspects of our drugs, defining actions, indications, and dosage, as well as all contraindications, precautions, and side effects. These circulars are updated in the process of continuous medical review.


Life support issues: is involvement of the court required?


An Asian perspective on drug and related health care information. To ensure that drugs are available in adequate quantity and quality for the health needs of the population and properly used, Asian governments in the past decades have exercised their sovereign rights quite independently and differently. A high number of patients per prescribing physician has consequences for drug information, in regard to both prescribers and consumers needing to self-medicate. To reliably inform patients through physicians, pharmacists, or medical auxiliary personnel is of great importance in the face of an illiteracy problem. Self- medication and illiteracy place emphasis on communication by word of mouth or by pictures. Word of mouth is the most important route, because even with a steady increase in literacy, the increase in transistor radios has been even more pronounced. For specific health information, instructional posters, with emphasis on pictures, have been very effective. Billboards do not allow adequate information disclosure needed for drugs. The opportunity to expand the coverage of consumer drug information, in that labelling for consumers gives additional relevant general health information, seems appropriate.


The role of the innovation-based pharmaceutical industry in international drug information communication. The ultimate responsibility and social contribution of the innovation-based pharmaceutical industry is to discover, develop, and provide products that contribute to improved health care. Achievement of this objective is dependent upon effective communication of accurate and comprehensive information about our products. This is a unique role which the research-based segment of the industry performs well and must be allowed to continue to perform. Although the ultimate objective of improved health care is a constant, the effective communication of product information is affected by a variety of factors which represent change or evolution. The discussion of drug information will review: the various forms that such information takes; the effects of differences in national health systems and objectives; and the implications of the fact that product data bases continue to develop after introductions. The systems and experience at the Upjohn Company, while not necessarily applicable for all companies, will be discussed briefly as useful examples of a working, effective process.


Drug design and the CAS ONLINE substructure search system. CAS ONLINE, the chemical substance search and display system available directly from Chemical Abstracts Service, is a new service which is particularly useful in drug design studies. In CAS ONLINE chemists search by structures to identify chemical substances, for example, derivatives or analogs of a drug or its pharmacologically active fragment, which share user-defined features. Search questions are phrased in terms of one or more structure diagrams, each of which can include variable atoms, bonds, or positions of substitution as required by the searcher. CAS ONLINE provides access to the world's largest (more than 6 million substance records) and most current chemical structure information data base. CAS ONLINE is updated weekly with 7,000-10,000 new substance records. Substance information available from searches in CAS ONLINE include structure diagrams, systematic and common names (including trade names) for substances, molecular formulas, and the widely cited CAS Registry Numbers. The searcher may optionally request for each substance bibliographic information for the ten most recent literature references which have been cited in Chemical Abstracts since 1967.


The Federal Communications Commission and interactive cable technology: the case for minimal regulation.


Medical licensure in the United States.

Medical licensure in the United States.


Influence of support systems on the use of social services by the Hispanic elderly.


Easing tensions between man and machine.


Laboratory fume hood control.

Laboratory fume hood control.


Nursing leadership evaluation.

Nursing leadership evaluation.


Employee training: the shape of things to come.


Activated health education: the development and refinement of an intervention model.


Advantages and disadvantages of committees.


Case in health care supervision.

Case in health care supervision.


Three kinds of supervisory knowledge: needed dimensions for training programs.


Microcomputers in health care management.


Reorganization: another view.

Reorganization: another view.


An international study of patient education in selected colleges and universities.


Reflections. Wellness for all by the year 2000: an old challenge for a new century.


Case in point. University Medical Center.


Variable staffing: an alternative to traditional practice for pharmacy. There are a variety of programs designed to monitor the utilization of hospital pharmacy labor and to measure fluctuations in workload. Few, however, address the problem of forecasting labor needs and adjusting staffing levels accordingly. This paper describes a system used by one hospital, whereby workload is correlated to census to provide variable staffing levels corresponding to fluctuating workload demands. This hospital's pharmacy uses a core level staff, supplemented by on call pharmacists and technicians. The following day's workload is forecast from the current day's level, and staff are scheduled accordingly.


Case in point--the answer. Metropolitan Charity Medical Center.


Case in point--the answer. University Medical Center.


Assessing the external environment.

Assessing the external environment.


Case in point. St. Mary's Mountain View.


Productivity monitoring systems: their use in management planning, forecasting, and labor budgeting. The productivity monitoring system (PMS) has long proved itself a useful and necessary management tool for controlling scarce and costly labor resources. Here, the reader is introduced to the use of the PMS within the hospital industry. The general concern with controlling productivity in hospitals is presented within the context of regulatory change and overall cost-consciousness, followed by a description of a successful PMS and the information it provides. Techniques and an example for using PMSs in workload forecasting are also provided.