Health maintenance organizations--PHS.

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


Nursing student loan program--PHS. Notice of proposed rulemaking. This proposed rule would revise existing regulations governing the Nursing Student Loan (NSL) program. These revisions would impose more detailed requirements concerning the exercise of due diligence by schools in loan collections.


Medical device reporting--FDA. Final rule. The Food and Drug Administration (FDA) is issuing a final rule that requires manufacturers and importers of medical devices, including diagnostic devices, to report to FDA whenever the manufacturer or importer receives or otherwise becomes aware of information that reasonably suggests that one of its marketed devices (1) may have caused or contributed to a death or serious injury or (2) has malfunctioned and that the device or any other device marketed by the manufacturer or importer would be likely to cause or contribute to a death or serious injury if the malfunction were to recur. FDA is taking this action under the Medical Device Amendments of 1976. The final rule is intended to assure that FDA is informed promptly of all serious problems or potentially serious problems associated with marketed devices. FDA is the principal public health agency responsible for ensuring that devices are safe and effective. To carry out its responsibilities, the agency needs to be informed whenever a manufacturer or importer receives or otherwise becomes aware of information about device problems. Only if FDA is provided with such information will it be able to evaluate the risk, if any, associated with a device and take whatever action is necessary to reduce or eliminate the public's exposure to this risk. Depending on the facts and circumstances, these steps could include contacting the manufacturer or importer of the device and monitoring its voluntary actions to respond to the problem, initiating a consumer or user education program, or initiating regulatory action, such as injunction, seizure, or other enforcement action.


Hill-Burton program; medical facility construction and modernization; federal right of recovery and calculation of interest charges--HRSA. Notice. On July 18, 1984, the President signed the Deficit Reduction Act of 1984. The law contains several provisions affecting medical facilities which are assisted under the Hill-Burton Program and which transfer ownership or control or cease to be used as medical facility. These provisions include authority to waive the Federal right of recovery and methods of calculating interest when recovery is not waived.


The high-stakes race is on to develop blood test to detect AIDS virus.


AMA President says patients want traditional doctor-patient relationship. Interview by Linda E. Demkovich.


Wellness programs used to cut costs: study.


Diagnostic x-ray systems and their major components; amendments to performance standard--FDA. Final rule. The Food and Drug Administration (FDA) is amending the performance standard for diagnostic x-ray systems and their major components by revising and adding requirements concerning computed tomography x-ray (CT) systems. CT systems are new medical diagnostic tools whose use in the United States has grown significantly in recent years. Because CT systems have many performance features that are unlike conventional x-ray systems, the current performance standard for diagnostic x-ray systems is not entirely appropriate for CT systems. The amendments to the standard address the special characteristics of CT systems.


California hospital group replaces insurer, brokers.


Federal health premiums rise only slightly.


A case study in quality assurance reports.


Living with the Canada Health Act: will you or won't you?


The challenge of change.

The challenge of change.


Silver: dollars and sense.

Silver: dollars and sense.


The changing face of malpractice law: a perspective for radiation technologists.


Staff ratings of elderly at day care centers: mental status, hypochondriasis, depression. Staff at two day care centers for the frail and/or impaired elderly rated participants (N = 33) for mental status, hypochondriasis and depression. The ratings were correlated with the MSQ, HSIG and GDS. The results indicated a significant correlation (P less than .001) between staff ratings and the MSQ. The correlations between other staff ratings and the respective tests were quite low. It was concluded that staff ratings for depression and hypochondriasis were not valid or reliable unless the staff member had done a structured intake.


Building and maintaining bridges: meeting the psychosocial needs of nursing home residents and their families. Elderly residents of nursing homes have many of the same needs as new members of any organization: to be oriented, to form a new support base, to establish a new role definition, and redefine previous roles. Resident families undergo related changes which must be addressed if a satisfactory adjustment is to be effected. Techniques to facilitate these changes and barriers to their implementation are discussed.


The classification of paranoid disorders in the elderly: a clinical problem. Data on the incidence of Paranoid Disorders according to modified DSM-III criteria in an outpatient geriatric clinic are presented. Results are consistent with previous research data which find paranoid symptomatology to be common in elderly psychiatric patients. The current definition of paranoid disorders is too narrow to encompass those elderly with good premorbid adjustment whose later life paranoid disorders often include hallucinations. The DSM-III paranoid subtype system does not have a separate category for chronic paranoid symptomatology which, although commonly seen in the old, is now subsumed under an atypical paranoid disorder classification. Further research into late life psychopathology may provide refinement of other diagnostic categories and a better understanding of the developmental relationship between personality disorder and major psychopathology.


The elderly in nursing homes: psychological aspects of neglect. It has been argued that many elderly people are placed in nursing homes to isolate them from view, and little research has been done to investigate the effects of such isolation. Some research has focused on certain aspects of abuse and neglect of the elderly, particularly physical, material, and fiscal aspects of abuse. The purpose of this paper is to discuss psychological aspects of abuse and neglect of the elderly in the nursing home environment. Data are presented indicating that psychological aspects of neglect are subtle and not readily apparent to the observer; yet they may be very impactful in terms of their effects. Data also are presented indicating that they constitute the most common form of abuse. Psychological aspects of neglect are divided into categories including: the nature of the physical environment; nutrition and diet; physical appearance and grooming; infantilization; environmental deprivation; and benign neglect. Possible interventions are offered as alternatives to neglect, and research data are summarized as to how such interventions might benefit both the elderly and the clinical staff dealing with such a population.


Pay for performance: accent on standards and measures.


Psychodrama: a therapeutic modality for the elderly in nursing homes. The elderly in nursing homes are subject to increased incidents of psychiatric disorders and are particularly vulnerable to depression. However, mental health services are rarely provided for these individuals. The authors conducted a psychodrama group with elderly psychiatric patients in a nursing home and found it to be an effective treatment modality. It proved especially useful in the alleviation of depression by allowing members to "relive" and grieve for unresolved losses and express repressed feelings of anger, abandonment, and fear. The psychodrama techniques also encouraged spontaneity and creativity and facilitated the life review process. The latter encouraged members to resolve old problems and to examine and restructure their identities. Case illustrations are presented and additional benefits of the group are discussed.


Incentive plans: short-term design issues.


A myth-shattering study: the hatching of decubiti.


Terminating pregnant employees: sex discrimination?


When the dust settles: responding after a strike.


Sharing profits: a cure for many ills.

Sharing profits: a cure for many ills.


Financing: no one has the right answer--yet.


Controlling costs at the source: educating the doctor.


The dental care dilemma.

The dental care dilemma.


Unleashing the mystery shopper.

Unleashing the mystery shopper.


Cooperative laboratory ventures reduce costs while enhancing revenue.


Special report: finance. Part one. Poised on the threshold of a boom.


Clinical pharmacy. Target drug programs can reduce some costs and avoid others.


Joint ventures in home health care.

Joint ventures in home health care.


Advertising: is it integral to hospital marketing?


St. John Medical Center laboratory conversion: a case study.


Milwaukee children's hospital has found the formula for reducing nurse turnover.


RSVP. An alternative approach.

RSVP. An alternative approach.


The "virtual" lab concept: a here-and-now consideration.


The RFP...why?

The RFP...why?


Am I computer literate?

Am I computer literate?


The in-office laboratory: benefits for you and your patients.


Substitution in public spending: who pays for Canadian national health insurance?


Hospitals begin to respond to economic pressure.


Creative regulation to stimulate an efficient health care system.


U.S. helps developing countries devise, upgrade EMS systems.


Changing nature of health care reflected in new EMS trends.


The health benefits cost containment audit.


Controlling violent patients.

Controlling violent patients.


Housekeeping's role in a disaster.

Housekeeping's role in a disaster.


Restroom cleaning: cleanliness influences image.


Domestic violence: the medical response.


EMS talks with Joseph D. Hansen, NAEMT president. Interview by Barbara Feiner.


Urban violence: pandemic of trauma.

Urban violence: pandemic of trauma.


Group practice strategies. Physician leaders from three group practices talk about their organizations in the light of a new era for the business of medicine.


State of group practice.

State of group practice.


How to protect a CAT scanner from possible fire loss.


The prototype physician organization.

The prototype physician organization.


A planned giving program for the small development office.


Dietitians' job market.

Dietitians' job market.


The FLEX Test Committee and the FLEX Board--present and future.


The 1984 Walter L. Bierring Lecture. The penalty of leadership.


Future: 10 key areas.

Future: 10 key areas.


Competition: past, present, future.

Competition: past, present, future.


Time management: from victim to victor.

Time management: from victim to victor.


Worker perceptions: the key to motivation.


Organizational climate in the health care setting.


Appropriate collective bargaining units: statutory provisions and judicial decisions.


Employee health services: a mutually beneficial program for facility and staff.


Natural progression: HMO to PPO.

Natural progression: HMO to PPO.


Sexist language in health care facilities.


Group computing survey.

Group computing survey.


Case in health care supervision.

Case in health care supervision.


The art of Japanese management: three lessons to be learned.


Quality assurance as a problem-solving technique.


Finding the new supervisor: inside or outside?


Evaluation protocol for information system planning. Although some believe that electronic management information systems in the health care setting are of questionable value, I cannot support that position. There are undoubtedly health care institutions with management information systems (MISs) that are of dubious value, just as there are institutions in which the MIS is of enormous value. The question of the value of an MIS to an institution has more to do with an understanding of what an MIS is, what the institution's information needs are, and what the MIS can and should be doing for an organization, than it does with any inherent benefits that the system displays in and of itself exclusive of its environment. The views that follow address the process of evaluation that should take place to assess these issues and maximize the effectiveness of an information system in an organization. Figure 1 is a graphic representation of the evaluation process.


Medical computing: present & future.

Medical computing: present & future. By the end of 1984, as many as one third of all solo practices and two thirds of group practices will have purchased a computer. As many as 25% of these practices, however, will derive only limited benefit from their investment.


The basics: selecting a system.

The basics: selecting a system.


New demands for data processing.

New demands for data processing. HCSM's interview this month is with Ronald V. Aprahamian, President of Compucare, Inc. Head-quartered in Washington, DC, Compucare provides information processing services and software products to health care institutions. In particular, they aid institutions in customizing and operating in house computer systems. In this interview Mr. Aprahamian discusses the recent changes in data processing systems for hospitals.


"Hands on:" out of the shadows. Communications is the key for a growing number of foundations.


The results are coming in. A groundbreaking new study demonstrates that recent federal budget cuts have indeed damaged nonprofits that serve the neediest.


The problem that won't go away. Foundations look for solutions to mounting problems in an aging society.


"Who should plan for the implementation of a hospital information system"? Two opinions are better than one, or are they? As a regular feature, HCSM presents the responses of two authorities to one topical question. This month HCSM presents two points of view on who should be responsible for planning for the implementation of a hospital information system. Responses to this question emphasize the attributes of both in house personnel and outside consultants.


Information planning for the 1980's and 1990's. With the shift in reimbursement, new medical technology, and increased competition, hospitals must be managed more effectively. Management information systems are being developed to meet these new challenges. This article provides an overview of the types of information needed and outlines the development of a comprehensive information systems plan.


The laser committee: its role in quality assurance.


Magnetic resonance imaging. Architectural design for an emerging technology.


Case in point. Bartholomew Memorial Hospital.


Case in point--the answer. Worth Hospital.


The impact of new clinical technologies. An interview with F. David Rollo, MD, Vice President, Medical Affairs, Humana, Inc. Louisville, Kentucky.


The impact of nuclear magnetic resonance imaging on health care architecture. Nuclear magnetic resonance instrumentation, while unprecedented in its diagnostic capabilities, remains a challenge to the architect and planning team. This article provides background information on the magnet types and their force fields a well as on the ideal inter- and intradepartmental spatial relationships. Three conceptual conclusions are illustrated that best meet the requirements of patients, clinicians, and the magnet itself.


Networking: a cooperative solution.

Networking: a cooperative solution.


A religiously affiliated health care system in today's competitive market: a success story. In today's competitive health care market, not-for-profit religiously affiliated health care systems face multiple challenges for survival. Their mission of providing for the effective and efficient delivery of quality health care and health-related services for the benefit of individuals, families, and society and a philosophy of maintaining a Christian emphasis in all endeavors conflicts with many of the current competitive themes in health care. The successful system profiled here is Evangelical Health Systems (EHS), a not-for-profit organization affiliated with the United Church of Christ.


Moving a hospital. The move is the easy part. On January 9, 1982 St. Francis Hospital in Cincinnati, Ohio, closed the doors of its old hospital and moved into a newly constructed facility to be shared with St. George Hospital, also of Cincinnati. This move was the culmination of almost ten years of planning by a Joint Long-Range Planning Committee. This article will detail the processes involved in planning the move, the move itself, and the problems encountered after the move.


Selling Community General.

Selling Community General. As Community General Hospital approaches its thirty-second year of operation, its once bright future appears dim. Public support, medicare cost reimbursement, and private insurance have always been sufficient to keep the facility in reasonable working order. With medicare now using DRGs for determining payments, however, the hospital is being forced to reduce its costs. Complicating matters is the deteriorating physical plant, the growing public concern over hospital operations, the declining census, and competition from a larger, newer, better equipped city hospital. County officials are now faced with a dilemma: issuing bonds to either build a new facility or to renovate the existing structure. If such bonds were issued, the problem then becomes how to repay them. As an alternative, county officials have decided to investigate selling the hospital. The above scenario faces many public hospitals. Sooner or later, public officials will have to consider selling the hospital. This article's purpose is to explore those topics that relate to this decision.


The future shape of health care systems. This month HCSM interviews Paul M. Ellwood, Jr., MD, President of InterStudy in Minneapolis, Minnesota. Dr. Ellwood is also a Clinical Professor of Neurology, Pediatrics, and Physical Medicine and Rehabilitation at the University of Minnesota. InterStudy is a nonprofit health policy research group whose aim is to research and develop cost-effective approaches to health care delivery and financing. In this interview Dr. Ellwood discusses the future of health care systems in the United States.


Case in point. Allied Christian Health.

Case in point. Allied Christian Health.


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


Vertical integration: the wave of the future? In today's environment, health care facilities need to expend more resources in developing comprehensive and coordinated health care systems that provide, preferably on one site, ambulatory and acute care, long-term care, mental health, physical medicine and rehabilitation, home health, wellness centers, and an integrated prepayment plan as a joint venture with the institution's medical staff. The wave of the future (the next several years) will be toward vertical diversification because of increased price competition for a broad range of services, an industry with a surplus of acute care beds, and an interest by existing multihospital systems in improving their present positions by diversification rather than growth for growth's sake.


Operating theatres. Propping up the theatre.


They don't build them like this any longer.


Learning to manage with change.

Learning to manage with change.


Women in the NHS. How the other half works.


Two brains for the price of one.

Two brains for the price of one.


Staff development. Appraisals reassessed.


Breath of fresh air for central storage.


Planning. A sense of scale.

Planning. A sense of scale.


Bonus incentive schemes. Face-saving schemes.


Tender talk offered for public services.


Alcohol. Towards early detection.

Alcohol. Towards early detection.


Women in the NHS. "Can you meet the requirements of the job?".


Private hospitals. The limits of legislation.


HSSJ salaries guide.

HSSJ salaries guide.


Who cares for the carers?

Who cares for the carers?


Open access for the record.

Open access for the record.


Closer encounters for health care.

Closer encounters for health care.


Planning roles.

Planning roles.


Coming unstuck in the middle of nowhere.


Working to the rules.

Working to the rules.


Designed for disasters.

Designed for disasters.


Alarm call systems. When the warden appears at the touch of a button.


Employment law. Everyone hurt by a touch of the awkwards.


Telephone bills and smooth operators.

Telephone bills and smooth operators.


Health promotion.. Policy begins at home.


Residential care. What about the workers?


Guardians on call at the pull of a cord.


The physician-computer interface: the major limitation of a digital clinical database.


New technology communications network. Rx for planned obsolescence in older hospital communication networks.


The healthcare DP steering committee.

The healthcare DP steering committee.


Space: a hidden resource.

Space: a hidden resource.


Choosing a consultant.

Choosing a consultant.


Community relations tool.

Community relations tool.


Hospital Management Systems Society (HMSS).


The RFP process, warranted or wasteful.

The RFP process, warranted or wasteful.


The professional implementation team.

The professional implementation team.


Hospital communications: the future is now.


Teleconferencing: a viable communications tool.


Materials management, decision-making and personal computers.


A report on the Hospital Satellite Network.


An organizational model for systems design.


Materials management...the future.

Materials management...the future.


Contract concerns. What questions you should ask when buying a system.


How to recognize integration.

How to recognize integration.


Prime vendor agreements: a panacea?

Prime vendor agreements: a panacea?


Micro-computers in medical records.

Micro-computers in medical records.


Innovate, increase productivity and save $$$ with an inhouse system.


Hospital information systems in a new era: how to make them work.


Hospital's liability for equipment failure during surgery.


Managing product changes.

Managing product changes.


Developing standards to reduce the cost of implants.


Controls on the bidding process revisited. Following up on the Purchase Law Clinic in the February, 1984, issue of HPM, consider this precondition to quoting inserted by a supplier in his proposal to a group purchasing organization. The supplier required that, if it was the low bidder and was awarded the contract, each member hospital agreed to purchase only from that specific supplier. The member hospitals agreed not to buy from any other supplier who might try to undercut the successful low bidder.


HPM med-surg index declines 2%.

HPM med-surg index declines 2%.


Materials management in multi-facility systems: a case study. Although the problems of managing materials in a health care institution are formidable, these problems increase when the institution is part of a multi-facility system. There are many issues of organization, standardization, centralization (or decentralization) of authority, reporting, and monitoring faced by the multi-facility system, which are not issues relevant to the single institution. The state of New York operates a centralized supply purchasing, warehousing, and distribution system through its Office of General Services. This system serves a number of state organizations, including the focus of this report, the Office of Mental Retardation and Developmental Disabilities (OMRDD), which is responsible for 20 residential facilities as well as day programs and community residences. Faced with the recognition that the cost of supplies ("commodities" in the official nomenclature) was becoming a significant and vulnerable part of the operating budget, OMRDD engaged Friesen International, Inc. to assist in analyzing and improving its commodity distribution system, with the object of holding the line on operating costs. This article describes the methods and results of the ensuing study, which began as a review of the procedures in place, and ended with on-site assistance in implementing changes at each of the component facilities. Neither HPM nor the authors suggest that any other system could, or should, proceed in exactly the same manner; however, apart from the specific information about particular commodities which can be gleaned from this report, there may be value for others in seeing how the task proceeded, and the authors' self-critical analysis of how well the employed methods worked.


Deciding who will not be treated--a difficult issue that may lie ahead.


Business: getting tough in Arizona.

Business: getting tough in Arizona.


Government: corporations will be the biggest influence for change.


Who wil control health care: seven trends that may determine the future.


Successful global competition depends, in part, on managing health costs.


Willingness to make health decisions associated with socio-economic factors.


Consumer's increasing price sensitivity is key variable.


Agencies should market "preferred referrals".


Hospitals group to provide care, income immaterial.


An interview with: Ron Hawthorne.

An interview with: Ron Hawthorne.


How to shrink linen losses: an update.

How to shrink linen losses: an update.


Selecting and retaining a security consultant.


An interview with: Richard Fisher.

An interview with: Richard Fisher.


Upgrading liaison with law enforcement.

Upgrading liaison with law enforcement.


An interview with: George (Pat) Morse, JD, CPP, and Robert F. Morse II, CMC.


Future relationships between DHAs and FPCs.


Housing for severely and profoundly mentally handicapped adults.


Contracting out in-patient care.

Contracting out in-patient care.


A patient advocate system.

A patient advocate system.


Patients' appeals against compulsory detention: a systematic procedure for applying the Mental Health Act 1983.


An epidemiological contribution to planning urology services.


Problems and solutions: the perceptions of NHS managers.


NHS supplies--Health Service Supply Council and regional developments.


Joint ventures. A guide to developing and operating an ambulatory care center.


Joint ventures. MRI as joint investment.


Health care manager's notebook. Training for microcomputer use.


Joint ventures. Nine pitfalls for the unwary.


Chimney design and prevention of failure.


Nurses for Laughter.

Nurses for Laughter.


A district works department structure.

A district works department structure.


The efficient use of NHS estate--functional suitability.


Effective use of executive time.

Effective use of executive time.


Training in the NHS.

Training in the NHS.


Outplacement. Never a substitute for legitimate termination, outplacement can soften the impact of organization retrenchment and change.


Carner's codes. Incentive compensation.

Carner's codes. Incentive compensation.


Productivity trends reshape role, redefine success of middle manager.


Video training tips help managers succeed.


HRM and culture: history, ritual, and myth. The concept of organizational culture is here applied to the practice of human resource management. Reasons for the current emphasis on culture as an organizational metaphor are suggested. Cultural indicators which have diagnostic value for human resource professionals include organizational usage of symbols, rituals, ideologies, language, stores, myths, relationships, and humor. Examples of these indicators of culture are drawn from a variety of HRM practices and functions to explore the implications of each indicator. Alternative strategies are presented for improving the management of organizational change through sensitivity to cultural impact and better utilization of existing cultural realities.


Cost concerns breed new health care systems.


The M-Form society.

The M-Form society.


A successful marketing campaign for individual hospitals in a health system.


The CEO's role in making marketing work.


An interdisciplinary approach to dealing with the problems of AIDs patients at a tertiary medical center.


FCC ruling in Centrex-CO access charge case.


Guideline report. Diagnostic ultrasound: principles and applications.


Your hospital can benefit from operating a free standing clinic.


Guideline report. Clinical laboratory information systems.


Guideline report. Evaluation methods for intensive care unit systems.


Guideline report. Ultrasonic fragmentation and cataract surgery.


Guideline report. An evaluation of automated infusion devices.


Hospital topical law: oral contract... to provide full-time pathology services.


How to plan and implement a downtown convenience medical care center.


Once your staff is unionized.

Once your staff is unionized.


Guideline report. Automated indirect blood pressure measurement devices.


Middle management stress. Some tips for top management too!


Standards of performance in central service. A key to a quality assurance program.


Guideline report. Digital subtraction angiography.


Guideline report. Buying and selling used medical equipment.


How to decide on the best quantities to order of a particular item--in the O.R., C.S., emergency room, materials management.


Guideline report. Ethylene oxide sterilization.


Innovative packaging improves productivity and sterility assurance.


Gatwick Park Hospital.

Gatwick Park Hospital.


Guideline report. Purchasing a satellite receiving earth terminal.


Hospital employees get back to basics--with productivity and benefits for all.


Guideline report. Materials management information systems.


Guideline report. Nuclear magnetic resonance.


The case of the non-curious members of the credentials committee.


The medical component of the CPI: how we know medical costs are soaring.


High quality, cost-effective care still our goals.


Consultations not a problem, but...

Consultations not a problem, but...


Consultations: a survey questionnaire.

Consultations: a survey questionnaire.


Evolving environment puts new pressures on consultation care.


The impact of newspaper advertising on a regional antenatal health campaign. In 1981 the West Midlands Health services undertook a publicity campaign aimed at helping women to understand more about keeping healthy during pregnancy and encouraging them to seek early ante-natal care. A series of full page advertisements on ante-natal care were placed in local newspapers in the Region. Set out here are the findings of two studies of the impact of the publicity campaign. The first shows how far people's knowledge of what to do during pregnancy was altered by the publicity, and the second shows what people thought of the advertisements themselves and the further information sent to them on request.


Research in health education units--warts and all. While there is general agreement that research in health education is valuable, there is considerable disagreement on the form it should take, and how it should be organised. After a review of the problems and opportunities from two perspectives, a number of points are suggested which should be taken into account by anyone considering basing research posts in service units.


Taking a closer look: disinfection versus sterilization of scopes.


MM view key to good home health decisions.


Reaction to new EtO regulations mixed.

Reaction to new EtO regulations mixed.


Considering the alternatives.

Considering the alternatives.


Reducing inventories can be unprofitable.


A positive environment: the second generation breakdown room.


Negotiating: go for it--you can get it.

Negotiating: go for it--you can get it.


States vary on CON legislation.

States vary on CON legislation.


Deregulation and the fear of "capitalized medicine".


MMs report substantial rise in CEO interest in purchasing.


The bonds between medicine and management.


Other people's money.

Other people's money.


Capital expenditures for hospitals.

Capital expenditures for hospitals.


Rational planning models for resource allocation in health care.


Have housestaff found a home?

Have housestaff found a home?


Why the Canada Health Act?

Why the Canada Health Act?


The great American health fortunes of 1983.


CATCH-22. How budget cuts can lead to throwing the baby out with the bathwater.


So, you're looking for a union.

So, you're looking for a union.


Evaluating your shop image.

Evaluating your shop image.


Shrinkage: increasing profits by decreasing losses.


HGSM gift shop profile. George Washington University Hospital.


Let there be light.

Let there be light.


Omaha's winning pair.

Omaha's winning pair.


The hospital medical staff of 1994.

The hospital medical staff of 1994.


Credentialing and medical membership.

Credentialing and medical membership.


MDs and multihospital systems.

MDs and multihospital systems.


Closed or open medical staff? Consider all the factors.


Graduate medical education: where is it heading? Beset with problems in funding and manpower, graduate medical education (GME) seems to be heading toward a confrontation between expectation and reality.


How to cure stagnating standing committees.


How to avoid the interspecialty turf battle trap. As competition and increased numbers of physicians heat up efforts to obtain hospital privileges, medical staffs and hospitals need to develop a quality-based privileging system that minimizes discord and protects from antitrust liability.


Preparing the P & T committee agenda for new drug requests. Preparing an agenda is an important element in conducting an effective P & T Committee meeting. A key responsibility of P & T Committee members is reviewing the rationale for formulary requests. Therefore, it is generally an agenda item. This article describes a process for planning, preparing, and distributing agenda materials for a committee meeting. A specific format and sequence for reviewing new drugs for formulary admission and criteria for selecting new drugs are discussed.


Protection from discovery of hospital peer review committee records. Integral to an effective peer review process is the assurance that the comments of those serving on the hospital's peer review committee will remain confidential. In recent years, several court cases appear to have eroded this assurance of confidentiality by allowing the discovery of hospital review records. This article examines the legal status of peer review confidentiality in selected states and concludes that the confidentiality of peer review proceedings remains intact in most states.


Therapeutic substitution: has its time arrived? Therapeutic substitution refers to substitution by the dispenser of a drug product that is not chemically identical but is therapeutically equivalent to the product prescribed, pursuant to guidelines established by the hospital P & T Committee. Until recently, the extent to which this concept has been adopted by hospitals across the country was unknown. Late in 1980, we conducted a nationwide survey of hospital pharmacies to learn more about therapeutic substitution. This paper reviews some of the issues involved, some of the findings of our study, and the pros and cons of therapeutic interchange. It also provides an update as to some of the recent changes that are occurring in therapeutic substitution procedures.


Computer skills enhance a hospital pharmacy residency training program. Hospital pharmacy residents participated in a program designed to introduce them to computer systems useful in pharmacy practice and to provide them with access to a variety of computer resources that could be helpful in completing their residency projects. Using existing computer facilities, various short courses and individual tutorials were employed to train residents in a variety of computer skills. These courses provided a useful vehicle for recent pharmacist graduates to acquire necessary computer skills not obtained during their academic training. Because the program provided residents with the tools needed for the management and analysis of large data sets, a marked increase occurred in the number of residency projects acceptable for publication in peer-reviewed pharmacy journals. Thus, residency projects improved in quality and faculty preceptors were more motivated to get involved in such projects.


Determining staffing for pharmacy chemotherapy admixture program. This study was designed to assist the hospital pharmacy administrator in assessing personnel and staffing requirements for a pharmacy chemotherapy admixture service. Time study data was collected on 250 consecutive new and refill chemotherapy admixtures. Both pharmacists and technicians admixed during the 32-day study period. Protective clothing and a vertical hood were utilized. The admixtures were divided into three categories depending on the drug's original packaging (ampul or vial) and the delivery system used for the final solution (syringe or IV bag). Total processing time (compounding time plus auxiliary time plus allowance and absentee time) for all admixtures was determined. The average total processing time for new orders was determined to be 16.75 minutes with refill orders requiring 14.61 minutes. From the results of this study, it was found that an average of eight chemotherapeutic admixtures per day would require approximately 0.4 FTEs.


Twenty-four hour pharmacy service in hospitals with less than 300 beds--Part 9. In the June 1983 issue of Hospital Pharmacy, I requested pharmacy directors in hospitals of less than 300 beds who had 168-hour a week pharmacy service to describe their service and how they obtained it. Seven such descriptions appeared in July 1983. Below you will find a continuation of this feature. We plan to publish additional descriptions as they are received.


A study contrasting different modalities of medication discharge counseling. The effects of different modalities of medication discharge counseling on patients' medication knowledge were studied. Patients discharged from medical/surgical units in a community hospital were counseled utilizing one of three methods or received no counseling, according to their randomized study group assignment. The three types of discharge counseling studied were: (1) distributing written information and answering all patient questions, (2) verbal counseling performed by a pharmacist, or (3) verbal counseling performed by a pharmacist with distribution of written information. The control group received no counseling or written information. Patient information was collected, and the time and costs of the counseling were recorded. A questionnaire was sent to each patient 1 week after discharge from the hospital to determine a patient's knowledge of his/her medications. The questionnaires were scored by a pharmacist unaware of the type of counseling the patient had received. Upon completion of the scoring, the study data was collated and statistically analyzed. The results showed that medication discharge counseling conducted by a pharmacist does improve a patient's knowledge of his medications and that pharmacist intervention in medication teaching does improve the counseling results. Also, the study demonstrated that verbal counseling in combination with written information increased the patient's awareness of his medications the most, and was a financially feasible method. This study supports the development and continuation of pharmacist-conducted medication discharge counseling in rural community hospitals.


Corporate cultures and business strategy: a health management company perspective. This article develops a framework of analysis for understanding corporate cultures, and applies available analytical tools to the cultural study of four health management organizations. A distillation of the relevant literature was performed to establish working definitions, tools of analysis, and various caveats. Examples of corporate cultural studies follow, and an attempt was made to identify the cultural dimensions, typology, and anticipated strategies for the four multis. The author emphasizes that healthcare companies which want sustained changes in their business lines must examine and carefully alter their firms' culture to support and reinforce such changes.


Comprehensive intravenous admixture services: logistics and quality assurance in a university affiliated teaching institution. The role of supportive personnel, as well as the supervision of intravenous (IV) admixture compounding by staff pharmacists, should be clearly identified by the departmental manager. In doing so, the department should strive to achieve an optimal mix of professional and technical personnel with automated technology. Close attention must be paid to quality assurance in order to maintain the highest quality parenteral admixture. The logistics of comprehensive IV admixture services are described for a university affiliated teaching institution. Emphasis is made on a three-faceted approach to quality assurance, including technician training, end-product testing, and equipment maintenance.


An anesthesia controlled substance dispensing system. The problems associated with drug abuse or diversion by anesthesia personnel in the operating room (OR), causative factors, effective mechanisms of control of abusable drugs in this area of the hospital, and the need for these systems to be cost effective for the smaller hospital are discussed. A system utilizing anesthetist/case specific drug kits that are dispensed by the pharmacy to the OR and then to individual anesthetists is presented. The system limits quantities of drugs available at one time to anesthesia personnel and provides for clear individual accounting for drugs and the rapid detection and reconciliation of discrepancies. The system demands modest increases in personnel expense and capital and consumable equipment costs. The authors conclude that the system described may provide for improved abusable drug control in the OR at costs reasonable for the smaller hospital.


Emergency service: a strategy for hospital-sponsored ambulatory care satellites. This analysis of the overall market position of free-standing emergency care was based on a telephone survey of 300 randomly chosen households in a southeastern metropolitan area. Results show that consumer preferences for cost and convenience create a strong market for free-standing emergency facilities. Emergicare centers are in an ideal situation to capture the market for acute and minor emergency care. To be worthwhile, the emergency room in a more comprehensive ambulatory care facility should serve as a feeder of new patients and be profitable in its own right. However, free-standing emergency facilities must not only attract patients through convenience and price, but they must also maintain patients through assuring quality care and satisfaction.


Noncutting methods of needle and syringe disposal. The time required of nurses to cut needles and syringes, the costs of boxes used to cut needles and store used syringes, as well as some of the costs related to treating needlesticks are discussed. A new method of utilizing a large box (3 X 13 X 31 inches) in a medication cart is described. The box is made of one-quarter inch cardboard and waxed. It is replaced daily and incinerated. The system is time-saving, economical, and should reduce the number of needlesticks.


Employer perspectives on the preferred provider organization concept. The goal of preferred provider organizations (PPOs) is to identify cost effective physicians, hospitals and other providers and form them into healthcare delivery systems. Widespread interest in PPOs stems from the belief that they can contain costs while offering consumers a choice of physicians and hospitals. But there is little information available about the demand by employers to offer PPOs as a health plan option. This study gathered information on employers' attitudes toward PPOs through a survey of companies in the Minneapolis metropolitan area. Most of the surveyed firms were found to be self-insured and offered a choice of healthcare plans, including HMOs. Contrary to some previous studies, healthcare costs are a major concern by all of the firms. PPOs are viewed as one part of an overall strategy to reduce those costs while maintaining quality of care and convenient access to providers. Although somewhat skeptical about potential savings and concerned over the administrative costs of offering a new health plan, most of the firms indicated support for the PPO concept. The greatest market opportunity for PPOs is to offer the plan as an alternative within the company's existing indemnity plan, wherein employees who use the preferred providers are exempt from at least a portion of the coinsurance and deductible requirements.


Industry notes.

Industry notes.


A respiratory therapy unit dose system in a 500-bed hospital. A comprehensive unit dose distribution system for respiratory medications is described with emphasis on generalized design principles. This system may be tailored to meet the needs of any institution. Methods for receipt and interpretation of the physician's orders, the profiling system, handling of initial orders, monitoring medications, preparation of unit dose respiratory medications, and routine distribution of orders are covered. This unit dose system allows the pharmacy to assume full responsibility for the procurement, storage, and distribution of all respiratory medication. The pharmacist can provide the respiratory therapist with standardized, sterile quality-controlled medications that are ready to administer. Controlled cost and equitable charging procedures are also provided.


Hospital expense growth slowing dramatically.


Successful acquisition planning.

Successful acquisition planning.


Positioning doctors for convenience medicine. Faced with an increasingly competitive environment, physicians must learn to organize themselves into group practices positioned to perform as the customer expects. To be successful, these new group practices must recruit the kind of physician who will meet the consumer's demands for quality care: convenience, continuity of care, and confidence in the doctor's competence. This article describes how doctors can become more competitive based on my observations as a former consultant with such healthcare companies as Cigna Healthplan, the largest for-profit HMO, and as the current vice president of Operations Planning and Development with Republic Health Corporation, a Dallas-based hospital management company. These observations should help hospital managers learn how to organize their medical staffs to better serve the patient's needs. By repositioning their physician services, hospitals should become better positioned to compete for new patients.


Setting strategy using variable ROI analysis.


The psychology of corporation: how identity influences business.


Medically intelligent computer systems--a nurse's view.


The board of directors: beware of those triggers that cause board change.


Guideline report. Bar code technology: applications in health care.


Physicians and nurses using a hospital information system.


Echocardiography. Guideline report.

Echocardiography. Guideline report.


CT scanner. Guideline report.

CT scanner. Guideline report.


Finding the right architect.

Finding the right architect.


A medical device recall and reporting system. Guideline report.


The challenge of opening a new facility.


To build or renovate: an architect's perspective.


Humanizing design for tomorrow's facility.


Tomorrow's facility: build or renovate? Evaluation key to accurate cost projections.


Tomorrow's facility: build or renovate? Financing: some pointers on the FHA insured mortgage loan.


Mergers and acquisitions--current antitrust law.


Tomorrow's facility: silk purse or sow's ear?


Surveying the gender gap. Attitudes on women in EMS.


MCI vs. disaster. An overview of mass casualty response.


A comparison of the effect of music therapy and medical play therapy on the verbalization behavior of pediatric patients. Therapeutic play activities are designed to help children verbalize their hospital experiences so they can cope with the trauma of hospitalization. The purpose of the study was to determine whether a music therapy session was more effective than a medical play therapy session in facilitating this verbalization. Forty school-aged subjects were randomly selected to receive an individual music therapy or play therapy session. The two groups were equated on the following variables: sex, age, socioeconomic status, length of present hospitalization, session interruptions, type of illness and related number of prior hospitalizations, and prior Child Life involvement. The last two variables were thought to influence verbalization. The dependent variable was comprised of each patient's response to four critical incidence questions about hospitalization. Content analysis was employed to code each response as a three-digit number with numbers increasing as the verbalization became more involved. The chi square statistic revealed that music therapy elicited significantly more involved verbalization about hospitalization than did the play therapy session for each of the seven variables. Verbalization was unrelated to the patient's diagnosis and prior hospitalizations. Patients without prior Child Life involvement had more involved verbalization than patients with prior involvement.


Some implications for the clinical use of music facilitated imagery. In this study, Helen Bonny's Guided Imagery and Music technique provided the base experience for questionnaire responses from short-term psychiatric inpatients, students, and staff (total/n = 107). Independent measures of age range, sex, medication type, and recent relaxation practice were compared statistically with dependent responses of skin temperature, perceived ability to relax, production of images, and perceived helpfulness of the experience. Results demonstrated increases in skin temperature and relaxation perception and defined the average experience as manifesting three concurrent imagery modes. Among the man independent-dependent variable relationships, some significant differences in mean responses were present. These differences and their possible clinical implications are discussed; further research in the area, including replication, is recommended.


Player piano music as therapy for the elderly. With the increasing geriatric population, more research is needed to identify strategies for enriching the quality of life for older adults. Music therapy has been well documented for its beneficial effects on physical and mental health. The notion of using player piano music as therapy for the elderly evolved because of the absence of this approach in the literature. Eleven elderly clients in a midwestern retirement center participated in an ABA experimental design to measure responses to player piano music. Cognitive, affective, and behavioral data were collected through observational and subjective interview tools. Results demonstrated marked increments of rhythmic and extremity responses to musical treatment. Additionally, player piano music was enjoyed and enhanced a state of well-being and youth, enabled retrieval of specific long-term memories, and provided "action-oriented" cognitive themes and stimulation.


Changes in business communications: innovative uses of new media and technologies. An overview of communication technologies and concepts for intra- and inter-business communication, including local area networks, electronic mail and tele-conferencing, illustrates the wide spectrum of methods which challenge traditional forms of business communication such as correspondence and telephone. It is shown how the application of these technologies, in concert with the computer and new storage media, allows integration of communication, data management and recordkeeping functions. The systematic application of electronic technologies and recognition of the advantages of graphics for effective communication lead to the stimulation of graphic forms of communication. Technologies and methods of graphic communication are discussed, and the impact of these new approaches on the work environment in the office is explained.


The institutional chaplain: constructing a role definition. Reports on a questionnaire survey of members of the Omaha Nebraska Area Institutional Chaplains' Association and the Nebraska State Chaplain's Association. Develops a typology of the role of the hospital chaplain based on findings which indicate that chaplains see themselves as (1) counselors, (2) professionals, and (3) religious functionaries. Notes that these perceptions are often at dissensus with relevant publics, and interprets the role of definitions in terms of secularization and social structure principles. Discusses and suggests ways of addressing role differences in view of current changes in health care developments.


Computers and chaplains: using the technology revolution. Describes how microcomputers may be used by departments of pastoral care for management analysis and for time usage studies. Claims that such analyses help to document the activities of chaplains and provide an accountability means and a way of demonstrating the contention that pastoral care is an integral part of complex health care institutions.


The female chaplain's contributions to breast cancer management. Maintains that a female chaplain's ministry to women breast cancer patients holds unique qualities because of the chaplain's ease of achieving physical and psychological identification with the mastectomy patient. Notes particularly how a female chaplain can provide a relationship for affirmation of self-esteem, confession, and repentance. Illustrates with actual cases ways the female chaplain can share in the feminine identity crisis, participate in the struggle to claim God-given dignity and worth, and be genuinely present for healing the resentment and guilt often accompanying the mastectomy patient's loss.


A method for doing grief work with families who have had a child die with cancer. States an approach to doing grief work with families who have had a child die of cancer and outlines a small group process which follows Erich Lindemann's themes of (1) reviewing the life of the deceased, (2) reflecting on the meanings of the deceased person's life; (3) restructuring of relationships, (4) liberating the dead person, and (5) recognizing the reality of a form of resurrection.


The role of CPE in medical education.

The role of CPE in medical education. Describes a program designed to aid medical students relate more empathically to patients and their families. Outlines the content of sessions, notes resistances and attitudes toward the program, and offers an anecdotal evaluation of the educational project.


Comment. The interwar health insurance scheme: a rejoinder.


Comment. Interwar health insurance revisited: a reply to Frank Honigsbaum.


Public opinion and the privatization of welfare: some theoretical implications. The social policy of the Thatcher government is characterized by an abrupt shift in the direction of the private sector. To what extent does this reflect what people want? The Institute of Economic Affairs conclude from the only suitable national opinion survey that such a move is strongly supported. Our reanalysis of their data shows that this strand in public opinion can coexist with, and need not contradict, an equal public enthusiasm for state welfare. Such results have important implications for our understanding of social policy. We conclude, therefore, with a discussion of contrasting marxist and liberal accounts which seeks to show that the evidence of ambivalence in popular attitudes about the welfare state supports particular developments in theory.


Managing external constraints: the case of nursing homes.


How many Americans lack outside sources of payment for major health care costs?


Phases of psychological burn-out and organizational covariants: a replication using norms from a large population.


Hospital unionization trends: effects of the shift from state to federal jurisdiction in three states.


Professional collaboration in services for mentally handicapped people. There has been growing academic and practitioner interest in the problems of and opportunities for joint working in the care of mentally handicapped people. The paper outlines alternative methods of such joint working and tests these against survey and case study evidence. Attention is drawn to the danger that joint working may have little impact at patient level and the paper recommends an emphasis on the appointment of frontline key workers.


Nursing homes and quality of health care: the first year result of an outcome-oriented survey.


Hospital security: the future is now.

Hospital security: the future is now.


Restructuring the health care financing and delivery system: national health insurance through market competition.


The impact of Florida's matrix-model organization on implementation of the Older Americans Act.


Action planning to enhance training program results.


Empirical measures of grievance procedure effectiveness.


The role of volunteers during a strike.

The role of volunteers during a strike.


Disagreement on infection control.

Disagreement on infection control.


Accuracy important when computing costs.


Are high temperatures really needed in our institutional laundry washrooms?


New St. Louis central laundry opens. Five area hospitals will share service.


The artificial heart. A study in myopia.


Forecasting expenditure on capital projects. S-curves are widely used for planning, forecasting and control of cost, time and resources of a project. In this paper, a comparison of two S-curve models developed at the Department of Health and Social Security (DHSS) and Bradford University is carried out both from the viewpoint of predictive accuracy and ease of use. The models are validated using expenditure data for 21 recent U.K. health building projects. Methods of least squares is used to estimate the parameters of the two models. These parameters are categorized according to the total cost of the projects. Both the models are shown to be of comparable accuracy for fitting actual expenditure data. The DHSS model has a major advantage of simplicity of form and use, although the slightly greater mathematical complexity of the Keller-Singh model is off-set by the readily interpretable nature of its form and basic parameters. It is concluded that both or either of the models could be used by clients/contractors for effective planning and control of project costs.


The health care environment. Factors affecting the system.


The Occupational Safety and Health Act. The national policy for the prevention of work-related illness. Occupational health and safety issues are increasingly important on the broader health agendas of both industrial and non-industrial communities. These issues go beyond traditional industrial hygiene into areas of environmental epidemiology and public health engineering. The policy framework for addressing such issues is the Occupational Safety and Health Act of 1970.


How a doctors' paradise was spoiled. An émigré physician reports on the depressing impact of socialization on medical practice in his native Finland.


When peers put the heat on doctors who overhospitalize.


Can Florida end its malpractice nightmare?


Buy-in buy-out. Is your plan in shape?

Buy-in buy-out. Is your plan in shape? Though once relatively inconsequential, in today's competitive climate a strategic buy-in/buy-out plan is critical to a medical group's success. A plan that is too costly in relation to competitor's plans can spell a death sentence for a group seeking to attract new physicians. In this case study, a group confronts its buy-in/buy-out problem and uses it as an opportunity to redefine goals and objectives and rebuild the group.


Writing DNR orders that won't get you sued.


Winning medical groups.

Winning medical groups. What does it take to win? Quite simply, excellence. Twenty suggestions for promoting excellence are provided to help you turn your medical group practice into a winning organization--an organization with quality management as well as quality medical care.


What do attitudes tell you?

What do attitudes tell you? Increasing employee productivity and efficiency is a goal for every medical group administrator. By allowing employees the opportunity to voice their opinions anonymously, management can gain accurate and valuable information on employee attitudes. The author demonstrates, through a case study, how an attitude survey can provide specifics on the strengths and weaknesses of a group, thus giving direction to initiate needed changes.


The price of leadership.

The price of leadership. Whenever an individual displays creativity, strength, and initiative that go beyond the norm of society, he is set apart from others. Being a leader (whether born or made) in any walk of life can and generally will produce unanticipated consequences such as jealousy, resentment, mistrust, and criticism from subordinates. By being prepared for and accepting the obstacles that go hand in hand with a leadership role, the medical group administrator can help his organization reap the benefits that an effective, well-adjusted leader can bring.


UPS uninterruptible power system.

UPS uninterruptible power system.


Medical Electronics buyers guide 1983, Part 6: CAT scanners, electrical safety & test equipment, neonatal & pediatric equipment, pulmonary/respiratory equipment, simulators, stress-test systems/ergometers.


Is your doctor a groupie?

Is your doctor a groupie? What characteristics do you perceive as being most important when recruiting new physicians for your medical group? While technical competence is of course necessary, the medical group must also consider how well the candidate will fit into the group. By understanding the characteristics that will make a candidate fit into the organization and by carefully assessing the prevalence of these characteristics in physician candidates, the perceptive administrator can select the candidate that will best contribute to the long-term success of the organization. A specialist in physician recruitment offers her advice.


Defibrillators. State of the art.

Defibrillators. State of the art.


Medical records manpower.

Medical records manpower.


Uncontrollable variables in marketing.

Uncontrollable variables in marketing. Controllable variables such as product, price, and promotion are only part of the total package in marketing a medical practice. What about technology, demographics, society and culture, politics, and economics--the uncontrollable variables? These critical factors can enhance or destroy a medical group practice in today's fast-changing world.


Community records.

Community records.


Hospital Activity Analysis, the Korner Report and ward based computers.


Northern Health & Social Services Board--Coleraine and Waveney Hospitals patient administration systems.


Community records. Part 2--District nursing staff.


Automated coding of diagnosis, operation and occupation texts in hospital in-patient discharge summaries.


Navigating on the medical management freeway. Ready or not, the role of the medical group manager is rapidly expanding and only those who are well prepared and in control will survive. The views of a medical management consultant are presented in this entertaining article on a critical subject, along with guidelines for developing formal organizational goals.


Grounding in instrumentation systems.

Grounding in instrumentation systems.


The hospital. Spending up sharply.

The hospital. Spending up sharply.


Mental health (Amendment) (Scotland) Act 1983.


Health care rationing: MD takes issue with insurance, government officials.


Birthing alternatives: a matter of choice and turf.


Dramatic variations in medical practice blamed for misspent health dollars.


Is the grass greener? Physician billing under Canadian Medicare. With the US healthcare system currently in a transitional state, medical group administrators here are becoming more curious about the way that the healthcare systems of other countries work. The experience of the Haig Clinic, a medium-sized multi-specialty family practice, is offered as a representative example of the Canadian Medicare system in the province of Alberta. Nearly one-half of all claims are now received by Alberta Medicare in EDP magnetic tape form, and total turnaround time is approximately two weeks for "clean" claims. Thanks to the dedicated efforts of man Alberta health professionals, it is an efficient system of billing, merging the world of Medicare with the world of electronic data processing.


The fitness boom. Must staying in shape extract a price?


Filling in the blanks of the hypertension puzzle.


AMA delegates approve resolution calling for hospital ethics committees.


Diabetes. Can tight glycemic control stem the tide of complications?


Congress faces fragile compromise on 'Baby Doe'.


Health care forecast: delivery systems deluge and dampened incomes.


Is it time to buy a computer network?

Is it time to buy a computer network?


Larceny in the lab: how to control time theft.


How to keep those inspection jitters down.


The artificial heart and the public purse.


A psychological approach to better phlebotomy.


A power outage: one lab's experience.

A power outage: one lab's experience.


Retention strategies: keeping good employees.


A journal core list for health administration libraries. Health administration is an interdisciplinary profession practiced in various settings. This paper presents a core list of journals for libraries responsible for supporting the study or practice of health administration in any of these settings. This paper initially examines and defines the parameters of the field of health administration to guide in the selection and organization of the list of core health administration journals. The organization of the list is based on the definition of the field as presented in the paper. The most important journals have been indicated, and sufficient information is given to facilitate ordering.


A seminar for public health graduate students.


Creative arrangements benefit hospitals, home care agencies.


Social/HMOs: an innovative response.

Social/HMOs: an innovative response.


The AAA/hospital partnership.

The AAA/hospital partnership.


Program makes most of vintage years.

Program makes most of vintage years.


Medical libraries at the crossroads.

Medical libraries at the crossroads.


The user friendly card catalog.

The user friendly card catalog. The changing roles and relationships of professional staff in Reference and Cataloging departments in the catalog creation process are discussed. Specific examples are given for handling classification, subject headings and cross references. The article stresses the importance of interface between the two departments in making the catalog more accessible to the users of the library.


Multihospital systems. Chains offering more services.


Glut of bonds won't raise interest rates.


One approach to a health care gap.

One approach to a health care gap.


Act could erode ventures' tax benefits.

Act could erode ventures' tax benefits.


Home care agency adjusts to competing interests of hospitals.


Contract management surveys. Contract management companies manage growth rate of 13.3%.


Contract management, shared services surveys. Popularity of management firms, shared service arrangements fails.


Shared services surveys. Prospective pay doesn't boost shared services' sluggish growth.


Major alliances focusing efforts on creation of new business.


Consulting services. Hospitals shell out $285 million to 151 consulting firms in 1983.


Hospitals pump dollars into finance, nursing.


Market surveys, ads help suburban Atlanta facilities focus on strengths.


Many systems incompatible.

Many systems incompatible.


Analysts laud chains' information systems.


ICU patients benefit from data merging.

ICU patients benefit from data merging.


Catholic chain inks record pact for hospital computer system.


Alliances tailoring programs to meet small hospitals' needs.


Physicians get hefty financial guarantees, perks as attractions.


Trustee talent aids small hospital staff.


Rural hospitals' lab workers feel they need more training.


Municipal bond insurance may create two tiers of healthcare borrowers.


Future belongs to new multihealth corporations; hospitals should join now.


Chains will profit despite competition, forecast by industry leaders says.


Paying for healthcare is in the cards.

Paying for healthcare is in the cards.


Competition spurs hospitals to offer group health insurance to employers.


Alternative services. Surgicenter operators may choose structure from several legal options.


Disease risk and the health of the public. Different ways of looking at the epidemiology of health and illness in the population can influence the allocation of resources to research and public health programs. This paper presents several epidemiologic concepts of risk that are useful in making clinical and public health decisions, drawing on coronary heart disease (CHD) and its risk factors for examples.


Not-for-profit growth has national look.


Using birth and death certificates to describe maternal and child health risk in California.


Anatomy of a takeover: AMI in the aftermath of Lifemark.


Success best testimonial for ads.

Success best testimonial for ads.


Financing technique preserves autonomy, gives strength of numbers.


FDA device regulations and the home care dealer.


Multi treats advertising as board policy decision.


Mission control. Never one to dodge a challenge, Evangelical Health System's John King feeds on the 'creative tension' that a sense of mission brings to health care. Interview by Kelly F. Guncheon.


Key to multi advertising is finding the right channel.


Businesses seek allies in curbing health costs.


Reproductive risks in the workplace.

Reproductive risks in the workplace.


In sterilization, off-site is still not within sight.


Quick return to work can save industry millions.


Simplifying MORT for supervisors.

Simplifying MORT for supervisors.


The impact of supply on the use of the hospital facilities. Differences between high and low income groups in The Netherlands.


Diabetes education reduces hospital use and costs.


What are your practice alternatives?

What are your practice alternatives? The possibilities for the future of the practice of pathology have never been brighter, the author says. He explains how pathologists can be successful in alternative practice arrangements, and what these alternatives are.


Educating residents in the 80s: how much, how many, who, where, and how? The way future pathologists are educated will change greatly, the author says. Though there is danger in what is to come, there are opportunities as well, and the author remains optimistic. In this article he explains why.


Consultation corner--problem of documentation of patient education.


Shared services for closed-circuit television.


Using our time the best we can.

Using our time the best we can.


Two goals in every performance appraisal.


Involving patients in decision-making.

Involving patients in decision-making.


What Bechtel learned creating an employee assistance program.


A primer on legislation and responsibilities. An introduction to employee right-to-know laws.


Patient education programming for psychiatric patients.


Computers plus business equal liabilities.


EDP applications for personnel activities by hospitals. A current survey of practices and plans.


What questions do resident physicians ask pharmacists?


Reasons for the lack of association between changes in health behavior and improved health status: an exploratory study. Persons with arthritis who attended a 12-hour self-management course generally showed improved health behaviors and improved health status. However, no association was found between the two. We therefore interviewed 54 course participants to determine factors that were associated with positive and negative health-status outcomes. Persons having positive outcomes indicated that they had more control over their disease and had a positive emotional status. Persons with negative outcomes indicated a lack of control and generally had a negative emotional status. These differences were statistically significant.


Obesity: prevention is the treatment.

Obesity: prevention is the treatment. Prevention of obesity at all ages is a matter of considerable concern for health professionals. A review of current theories of the etiology of obesity provides the basis for discussion of preventive measures at critical developmental stages throughout the life cycle. Good nutrition during pregnancy, breast feeding, and avoiding early introduction of solid foods are advocated to avoid obesity during infancy. For the young child, healthy eating habits and sufficient physical exercise are prescribed to prevent the accumulation of excess weight. Psychological and social difficulties make weight loss difficult for obese adolescents. The advantages and disadvantages of diet, anorectic drugs, exercise, and behavior modification are discussed. Adult-onset obesity is often easier to prevent and treat than is juvenile-onset obesity. Intervention is basically the same as that for adolescents. The role of health professionals is clear: encouragement of behavior consistent with sound nutrition and good health before excess weight is gained, early recognition of overweight individuals, and assistance in the choice of corrective measures.


Perceptions of educational needs for patients after myocardial infarction. Twelve physicians, 33 nurses, and 30 patients completed questionnaires to elicit similarities and differences in perceptions of educational needs of post-myocardial infarction (MI) patients. Results, using chi-square analysis, indicated that the three groups generally agreed upon which areas should be included in education programs for such patients. The topics rated most important by all three groups were: "knowing the signs and symptoms of a heart attack"; "knowing how to modify or change personal risk factors"; "knowing the names, dosages, and side effects of medications"; and "knowing personal risk factors." Congruence of perceived educational needs of post-MI patients should not be misconstrued to mean that an educational needs assessment for these patients is not necessary.


Explaining attendance at a class teaching breast self-examination. Using the health belief model as an organizing frame-work, variables were examined that might predict attendance at a class teaching breast self-examination. The results show that various health belief dimensions are among the best predictors although other strong predictors are identified and some modifications to the health belief model are proposed.


The effects of lay counseling on medication adherence and blood pressure: adjunctive treatment for hypertension. Ten noncompliant hypertensive patients were monitored and received counseling from trained aides. Monitoring and lay counseling was associated with a reduction of -10 mmHg in systolic blood pressure and of -7 mmHg in diastolic pressure (P less than 0.05). Medication adherence increased from 69% to 84%. Counseling resulted in pressure decreases equal to those obtained by usual care for similar but compliant patients. This analysis provides a model for paraprofessional adjunctive counseling of patients thought to be adhering poorly to their medication regimen, which may improve control of hypertension.


What's the latest in patient confidentiality?


Building fire safety--lessons learned thru litigation. Building codes and standards are enforceable by law, but are recognized as a minimum design basis relative to fire safety. The same system that mandates these codes does not, in a court of law, judge solely by the codes. In civil litigation involving death and injury from a building fire, the jury must evaluate the design based not only on the codes but also on what is reasonable. This paper will examine the civil trial and its impact on engineers, architects involved in building design, and manufacturers who supply materials and products for such buildings. Actual case histories will be cited and recommendations for a greater information feedback from trials to practicing designers and manufacturers will be presented.


No-fault bill picks up steam.

No-fault bill picks up steam.


New pressures on fees from third-party payors.


How Oral Roberts' City of Faith came to be. Old-time religion meets big-time medicine.


Will hospital corporations move into private practice?


Should the government have access to medical records?


New malpractice trouble: be prepared!

New malpractice trouble: be prepared!


How to tell a patient and his family bad news.


Views on doctors' income and legislation. An interview with Senator Kennedy. Interview by Penny Tselikis.


Federally funded demonstration projects: following the path of S. 234.


The aging of America and the implications for health promotion.


Filling the gap: programs offer ideas for meeting special needs of older persons.


International perspectives on home health care: introduction.


Benefits of university, state hospital cooperation lauded. Part 2.


Guidelines on patients' rights found lacking.


Study of seniors identifies attitudes, barriers to promoting their health. What information and skills do older persons need in order to enhance their health? What obstacles stand in the way of promoting their health? One way to find out is simply to ask them, as the Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services, did in a study undertaken as part of the Health Promotion and Aging Initiative sponsored by th Public Health Service nd Administration on Aging. Following are excerpts from an executive summary of "Aging and Health Promotion: Market Research for Public Education," a report of a research study that involved 15 focus groups of persons aged 58 and over, as well as a review of data on the media habits and the demographic characteristics of older Americans. The study, which was undertaken to serve as the basis for recommendations for national action, also offers insights that should be useful to program planners interested in meeting the needs and capturing the interest of older persons.


A child psychiatrist's observations on care of the mentally ill in the People's Republic of China. In April, 1983, I was a member of a delegation from the American Academy of Child Psychiatry invited by the People's Republic of China to visit colleagues and study facilities in the Chinese nation. I toured six cities and visited a considerable number of hospital facilities, schools, and other special settings for youth. The experience was culturally and professionally broadening and I am pleased to share it with readers of The Psychiatric Hospital. Prior to my visit I familiarized myself with the limited literature covering child and general psychiatry in the People's Republic of China. A list of suggested readings appears at the end of this article.


Psychiatric malpractice: some aspects of cause. The legal concept of malpractice is rooted in the issue of negligence. Liability and duty are related matters which bear on the doctor-patient relationship. The quality of the doctor-patient relationship appears to be the crucial factor related to the emergence of malpractice claims in general medicine and surgery and also in psychiatry. Two methods for assessing negligence are described and their limitations discussed. An alternative concept of a "malpractice threshold" is proposed. This threshold is derived from the arithmetic product of two variables (risk and doctor-patient rapport) which, when exceeded, triggers a patient response in the form of a lawsuit. Brief clinical examples are provided. Review of a large number of psychiatric malpractice cases may permit quantification of these variables. The identification and study of such factors is a rational step toward the prevention of incidents which may give rise to claims of malpractice.


When and when not to join a PPO.

When and when not to join a PPO.


Health-care association adopts new name, image.


Construction regulations: new approach required. The growth in the number of psychiatric beds has continued unabated since the passage of Medicare and Medicaid, and trends indicate further development will occur. While freestanding facilities have grown in number, a greater degree of growth in beds has occurred in the medical/surgical environment where psychiatric patient units have been developed or have been converted from other purposes. In regulating these different types of psychiatric facilities, most states have adapted regulations from those developed by the Department of Health Education and Welfare (now Health and Human Services) that apply to medical/surgical hospitals. The result is often a situation where important distinctions between patient populations are ignored or patient needs are overlooked. Some more progressive states have developed regulations that are independent of HHS' requirements. The authors have found that even in those states where separate regulations exist, the unique needs of psychiatric patients may not be met.


Environmental impairment in the hospital: assessing the risks.


The duty of hospitals and hospital medical staffs to regulate the quality of patient care: a legal perspective.


Nursing homes: a business growth opportunity.


Health planning and antitrust law: the implied amendment doctrine of the Rex Hospital case.


Respite care and the therapeutic recreator. Respite care provides temporary relief to families who maintain their handicapped child at home. With the recent interest and growth in respite care, therapeutic recreators need to consider the role they may play in providing this type of service. The paper examines the various models of respite care currently in use, and considers the function of therapeutic recreators in such settings.


Analyzing program cause as well as effect: a methods for program analysis. Measuring the impact of therapeutic recreation services appears to be a major concern in the field. While effects and outcomes are of primary importance in determining service delivery impact, of equal importance is the documentation and evaluation of the intervention program presumed to cause the effect. Very little attention has been directed toward methods of analyzing intervention programs prior to attempting research studies which search for cause and effect relationships. Additionally, within research studies which purport to measure service delivery impact and effect, very little information tends to be given on the nature and structure of the intervention program that supposedly led to such effects. Thus, the Program Plan Description Form is presented as a method of program analysis to aid in the applied research process of analyzing the impact of therapeutic recreation service delivery programs.


Code of Ethics--National Therapeutic Recreation Society.


National Council for Therapeutic Recreation Certification--certification standards for therapeutic recreation personnel.


The effect of refreshments on attendance at recreation activities for nursing home residents. Activity directors must recognize variables which increase patient involvement by nursing home residents. Refreshments are one variable which can be used to increase the attendance of the aged at recreation activities. This study was conducted to determine if refreshments had an effect on attendance at recreation activities for residents requiring various care levels and in different activities in a nursing home. The mean attendance at activities when refreshments were provided was compared to the mean attendance at activities when refreshments were not provided for three resident care levels. A paired-comparison t-test indicated refreshments were effective in increasing attendance at activities for residents at all competence levels. These results will be helpful to activity directors who may desire to increase attendance.


Issues in continuing professional competence of therapeutic recreators. Entry level knowledge and skills of professionals become outdated with technological advances and the accumulation of practical skills. Participation in programs offering continuing education units (CEU's) has been the most widely accepted way to combat the obsolescence problem and to document life-long learning. However, research has yet to establish improved service delivery as a result of practitioner involvement in such training programs. Credentialing requires reliable and valid measurement of competence over one's professional life. Therapeutic recreators have yet to present a definitive "scope of practice" or to determine the "half-life" of those competencies believed fundamental to practice. The field of therapeutic recreation is void of research on quality assurance alternatives. Thus, there appear to be unresolved issues regarding therapeutic recreators' needs to maintain their professional competence throughout their careers.


Medical record productivity standards: one hospital's response.


Proposed uniform patient Health Care Information Act.


On-side ambulatory medical records: a medical and management information system.


Difficult management issues that resist bandaid solutions.


Filing equipment alternatives for medical record storage.


The transition from director of the medical record department to hospital administrator.


My reincarnation as a hospital administrator.


The burgeoning home health care market: assessing your options.


A home health care story. Miz Lizzie.

A home health care story. Miz Lizzie.


Marketing home health care.

Marketing home health care.


Is hospital-based home care for you?

Is hospital-based home care for you?


Hospital hospice goes home.

Hospital hospice goes home.


Reducing the cost of health care capital. Although one may ask four financial experts their opinion on the future of the hospital capital market and receive five answers, the blatant need for financial strategic planning is evident. Clearly, the hospital or system with sound financial management will be better positioned to gain and/or maintain an edge in the competitive environment of the health care sector. The trends of the future include hospitals attempting to: Maximize the efficiency of invested capital. Use the expertise of Board members. Use alternative capital sources. Maximize rate of return on investments. Increase productivity. Adjust to changes in reimbursements. Restructure to use optimal financing for capital needs, i.e., using short-term to build up debt capacity if long-term financing is needed in the future. Take advantage of arbitrage (obtain capital and reinvest it until the funds are needed). Delay actual underwriting until funds are to be used. Better management of accounts receivable and accounts payable to avoid short-term financing for cash flow shortfalls. Use for-profit subsidiaries to obtain venture capital by issuing stock. Use product line management. Use leasing to obtain balance sheet advantages. These trends indicate a need for hospital executives to possess a thorough understanding of the capital formation process. In essence, the bottom line is that the short-term viability and long-term survival of a health care organization will greatly depend on the financial expertise of its decision-makers.


Revisions in DWI statute.

Revisions in DWI statute.


Film satisfies community interest.

Film satisfies community interest.


Quality assurance may need a change of name.


Hospitals' quest for financial success is elusive, but not impossible. As the hospital industry moves from a heavily regulated, cost-reimbursed payment system to a less-regulated, at-risk payment system, the financial and business acumen of boards and management will become increasingly important in the quest for adequate capital. This article discusses ways of reducing the need for, and increasing the supply of, debt and equity capital.


Nurse practitioners fill primary care giver gap.


Developing dietetic in-service programs.


Going into a hospital? Stick up for your rights.


VA develops guidelines for appropriate staffing.


Protocols seek most effective use of scanner's diagnostic potential.


Allied roles seen best left to experience.


Perspectives. Practice style: key to health care costs?


Perspectives. Withholding treatment--who should decide?


Perspectives. Uncompensated care: paying the price.


The medical-industrial complex: debate.

The medical-industrial complex: debate.


The choice of strategic alternatives under increasing regulation in high technology companies. The strategic response of U.S. high technology companies in the medical X-ray manufacturing industry to increased governmental regulations from 1962 to 1977 is examined. Results suggest that regulations increase consumer and competitor uncertainty, with the consequence that firms select less risky strategies and decrease the riskier new product invention strategy. Larger firms reduce inventions less than smaller firms.


Evaluating the management journals: a second look.


Research on the use of art therapy in a university setting.


The decision is yours.

The decision is yours.


To afford high-quality health care, technology assessment is a must.


The Center for the Well-Being of Health Professionals.


A counseling group for nursing home residents.


When someone dies in the hospital: the family point of view.


Violence is a medical problem, asserts physician from CDC.


The Flying Physicians Association.

The Flying Physicians Association.


NSW in frontline of Medicare row.

NSW in frontline of Medicare row.


Trends in medical malpractice insurance.


WA health service to be restructured.

WA health service to be restructured.


Get well messages. The holidays are over but the spirit continues.


Hospital seeks to please the palate.

Hospital seeks to please the palate.


Action agendas make better meetings.

Action agendas make better meetings.


DRGs help trace revenue sources.

DRGs help trace revenue sources.


Public domain computer software can save many hospitals up to 20%.


Agencies use education more than regulation to lower X-ray exposure.


Mammography. Part 1: Physical principles. In this final part of a two-part article, fundamental imaging principles are related to the design features of mammography equipment, to give readers information helpful in making equipment decisions and selections.


Proposed halt of federal funds for hospital building strongly resisted.


Consultants say supervisors can make or break an anti-union effort.


AMI pegs hospital targets, renews aggressiveness in acquisition game.


AHA board fears unknowns; resisting competition bills. Interview by Sheila L. Simler.


ACHA hatches $3 million program to implement its new four-year plan.


Trustee group affiliates with hospital association.


Hospitals' on-campus M.D. office buildings increase hospital use.


Bourque in, Willging out in shake-up at HCFA.


Heart implant gives life to new payment issues.


Consumers aren't keen on sacrifices.

Consumers aren't keen on sacrifices.


Problem of 3 separate kitchens also provides opportunity for varied meals.


Indigent care hobbles financings.

Indigent care hobbles financings.


IBM grabs for mid-size hospital market.

IBM grabs for mid-size hospital market.


Trustee swap knits hospitals together.

Trustee swap knits hospitals together.


Price increases recede to inflation rate.


Alternative services. 75% of hospitals offer alternative care to meet consumer demands.


Lab tests the reference business.

Lab tests the reference business.


Hospital advertises cost comparisons to impress employers, physicians.


Information at your fingertips.

Information at your fingertips.


Argentina. Strongly articulated, brightly colored emergency hospital.


Australia. Hospital divided into 'factory, hotel, and street'.


Surinam. Vaulted 'lungs' cool a hospital in a tropical climate.


A code of ethics for ASIS.

A code of ethics for ASIS.


Informational/educational needs in rural intermountain communities.


Accident and health premiums 1983.

Accident and health premiums 1983.


Appendix D to hospital resources document. Air ambulance operations. Committee on Trauma, American College of Surgeons.


Appendix C to hospital resources document. Interhospital transfer of patients. Committee on Trauma, American College of Surgeons.


The management of trauma: imperatives for hospital cost containment.


Toward optimal trauma care.

Toward optimal trauma care.


Appendix G to hospital resources document. Quality assessment and assurance in trauma care. Committee on Trauma, American College of Surgeons.


Insured maximum mortgage amount for hospitals--Office of the Assistant Secretary for Housing. HUD. Proposed rule. The Department proposes to modify its regulations governing the maximum mortgage principal amount that it will insure for a new or rehabilitated hospital. Under its existing regulations, the Department can insure a mortgage in any amount that does not exceed 90 percent of HUD's estimate of the replacement cost of the hospital (including major movable equipment). Under the proposal, however, the loan to replacement cost ratio would vary for insured mortgages on projects where the replacement cost exceeds 100 million dollars. In essence, the mortgagor's equity requirements would be required to increase as the principal obligation sought to be insured increased. This proposal is intended to (a) mitigate the possibility of large-scale defaults in future years; (b) ensure the long-term adequacy of the Department's insurance fund, and (c) avoid undue concentration of insurance commitments in a relatively small number of projects.


Health maintenance organizations; basic health services; exclusion of in vitro fertilization--HRSA. Notice. This notice of a decision by the Director, Office of Health Maintenance Organizations (OHMO), to allow federally qualified HMOs the option of excluding in vitro fertilization from the basic health services they are required to provide their members.


Mortgage insurance requirements for private and public hospitals--Office of the Assistant Secretary for Housing--Federal Housing Commissioner. HUD. Proposed rule. The Department proposes to amend its regulations governing the insurance of mortgages for hospitals in two significant ways. First, this rule would provide for the eligibility of public hospitals to obtain federal mortgage insurance for rehabilitation or new construction. This revision comports with recently enacted legislation. Second, the rule would contain new provisions designed to protect the Department's General Insurance Fund with respect to the insuring of projects that would otherwise pose and added insurance risk. The Supplementary Information section of this preamble invites comment on alternative proposals that would achieve this latter goal, while permitting hospitals to obtain needed financing. The Department's final rule will reflect its consideration of public comments received, as well as the feasibility of implementing any of these alternative programs.


Brokered partnerships: a new way to cap health costs.


Malpractice rates increase for hospitals.


Cost of benefits continues to rise. Higher health care costs lead increase, according to survey of U.S. employers.


Risk management checkup. Health care changes demand action.


Checklist shows the role of a hospital risk manager.


R. vs Nomm: testing the boundaries of medicine and other healing professions.


What lawyers look for in patient records.


Is trial by jury your best option in malpractice suits?


Interdisciplinary approach to cardiac rehabilitation in a university setting.


A residency program in community pharmacy practice. As pharmacists increase their involvement in patients' drug therapy, the lack of opportunity for advanced clinical and administrative training becomes more critical, particularly for community pharmacists. To assist in the postgraduate development of community pharmacists, the faculty of pharmaceutical sciences at the University of British Columbia began a residency program in community pharmacy practice in June 1981. Modeled on the successful hospital pharmacy residencies, the program goals are to provide advanced clinical training in ambulatory patient care, and detailed and practical management training, and to develop pharmacists with skill in clinical teaching who will participate in the undergraduate programs of the faculty. The 12-month residency includes guided self-study and a series of practica in areas of therapeutics, management, drug information, clinical and teaching skill, professional service, and continuing education. These practica are served mainly in clinical practice settings such as community pharmacies, clinics, physicians' offices, and teaching hospitals. The residency has demonstrated its value and viability. Growing interest in such programs, and the success of this program in particular, should encourage the development of similar programs in Canada.


Prescription pricing across Canada (Part II). The first of a two part article entitled "Prescription Pricing Across Canada" appeared in the June issue of CPJ. The article was prompted by recent press reports of a prescription drug study commissioned by the Saskatchewan government, and the consequent attention-getting headlines. The first article dealt with the Western provinces. The second part discusses prescription pricing in Ontario, Québec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland, and the Northwest Territories.


The Copperweld case: antitrust considerations in hospital/home health agency relations.


Boston VNA: learning the dinosaur lesson.


How vital are the VNAs?

How vital are the VNAs?


Medical quackery: a national scandal.

Medical quackery: a national scandal.


Ethical challenges of the movement for home care.


Negotiating today means survival tomorrow: a home health care affiliation model.


The social worker in home health care.

The social worker in home health care.


CHANS of Camden County, New Jersey: "doing more with less" for 80 years.


Bereavement counseling in groups.

Bereavement counseling in groups.