Should you have an internal consultant?

Should you have an internal consultant? During the past 10 years, quietly, without much fanfare, between 250 and 500 organizations have developed an internal consultant function. Many of these consultants play similar roles to the ones traditionally played by external consultants such as troubleshooting, advising the CEO, analyzing research, and implementing new programs. Because the internal consultants can respond rapidly to organizational needs and are immediately accountable to the CEO, these functions have been successful so far. There are, however, according to this author, who has surveyed 200 internal consultants and personally interviewed many of them, areas where an external consultant still works out better. In the main these are the politically sensitive areas where an internal consultant's credibility can be too easily damaged. The author discusses other aspects of the problems that surround the internal consultant, the controversy about the merits of the outsider versus the insider, and ends his article with some guidelines for developing an in-house function.


Much ado about mentors.

Much ado about mentors. An international management firm conducted a study of executives that included questions regarding compensations, personal data, and current position. It was of special interest to determine the effect of mentor and protege relationships on business careers. Of the individuals surveyed, two-thirds reported a relationship with a senior person who took a special interest in their career, during the first five years of their professional development. In general, executives who had a mentor are better educated, earn more money at an earlier age, more apt to follow a career plan and report high job satisfaction. The majority of sponsors are older businessmen holding positions of authority and who feel that personnel development and management succession are key responsibilities. The following characteristics of a mentor are judged most important: willingness to share experiences, knowledge of the organization, organizational power and respect from peers. Mentor-protege relationships frequently develop into lengthy friendships which in turn encourage young executives to eventually sponsor their own proteges.


The hidden messages managers send.

The hidden messages managers send. If a manager in an organization talks about making an "end run," what is he saying? Is he seeing life in the organization as a game; is he seeing it as hazardous and maybe nominating himself for a hero role; or is he merely saying he's going all the way with a project, regardless. The truth is we don't know what he's saying. It is all too easy both to interpret the metaphors others use to fit out own meanings and to ignore the fact that metaphors have idiosyncratic meanings that should be listened to. The author describes three ways managers convey messages about themselves and the ways they see the world. He encourages the reader to see these ways--their metaphors, office settings, and body language and tones that accompany their speech--as means of communicating. Just as speech or mathematics, these are languages that can be learned. With skill in them, a manager can see or hear what is really going on when people talk, what hidden messages we are sending all the time. The author gives some hints on what to look and listen for in trying to understand others, but he warns against simplistic interpretations: all messages occur in context.


Leadership: sad facts and silver linings. The typical CEO has endless interruptions and limited options for action. In addition, he may not even hear about his choices, or any bad news that might require action, until it is almost too late. Finally, any decision he does make will probably require months or years to implement fully. This author suggests that this gloomy picture has another side. In fact, each of these "sad facts" of managerial life can be turned into an opportunity to communicate values and to persuade, and they add up to a new notion of the chief executive's function.


The organisation of holiday relief: a pilot scheme to support families caring for dependants.


The integration of health and social services--the Northern Ireland experience.


Notes for students: data routinely collected in a medical records department.


A BSc level option in biomedical electronics.


Planned preventive maintenance: drainage and sanitation for hospitals and other buildings.


Hospital risk management.

Hospital risk management.


Hospital design philosophy for the 21st century.


Steam humidifiers--their use and application.


Security for a library.

Security for a library.


Discharge planners prepare for fuel shortage problems.


Special update: antibiotic review.

Special update: antibiotic review.


Tips for reviewing blood usage.

Tips for reviewing blood usage.


An administrative philosophy toward the concept of materiel management.


Administrative reporting--the necessary elements.


Gaining administrative support and respect.


Carrels for two libraries.

Carrels for two libraries.


Carpet for two libraries.

Carpet for two libraries.


The management of change: an overview of the transition process.


Moving two libraries.

Moving two libraries.


Getting results from your materiel manager.


The materiel manager: a member of the administrative team.


Evaluating the effectiveness of the materiel management effort.


Administrative considerations in the selection of a materiel manager.


Materiel management by objectives.

Materiel management by objectives.


What did accounts payable do with that great deal you negotiated?


Avoiding hide-and-seek in the storeroom.


The role of materiel managership in property (asset) management.


Application of the prudent buyer principle to purchasing administration.


Effective determination of patient charges.


The receiving process: a key to effective materiel management.


The age of accountability and hospital inventories.


Hospital procurement and illegal price discrimination.


To lease or not to lease.

To lease or not to lease.


Materiel interfaces with financial management.


Total centralized purchasing: can it ever by achieved?


Point of view: role of the materiel manager in the budgetary process.


Getting hospicized.

Getting hospicized.


Selecting a new residency.

Selecting a new residency.


The art of persuasion: logic and language in proposal writing.


The research grant application: an exercise in scientific writing.


The National Cancer Institute and its redefined mission.


The research grant budget: preparation and justification in relation to the proposed research.


The institution of administrative change in the home health service agency.


Public cancer education.

Public cancer education.


The successful promotion of behavioural change and increase in knowledge by means of active participation in a 'Look After Yourself!' exhibition.


Team care: solution for hospital oncology units? Team care promises improved patient care through improved coordination of existing hospital services, as well as continuity of care for the patient between the hospital and the home. Commitment to the team concept, however, calls for more than lip service.


Point/counterpoint: declining public health organizations--will management make a difference? Time is running out for public health organizations, says Charles Harper. Their traditional role in the health system is eroding rapidly. To reestablish the place they deserve in the health system will require an aggressive and united effort on the part of all public health professionals. As a counterpoint to Harper's article, Donald Smith asserts that the decline is a result more of a negative image and changing standards than of managerial problems.


Academic health science centers: headed for rougher times?


Resource requirements for health care organizations. Decisions regarding resource requirements are often based on single-factor decision rules. Although the use of such rules will simplify the decision process, these rules ignore the multiple consequences of each decision. Instead the health care administrator should base a decision on the mix of performance promised by a given resource decision.


Dimensions of professional development: the case for health administration. Can someone be prepared to be a specialist and then be expected to assume general leadership roles? Should the general leadership role be abandoned by administrators and left to the medical profession? These are some of the questions that must be considered in order to meet the education needs of health administrators.


The behavioral sciences and physicians' concerns. Although behaviorial scientists have become more involved in health care settings recently, their impact has been less than desired. An inadequate understanding of individual physicians' concerns has contributed to this situation, and improved insight into physicians' lives might benefit behavioral science work in health care settings.


HCMR interview: Gail Warden. Interview by Monty Brown.


How reasonable is reasonable?

How reasonable is reasonable?


How practical is the method?

How practical is the method?


Physician contracts.

Physician contracts.


How to develop or buy a computerized financial planning model.


Management study sets medical records performance standards.


Discounted coefficient: best way to evaluate capital expenditures.


A closer look at HEW's accusation. Waste not, want not?


Relating costs to charges: analyzing 3 labor/delivery services.


Ways need to be developed to expedite hospital admissions, discharges.


Hospital and donor both benefit from deferred gift.


Cost counsel: saving a "buck a day".

Cost counsel: saving a "buck a day".


The hospital--will it survive?

The hospital--will it survive?


Payment patterns: health care facility operations.


The positive side of conflict.

The positive side of conflict.


Satisfy your need to know.

Satisfy your need to know.


Planning strategically.

Planning strategically.


Personnel accountability: key to effective management.


Violence: teaching staff to cope.

Violence: teaching staff to cope.


Making changes.

Making changes.


Take time to make time.

Take time to make time.


Let employees solve your problems.

Let employees solve your problems.


Resistance to safety: what can be done?

Resistance to safety: what can be done?


To hire or not to hire.

To hire or not to hire.


The high cost of working dangerously.

The high cost of working dangerously.


Keep the record straight.

Keep the record straight.


The everyday problems of discipline and grievances.


A computerized system to schedule nurses that recognizes staff preferences.


Human resources accounting system and productivity monitoring.


Finding inefficiencies: an operations audit model.


Renew your career--take a sabbatical.

Renew your career--take a sabbatical.


The public stake in shared services: some political considerations.


The movement toward multi-hospital arrangements in Michigan.


Replacement cost accounting: an alternative to price level indexes.


Family practice finds a home in the hospital. A brief description of the growth of family practice over the past 10 years into what is now a major specialty leads into a discussion of the implications of this development for hospitals. A fundamental shift of emphasis to family practice in medical education has already occurred and hospital departments of general practice, traditionally administrative in character, are being reorganized into clinical departments with responsibility for assigning privileges and administering educational and peer review programs.


Court affirms physician's choice of abortion procedure. In Colautti v. Franklin the U. S. Supreme Court threw out those portions of a Pennsylvania statute making physicians criminally liable for performing abortions of a "viable" fetus except to preserve the health of the pregnant woman and, in such a case, requiring physicians to use the abortion technique offering the best opportunity for the fetus to be aborted alive. The U.S. Supreme Court has consistently recognized the principle that physicians should be free from government interference in their exercise of professional judgment regarding treatment of women seeking abortions.  That principle was once again reiterated in a decision in the Colautti vs. Franklin case.  This decision dealt with the Pennsylvania Abortion Control Act, passed in 1974, which made physicians criminally liable for performing abortions of a "viable" fetus except to preserve the life or health of the pregnant woman and, in such cases, required physicians to use the abortion technique most likely to result in the birth of a live infant.  Argument was presented that the statute's viability and standard-of-care provisions were unconstitutionally vague.  The Court found the statute at fault in that it did not take into account intention of the physician in attributing criminal liability.  Medical testimony showed that, although saline instillation is nearly always fatal to the fetus, it is the safest and most effective 2nd-trimester method for the mother.  The Court found that the Pennsylvania law was unclear as to the prime duty of the physician: to the fetus or to the woman.  The Court decision leaves both determination of viability and method choice up to the physician.


Health promotion--keeping people out of the hospital. Health promotion is finding a place in the community hospital. This article discusses the need for commitment to health promotion as an ongoing program and not a publicity campaign. Examples of successful programs, principles of good practice, and the benefits of providing the community with information are presented.


A blueprint for medical staff consolidation. Consolidation of the medical staffs of merging hospitals must be considered separately from the corporate merger, and the organizational framework combining the staffs must be carefully planned. A participant of a recent merger outlines the mechanism through which two medical staffs established common principles of consolidation, separately enacted identical bylaws, developed a cross-credentialing procedure, and instituted a transitional organizational framework.


Physicians join in efforts to reduce risks. Four risk management programs, recently coordinated on a hospitalwide basis by a risk manager or risk management committee, stress the importance of a multidisciplinary approach to risk identification and reduction.


LCCME opts to continue accreditation process. The remaining members of the Liaison Committee on Continuing Medical Education have decided to continue accrediting continuing medical education programs despite the withdrawal of the AMA from the group. The LCCME will be staffed by the Council of Medical Specialty Societies and will focus its accrediting program on the national level.


Assessing antibiotic usage in a community hospital. Data from a study of aminoglycoside prescribing patterns at a community hospital resulted in the hospital infection control committee issuing recommendations that were subsequently approved as standard medical practice. These data and recommendations are presented in full.


Physician rights and selective closed staffs.


Intravenous infusion pumps: a P&T committee concern.


The career cycle.

The career cycle.


Pharmacy services in a 240-bed Gordon Friesen-design hospital. This article describes a typical Gordon Friesen-design institution in which the facility design and systems design complement one another to make an efficiently run hospital. The basic concepts of the hospital are to keep the nurse with the patient and to maintain a steady supply flow by centralizing responsibility for materials. Problems that occur in pharmacies of facilities designed by Friesen usually are related to logistics. The design of the institution make delivery of medication and communication with staff nurses more difficult. Pharmacy programs such as unit dose and intravenous admixtures, excellent examples of products in "patient-ready units," complement the other supply delivery systems that are typical of a Friesen-design institution. Good written and verbal communications between nursing staff and pharmacy can bring about a smoothly flowing pharmacy service that blends with the overall concept.


New revenue and improved services in handling ambulatory radiology patients. In 1978, the Pharmacy Department at the University of California, Irvine, Medical Center succeeded in establishing a procedure whereby all drugs used for outpatient radiology procedures were dispensed from the pharmacy and were no longer handed out by radiology clerks. Additional revenue was generated for the medical center because the pharmacy started to charge patients for the drugs, which had not been done previously. This was accomplished with no increase in personnel. The procedures have been operating successfully for six months.


Locked medication drawer in each patient's room.


Medication drawers in each patient's room.


A simple systems model for community programs. A simple model for general application to the planning and evaluation of community programs is presented. It is based on a systems approach and consists of seven procedural steps: overview, need assessment, goal-setting, resource organization, action, reviews, and outcome statements. Feedback information is used to correct and improve system performance. Two examples of the model in use are given to illustrate both its application and its generality. These concern the management of individual patients in a community-oriented psychiatric ward program and the organization of a comprehensive community development project. The feature common to these applications is the ability of the model to reduce complex endeavors to a few manageable steps, with no loss of comprehensiveness.


Mental health treatment and referral practices of clergy and physician caregivers. Consistent with previous literature, the results of a detailed survey mailed to clergy and physicians from a community known for its longstanding, excellent mental health system indicated extensive treatment and referral of mental health problems by clergy and physicians. Clergy and physicians, though, displayed very limited knowledge of mental health services and personnel, particularly innovative approaches and workers. Receiving mental health training was identified as a key factor, particularly for physicians, in terms of knowledge of services and personnel, referral to a mental health center, and treatment of serious mental health problems. Strategies were, therefore, outlined to provide more accurate information to this natural treatment and referral system.


An evaluation of traditional and alternative mental health facilities. Traditional mental health facilities were compared with alternative mental health facilities on their response to a crisis situation. Over one-third of the total sample of facilities (n = 50) did not respond with any help. Alternative facilities gave more direct counseling than did traditional facilities, indicating the particular suitability of alternative facilities for crisis intervention.


A community mental health accountability scale. An Accountability Questionnaire was administered to administrators, service providers, and board members of 50 community mental health centers. The results, using cluster analysis techniques, yielded an Accountability Scale of 22 items. Four clusters with satisfactory discriminative validity were extracted: (a) Importance of Program Evaluation; (b) Satisfaction with State Monitoring Procedures; (c) Traditional Clinical versus Community Psychology Concerns; (d) Agency Preservation versus External Accountability. Analyses of variance indicated that board members, staff, and administrators differed significantly in their scores on each cluster. The Accountability Scale is a potential tool for community mental health agencies in assessing intraorganizational attitudes concerning accountability and has implications for administrative planning and evaluation.


Role perceptions in a community mental health setting. The increasing trend of utilizing nonprofessional personnel in community mental health has led to considerable controversy. It is suggested that studies comparing the relative competence and efficacy of professional therapists to that of nonprofessional therapists may be counterproductive and in need of augmentation. The present study employed a role perception procedure in which members of three different randomly chosen groups (11 professional therapists, 11 nonprofessional therapists, and 11 children-clients) from a community mental health program were asked to rank various aspects of the therapeutic relationship in order of importance to the children-clients' improvement. It was hypothesized that (a) due to their relatively low self-concept, nonprofessionals would underestimate their own role importance in comparison to that of the professionals; (b) professionals would overestimate their own role importance; and (c) children would selectively value certain aspects of each role without preferring one over the other. The last two hypotheses were supported, but the first hypothesis was not: nonprofessionals, in fact, showed the highest level of overestimation of their own role importance. A further analysis of the data showed that inexperienced nonprofessionals did not overestimate their own role performance. This suggested specific training procedures for nonprofessionals.


Assessment of paraprofessionals' on-the-job performance in an outpatient child guidance clinic. On-the-job performance of paraprofessional and professional staff of an outpatient child guidance clinic were compared in three respects: (a) ability to do intake interviewing, (b) maintain case records, and (c) collect research data for a therapy outcome study. Data indicated that paraprofessionals performed as well as professionals on each job activity, and suggest generally that paraprofessionals can adequately perform the various tasks assigned to them.


Program evaluation/quality assurance: a waste of time?


Development of a nurse aide screening instrument.


Firesafety evaluation system for health care facilities.


Rock'n Roll Jamboree: a testimonial.

Rock'n Roll Jamboree: a testimonial.


Designing the open nursing home SSI fact sheet.


Rock'n Roll Jamboree: $1,000,000 worth of fun.


Responding to calls for nursing home reform.


President Demisay's symposium speech.

President Demisay's symposium speech.


Managerial analysis and decision-making in outpatient health clinics.


The allocation of specialties to hospitals in a Health District.


Boards of inquiry in health care disputes: new options for the parties.


Periodical prices: 1977-79 update.

Periodical prices: 1977-79 update.


A productivity profile . . . guidelines to productive management.


Manager tells how to operate a successful laundry facility.


Hospital director suggests ways to contain health care costs.


Podiatrists: pushing for equal rights on the medical team.


Why Congress' deregulation mood doesn't apply to doctors.


Electric typewriter: Adler SE 1000 SC.

Electric typewriter: Adler SE 1000 SC.


General surgeons less busy, but still high earners.


The Kennedy liberal with a big voice in your future. Interview by Richard L. Peck.


Why catastrophic health insurance is going nowhere.


The night we worked through hell.

The night we worked through hell.


Group-practice jobs: suddently it's a buyer's market.


Internists: nearing an economic crossroads.


Radiological health.

Radiological health.


Microform storage in libraries.

Microform storage in libraries.


Regional variations in hospital stay: a preliminary view of causes.


Electric typewriter: Royal SE 5000 E.

Electric typewriter: Royal SE 5000 E.


The two-plus-two concept in the preparation of health record professions.


Misleading mortality rates in medical audit studies.


Health record professionals and prison health care. Interview by Jack A.N. Ellis.


The effects of reporting accuracy of entries in residents' personal files.


GAO rejects MAC, prime vendor; urges price talk by purchasers.


Suppliers, hospitals told to disclose common bonds.


Hospital Corp. members to consider vendor cutbacks.


Biofeedback: a feast ahead in hospital and home care markets?


The hospital market: its growth and the future.


Two big New York hospitals merge to stay out of red.


Living--and dying--by the dinosaur principle.


Malpractice demon stirring again.

Malpractice demon stirring again.


HEW targets 61 cities for HMO expansion in '80s.


Physicians riled by New York State's hospital computer.


Second thoughts on CME: it's mandatory for many, but who benefits?


First male volunteers at Grace Hospital love their work.


The hospital's obligation to protect patients from carriers of infectious diseases.


Dilemmas of dying.

Dilemmas of dying.


U.S. congressman spends a day as a nurse aide at Port Huron Hospital.


How to handle a deposition: a primer for defendant doctors. Depositions constitute an important element in any malpractice trial and, as such, must be understood in their full dimensions by physicians and others in the medical profession. The author gives a working definition of deposition and enumerates the preparations necessary for giving a deposition.


Avoiding malpractice claims through better hospital management. Within the control of hospital management is the capability of reducing malpractice claims through better employee and patient communications. Promises of successful treatment, billing charges and medical procedures that are unexplained, unfamiliarity of hospital management with what constitutes hospital liability, and wrong use of informed consent forms are among the factors that increase chances of bein sued for malpractice.


The trial of a malpractice case: Part one. The following discussion was presented by the late Mr. Levine, one of the country's most successful malpractice lawyers, during a series of lectures on medical malpractice. It is an invaluable, no-holds-barred introduction for administrators, risk management directors, physicians and attorneys to the real world of malpractice litigation.


Might the health care industry function as if it were a regulated public utility?


DRG: another way to reimburse costs.

DRG: another way to reimburse costs.


Hospital and medical care for the special patient: minimizing malpractice while improving service. The physically, emotionally, or otherwise handicapped child or adult presents special problems to physicians, hospitals and health workers--especially in the early years. Poor medical practice and lack of communication expose hospitals and professionals to greater malpractice risks when dealing with these patients than encountered with average patients.


Doctor, will you please testify!

Doctor, will you please testify! A special problem exists for the plaintiff's lawyer in most malpractice cases--obtaining expert medical witnesses. The authors explain how this can be done and offer a detailed outline for bringing the process to a successful conclusion. In addition, the article gives prospective defendants and their counsel insight into what can be expected when a case comes to trial.


The human dimension.

The human dimension. There has long been a correlation between the degree of anger of the patient towards his physician or hospital and the filing of a malpractice suit. The following article, reprinted from the Report of the Secretary's Commission on Medical Malpractice. DHEW, presents a comprehensive review of the human factor as it relates to medical malpractice. Providers and their attorneys wishing to obtain the complete two-volume report should write to DHEW in Washington, D.C., referring to publication number OS73-88.


An NHI alternative.

An NHI alternative.


The leading causes of hospital admission in the United States in 1977.


Local group OKs health care 'action plan'.


Videomicroscopy: system design and equipment assembly for resident teaching and interdisciplinary conferences. The author of this article, sharing the experience his department has had with its videomicroscopy system, explains what the advantages, and disadvantage, of the system are and what is involved in purchasing and assembling the equipment.


Television microscopy for education and consultation in pathology via coaxial cable, laser beam, and COMSAT satellite. In this article, the author describes how the closed circuit TV microscopy system used at The Johns Hopkins Medical Institutions facilitates discussion and diagnosis in consultation and promotes continuing education in, and out, of the institutions. The research, development, implementation, and use of this system at The Johns Hopkins Medical Institutions is supported in part by a grant from The William Penn Foundation and NCI contract NIH-NO1-CB-92172.


Video intercom: O.R. consultation and frozen section with screen display of gross and microscopic findings. Seldom does the pathologist at Saint Barnabas Medical Center, Livingston, NJ, enter the operating room to consult with the operating surgeon. Instead, consultation takes place via an audio-intercommunication system supplemented by video. In this article, the authors explain how and when the system is used, the equipment needed, and the benefits to be derived by pathology residents.


The autopsy: instrument of quality assessment.


Recertification unpopular at the polls.

Recertification unpopular at the polls. In March, the American Board of Medical Specialties approved the American Board of Pathology's multiple pathway proposal for voluntary recertification for pathologists. Just prior to this approval, a Committee Against Recertification in Pathology decided to poll CAP members to find out the consensus of pathologists on the issue of recertification.


Record sharing: a lawyer's viewpoint.

Record sharing: a lawyer's viewpoint.


Sharing records to share the onus for care.


Some practical implications of the Pregnancy Discrimination Act.


Employee theft and organizational climate.


Defining line and staff roles in collective bargaining.


Guidelines to corrective discipline.

Guidelines to corrective discipline.


Evaluating personnel programs through the reversal technique.


Personnel leadership in action: doing something about health care cost containment. It's no secret that health care costs are skyrocketing and will continue to do so unless business, particularly personnel professionals, takes responsibility for containing them. This month, we present a panel report whose participants--ranging from the corporate manager of employee benefits at TRW to the director of public relations at Blue Cross Of Milwaukee--are taking concrete action to improve employee health and company expenses.


Past and current trends in negligence and incompetence arbitration. With the inclusion of the phrase "just cause" in the collective-bargaining agreement, management found itself bound by new and complex limitations concerning discharge for negligence/incompetence. In this study, the author examines a variety of discharge cases, as well as the changing (and intelligent) management attitudes they represent.


Rethinking retirement-age policy in the United States and Canada. More than legislation, the recent amendments to the Age Discrimination in Employment Act also symbolize a growing interest in the older working population, both in the United States and Canada, particularly the question of their "failing" job skills and the effects of retirement age on the economy. Sociologist Rix examines this issue in terms of demographic, economic and biomedical factors, discussing their implications for management, employee counselors, insurance and pension planners, the tax payers and employees of all ages.


The computer: new common denominator in pharmacy practice.


What hospital pharmacists expect from drug wholesalers.


How the computer supports our clinical pharmacy program.


Arizona hospital operates an ambulatory and emergency care center.


Pressure to replace free for service with salaries in hospitals.


Why young physicians locate where they do.


The relationship of health locus of controls to preventive health behaviors and health beliefs.


A manager's guide to organizational change. With the increasing use of consultants to facilitate organizational change, managers need to be better informed about the range of available consulting services. In an effort to help managers better understand the various consulting approaches, Kleiner describes five techniques: "socio-technical systems;" "contingency;" "MAPS;" "Michigan survey feedback," and "process consultation." The author compares these techniques along nine dimensions: assumptions about technology and people; targets; objectives and directions of change; and the data and data collection methods used. While conceding the complexity of these considerations, Kleiner concludes that the benefits of meticulousness and care in consultant selection justify the effort.


The conditions of effective implementation: a guide to accomplishing policy objectives. Although most studies of policy implementation have been very pessimistic about the ability of important statutes actually to achieve their objectives, there have been a few success stories. The authors first identify five conditions conducive to effective implementation and then suggest a number of strategies available to legislative and other policy formulators for overcoming deficiencies in one or more of these conditions.


Issues affecting the medical care delivery system.


Ghana's health administration program.

Ghana's health administration program.


Health care and Puerto Ricans: a consultation and educational program.


The New England Workshop for Health Administrators and Planners. Development of a comprehesive continuing education system.


The information needs of patients with Crohn's disease.


Implications of the new EEOC guidelines. How can employers exercise their right to select employees without running afoul of the new guidelines? Are interviews best? Pencil and paper tests? "Nonrandom selection procedures are inevitable for most jobs," says Dr. Thomas Dhanens, a management psychologist. "Therefore, employers will always be open to charges of discrimination or favoritism from some quarter. Organizations that avoid their responsibility for examining and validating their selection procedures will be forced into a costly catch-up effort before long." The author shows employers how to collect data systematically, analyze job functions, evaluate applicants, record data, handle performance appraisals, maintain records, and identify priorities. Since a lack of data is no defense in an EEOC action, Dhanens suggests that these are the minimum steps wise employers should follow.


Legal precedents in American law for patient education.


The public's concerns about health care and cost implications.


The pay-for-performance dilemma.

The pay-for-performance dilemma. Who was it that talked about how to ruin motivation with pay? Frederick S. Hills digs hard into pay-for-performance programs in a striking excavation of the reasons why pay does not motivate performance. He examines the problematic effects of equity in pay (in terms of both internal wage structure and market surveys), the inflation factor, problems with the basic performance model, and the system of administration of merit pay systems in terms of the salaries of two hypothetical supervisors--one a high performer, the other a minimal performer. And while he raises a number of questions, he also leaves us with possible answers--which we can explore for ourselves. One result may well be significant changes in how organizations view their pay systems--and another may be the development of new approaches. One frequently recommended approach Hills espouses is the use of annual merit bonuses rather than annual merit increases. This way merit dollars can be made more effective.


The role of departmental management in the voluntary effort for cost containment.


Salaries and increments.

Salaries and increments.


Stress strategies for the health care professional--a case of self management.


Community health nursing: population focus and evaluation. A synposis of recent research contributions to evaluation in the field of community health nursing is presented in a framework which distinguishes this population-focused practice from clinical nursing and emphasizes the scientific aspects of community health practice. Systematic need assessment, estimation of target population coverage, evaluation based on outcome, and evaluation based on process represent the four major types of studies discussed. Throughout the paper issues related to the conduct and utilization of the type of research reviewed are considered; the paper concludes with a brief discussion of fruitful directions for future research and ways to foster practitioners' utilization of research.


The emergence of wholistic organization development.


A supervisor looks at human relations.

A supervisor looks at human relations.


Putting a price tag on human life.

Putting a price tag on human life.


Legal commentary: what type of liability insurance should a freestanding center carry?


Lightning protection is also liability protection.


Planning mental health programs for Hispanic communities.


Training the institutionalized elderly in interpersonal skills.


GAO hospital purchasing study.

GAO hospital purchasing study.


Changing hospital practice and social work staffing. If social workers are to survive in hospitals and gain satisfacation from their work, they must begin to find new ways to apply their skills. This article analyzes several factors affecting the health care industry and suggests that staffing a hospital social work department follow a situational rather than a universal approach.


The emergency room.

The emergency room.


International: medical equipment/Japan.

International: medical equipment/Japan.


Shared services, legal structures--a brief history.


Top-down training pays off at Mount Sinai hospital.


Physicians and hospitals--united in a common purpose, responding to common adversaries.


Communicating/marketing nursing education in the larger hospital.


Marketing: a way of life for educators.

Marketing: a way of life for educators.


Hospitals are saving more than lives--the Texas voluntary effort.


Medical staff privileges.

Medical staff privileges.


Fair makes safety fun.

Fair makes safety fun.


What the Pregnancy Discrimination Act means for hospitals. The Pregnancy Discrimination Act of 1978 requires employers to treat pregnant women on an equal basis with other employees according to their ability or inability to work. Regardless of increased costs, hospitals must make the necessary changes in their employment policies and fringe benefit programs to bring them into compliance with the new law.


Cost containment begins at the top.

Cost containment begins at the top. Cost containment must be a policy decision made and closely monitored by the governing board. This report, incorporating suggestions made by participants in the Second Annual AHA Conference on Hospital Governance, focuses on five aspects of the board's responsibility: organizing for cost containment, keeping informed, challenging the administration and the medical staff to do the job, supporting the staff, and serving as public spokesmen on hospital cost containment.


Some keys to working with physicians.

Some keys to working with physicians. Successful cooperative efforts among board, administration, and medical staff are a blend of efficient formal organization and informal personal and professional relationships. Efficient formal organization is an important key to physician participation. Medical staff bylaws frequently can be streamlined to good effect, and the efficiency and productivity of medical staff committees often can be improved.


Trustee development program: using financial and statistical information to monitor operating performance.


To merge or not to merge: it's a question of survival.


Snakes and kangaroos in pediatrics?

Snakes and kangaroos in pediatrics?


Hospital preparedness: when bad winds blow.


Forsyth Memorial turns tide against infant mortality in N.C.


At Southwest Texas Methodist Hospital, black-out test insures readiness.


Mental patients: a "forgotten minority" in U.S.


Study shows counseling uplift for dying patients.


HUD-HEW loan program to aid mentally ill community adjustment.


Antitrust implications of physician suppression of alternative health care providers.


'Burn out' seen severe for MDs caring for children with cancer.


Genetic disease programs and the black community.


Birthplace and attendants: Oregeon's alternative experience, 1977. In October of 1977 an article entitled "Birthplace Alternatives" appeared in the Oregon State Health Bulletin. This article presented a narrative based on facts taken from the data on birth certificates of all births occurring outside of a hospital in the State of Oregon in 1976. Tabulations were compiled to show where the infants were being born, who was delivering them, the educational level of the parents, and the prenatal care given. Insofar as was possible--from complications listed on the birth certificates, information from matched infant death reports, and full term fetal death reports--the outcome of these deliveries was explored. Due to the tremendous response to that article, this update of 1977 data on out-of-hospital births was prepared.


Pediatrics and social services at the King/Drew Medical Center.


Hospital risk management.

Hospital risk management.


Howard University Hospital diabetic clinic: ambulatory care of the diabetic.


Assessing awareness of coronary disease risk factors in the black community.


Health education: relevance to the black community.


Hartford, Connecticut: a prevalence study of folk medical beliefs.


Calling out and calling off the dogs: managerial diagnosis in public service organizations. Decision-makers spend their professional lives identifying situations that merit action. Nutt defines this process of placing problems in action or deferred categories as "managerial diagnosis." It is felt that this is a critical aspect of managerial action because it rests on assumptions that need to be considered in project planning and evaluation. To facilitate future studies of the effectiveness of managerial behavior, a framework of fourteen propositions which describe the process of managerial diagnosis is presented. The author says that: 1) the manager will defer those perceptions where performance exceeds expectations; 2) decision-makers are goaded into evaluation (a process used to measure performance or comparative alternatives) by stimuli such as conflict, uncertain performance, and uncertain expectations; and 3) evaluation findings are deemed acceptable only when they reduce conflict.


Emergency room care mandatory: Louisiana's rape treatment law attacked.


Private firms to run 3 military hospitals.


Medicine: business or charity?

Medicine: business or charity?


Hospital privileges, reimbursement: family MDs bid for equal treatment.


Those self-help groups: "our surgeons are our heroes!".


Medical education in the '80s: upheaval or utopia?


Caribbean transfer students tell story of singleminded determination.


How Baltimore 'rescued' its city hospitals.


Put doctors at risk for patients' bills.


Changing views on CME.

Changing views on CME.


Education for the institutionalized aged.


At U. of Chicago: chaplains serve on the treatment team.


Vietnamese need materials, medicine, and money, says American physician. Interview by Dennis L. Breo.


The productivity triangle. Part 1--in theory.


The productivity triangle. Part 2--in operation.


Butler Hospital, Providence, Rhode Island.


Baldwin Building for Community Medicine, the Mayo Clinic, Rochester, Minnesota.


Center for Preventive and Rehabilitative Medicine, Daniel Freeman Memorial Hospital, Inglewood, California.


Rehabilitating the older alcoholic.

Rehabilitating the older alcoholic.


Designing barrier-free toilet rooms within old & new buildings.


Quarantine unit, isolators in new government policy.


Political snake oil: the hospital cost containment bill is badly mislabelled.


Hale and hearty: Hospital Corp. has its own cost-control methods.


Abortion clinics rush to diversify.

Abortion clinics rush to diversify. There are about 500 public and private abortion clinics in the country.  These clinics still perform most of the estimated 1.3 million abortions annually, but many of them have diversified, offering a variety of outpatient medical services ranging from birth control and prenatal care to sex counseling and fertility help.  Many clinics are diversifying in reaction to the political climate hostile to induced abortion, and which has already placed limits on the use of federal funds for medicaid clients.  Consumers demand also has played a role in developing the newest service: attractively furnished so called birthing rooms, instead of the traditional delivery rooms.


Procedures to minimize medical x-ray exposure of the human embryo and fetus; recommendations for medical radiation exposure of women of childbearing potential--Food and Drug Administration. Proposed rule.


National Institutes of Health--statement of organization, functions, and delegations of authority.


Age discrimination in employment; final interpretations--Equal Employment Opportunity Commission.


Interstate shipment of etiologic agents; proposed rule--Center for Disease Control.


Protection of privacy of individuals: Department of Health, Education, and Welfare--proposed rule.


Final program criteria for screening of applications for grants made by American schools and hospitals abroad (ASHA) program--Agency for International Development.


Proposed interpretations; Age Discrimination in Employment Act--Equal Employment Opportunity Commission.


National Institutes of Health: proposed guidelines for research involving recombinant DNA molecules.


Recombinant DNA research; proposed actions under guidelines--National Institutes of Health.


Association standing to bring lawsuits.

Association standing to bring lawsuits.


Rules on confidentiality, access to records and council factfinding: Council on Wage and Price Stability. Publication of Final Rules.


Disposal of high-level radioactive wastes in geologic repositories; proposed licensing procedures: Nuclear Regulatory Commission. Proposed rule.


Quality assurance programs for diagnostic radiology facilities: Food and Drug Administration. Final recommendation.


The AMA--reports of its death have been greatly exaggerated.


Health focus: a strategy for competition.


Sammons: 'the term "negative" doesn't bother me.'.


Gephardt's rising star is hitched to success in building coalitions. Interview by Richard E. Cohen.


South Shore Hospital...: anatomy of a safety program.


Calif. HMO switches to fee-for-service.

Calif. HMO switches to fee-for-service.


New stance may swing NHI to first base.

New stance may swing NHI to first base.


Health plan charges to climb 8% to 15%.

Health plan charges to climb 8% to 15%.


National health insurance bills: proponents & proposals.


Health care execs promote HMO use to cut down costs.


HMO's will double, peak out in '80s: HEW predictions.


HEW plots HMOs for 61 localities in new promo push.


Employer groups exercise their clout to trim health costs.


Two insurers join hospice care movement.


The gentle pace of a practice in the sun.


Perspectives from tomorrow's therapists. This paper investigates the need for Occupational Therapy to establish a philosophy of its own. Two of the Eleanor CLarke Slagle Lectures, Reilly's of 1961 and Yerxa's of 1966, are examined as being representative of the philosophies of pragmatism and existentialism, respectively. Their philosophical approaches are compared in terms of their relevance to Occupational Therapy. A base is proposed from which a new philosophy could be generated, and a personal philosophy and opinion is stated from a student's point of view.


'Get it together,' or face greater controls.


Legal problems in CS: interview with a lawyer/physician.


Southeast hospitals launch buying group.


Linen conservation: maximizing use by minimizing abuse.


Materials management: what makes it tick?


GAO gives warning on hospital defaults.

GAO gives warning on hospital defaults.


Purchasing plays first-string on AHA's TEAM.


Phyllis Whittome on health care trusteeship.


Are ethics of industry appropriate to medical care?


The hospital lawyer.

The hospital lawyer.


Cost containment starts in your own backyard.


Meeting the challenge of new Hill-Burton regulations.


Hospital financing in Ontario.

Hospital financing in Ontario.


First national conference for health care trustees in Canada.


Le Bonheur Poison Center helps Memphis handle disaster.


Research project shows code deficiencies in many Tennessee hospitals.


Summary of study of task force on two levels of nurse entry.


Motivating pharmacists.

Motivating pharmacists. Although pharmacists are developing interest in many types of pharmacy practice, they are still spending the bulk of their time in the prescription dispensing process. Any effort to provide motivation must consider the prescription dispensing process. The pharmacy literature includes only a few studies that dealt with pharmacists as people. The studies usually showed that pharmacists basically were unhappy with their jobs. In developing a motivational climate for pharmacists, pharmacy supervisors have several concepts to consider: the hierarchy of needs by Maslow; the expectancy theory by Hampton; the gygiene-motivator theory by Herzberg; and the Theory Y management approach by McGregor. Because pharmacists must be induced to enter and remain in an organization, supervisors should be aware of the need to use any technique available in developing a motivational climate.


Pharmacy in family practice: a description and evaluation. Expanded pharmacy functions within a private practice setting are described. These activities are a component of a pharmacy training program. The medical practitioners evaluated the program, eliciting an overall positive response. Additionally, future services were priority rated by the staff, demonstrating more accessibility to the services, patient education, and chronic disease care programs as the most desirable projects. As the Clinic and the medical residency expand, the activities of the clinical pharmacist shall continue to develop.


Reuse of disposable dialyzer units has dramatic effect on dialysis costs.


The performance of foreign pharmacy graduates on the National Association of Boards of Pharmacy licensure examination. Since there is not a shortage of pharmacists, many fear that licensing foreign pharmacy graduates will create an oversupply. Boards of pharmacy are concerned with licensing qualified candidates. Until 1978, Illinois issued the national pharmacy licensure exam to foreign and U.S. graduates. The foreign graduates' scores were consistently lower. A prelicensure exam is needed to evaluate the foreign student's academic background. Foreign students could matriculate into an accredited college of pharmacy for remediation in the necessary areas.


'Deferred giving' programs.

'Deferred giving' programs.


Application of the Food and Drug Administration's current good manufacturing practices regulations to pharmacy practice: a legal view.


Hospital committee to shorten 'length of stay' effects six-figure savings.


Feasibility of symbolic directions on prescription labels. This project presents the results of a study designed to evaluate the usefulness of graphic labels in assisting functionally illiterate patients to understand how and when to take medication. The project's results indicate that comprehension of symbolic directions did not increase as rapidly as comprehension of typed directions. Symbolic directions did, however, reduce the variation in interpretation of directions among patients with 0-4 grade education. Neither age, nor sex, nor the order of label presentation affected level of comprehension of typed or symbolic prescription labels. The results of this study indicate that use of symbols may not be the sole answer to the problem of assisting patients with inadequate reading abilities. Symbolic prescription directions should be evaluated before their use. Then, when used, they should be accompanied by oral reinforcement.


A 'mini-residency' in drug information for the practicing pharmacist. Continuing education "mini-residencies" in drug information services were sponsored by the University of Washington School of Pharmacy's Division of Continuing Education and the University of Washington Drug Information Service (DIS) in August of 1976, 1977, and 1978. Each mini-residency covered a two-week period (a total of 80 hours) and was divided into didactic and experimential sessions. The university's DIS was the major resource for the residents. The two-week residency was designed to provide education and experience in the areas of drug information retrieval, analysis, and dissemination. The program was assessed through pre- and post-testing and a midcourse evaluation session. The residency format of the program allowed practicing pharmacists to return to the university to develop their skills in the area of drug information. The article presents a model for other drug information pharmacists who may want to offer similar training programs.


Workshops in caring: a first module.

Workshops in caring: a first module. Workshops in Caring were designed to expose attitudes, biases, and concerns of a nursing home staff toward aging, illness, and death. This paper touches on techniques and materials (more literary and humanistic than clinical) for encouraging participants to focus on and share their feelings. What inhibits or facilitates a caring relationship between elderly, often terminally ill, residents and staff members was the prime focus of both sessions: "Will You Still Need Me, Will You Still Feed Me?" and "Who Owns One's Life?"


Infection control in hospitals--what role does pharmacy play?


The need for quality hospice care.

The need for quality hospice care.


Managerial philosophy changes results in cost containment at Fentress County Hospital.


The evaluation of physician competency: a reply to Brockway.


Harnessing the reliability of outcome measures.


A case study in defining developmental costs for quality assurance in mental health center programs.


Evaluating sociodemographic data: implications for program planning and development.


Ethnic and class factors affecting mental health clinic service.


MEDIHC program targets in on shortage occupations. The expanded MEDIHC (Military Experience Directed Into Health Careers) program is successfully filling allied health positions for which employees are in short supply. Although the 12 state programs operate under uniform federal contracts, each has developed its own criteria for defining a shortage occupation.


Hyperbaric therapy for carbon monoxide poisoning.


EMS and disaster planning for the Winter Olympics.


Success motivation chases away employee blahs. An exercise that helps employees concentrate on their successes in life as well as on the job can promote healthier attitudes and a more pleasant working environment. Participants have come away with a better understanding of themselves and of their co-workers.


'Feel better/work better' epitomizes employee fitness program. It stands to reason that employees who feel better will take less time off because of illness and, consequently, improve their productivity. Rather than leave the health of their employees to chance, the Mercy Center for Health Care Services in Aurora, IL, put together a program that develops the total fitness of individual employees.


The tripod necessity for EMS communications.


Federal specifications for ambulances.

Federal specifications for ambulances.


An assessment of emergency medical services in North America: third annual survey.


Health care industry faces decision: competition or more federal controls?


Quality assessment in emergency medical services systems: the criteria mapping method.


Enthoven says his plan would return cost consciousness to health consumer decisions.


Congressional interest in competitive model for health care on the increase.


Fifteen residents die in mental hospital fire.


Carry on, doctor--privately.

Carry on, doctor--privately.


Firesafety symbols for worldwide communications.


Havighurst believes competition in health care possible with regulation.


McClure: Reorganize system, set up competitive structure.


Feldstein favors copayment increase.

Feldstein favors copayment increase.


Doctrine of consent poses questions in terminating life support system. Part 2.


FAH president favors a cost-sharing incentive health plan.


AMA leaders say medical marketplace concept is misunderstood because it is different.


McMahon wants Congress to make exhaustive study of competitive health concept.


Blood transfusion and stamps.

Blood transfusion and stamps.


An experiment in collaboration.

An experiment in collaboration.


Nurses and physicians--goals complementary, not exclusive.


On selling organs.

On selling organs.


Hospital management company officials tell views on health care competition.


Ellwood says the name HMOs stigmatized but not the concept.


Technology and values in medicine.

Technology and values in medicine.


Howard develops free market health proposal.


Medical manpower.

Medical manpower.


Commentary--consumerism in medicine: does your surgeon spill protein?


Puerto Rican folk healers in the big cities.


The influence of human and data retrieval resources on the patterns of use of drug information.


On the brink: facing baptism in the Potomac.


Should folk healers have a place in health care?


Women in medicine: still a long way to go.


Characteristics of non-board-certified internists.


Satellite education centers improve health care.


House rejects bill to bring housestaff under NLRA.


A critical management decision: selecting a first-line supervisor.


Betwixt priesthood and piracy.

Betwixt priesthood and piracy.


Dear Ivor...: Having spent my last four years in the NHS working for the mentally handicapped. An administrator who has been promoted out of the field of mental handicap writes an open letter to one of his recent patients in the mental handicap sector of Brentry Hospital. Aware of the deficiencies of the 1959 Mental Health Act and with deep reservations about any real improvements resulting from the Jay committee's recommendations, Winston Tayler, states the case, as he sees it, for the mentally handicapped.


Understanding how antitrust laws affect hospital mergers.


Setting objectives for the future--immediate and long range.


Bottom line on the top people--by Speakman. The Speakman review, that long-awaited probe into top posts in the NHS, is about to burst upon an impatient world. Alison Hyde has been taking a look at its contents. Speakman proposes 24 steps in appraising top jobs. He has some good tidings for area administrators and not so good tidings for works officers: the first are what he considers the supremos of the service and the second he places a poor third in the area ratings.


Health administration: planning: push-button age. With the development of strategic and operational planning in the NHS, the demands for techniques for gauging manpower implications have grown increasingly loud. At the same time the rise in labour costs has renewed interest in planning the use of NHS skills more purposefully. In the first of two articles (the second will appear in the near future) on the topic, Drew Clode examines some of the methods available nationally for collecting personnel data.


Robbing Peter to pay Paul.

Robbing Peter to pay Paul. Cutbacks in the health service are already affecting recruitment. Employing authorities are facing the problem of reducing expenditure and this will, inevitably lead to a reappraisal of decisions to employ locums. Peter Briggs, area medical officer for Hillingdon, discusses the implications and looks at the situation in the London area.


Keeping disease at bay: Singapore.

Keeping disease at bay: Singapore. The welfare state has arrived and is thriving in Singapore. Mark McCarthy, a senior lecturer in community medicine at University College Hospital Medical School, London, who visited the country recently, gives his impressions of the progress being made in health services, where the emphasis is on prevention.


The night comes alive with laughter.

The night comes alive with laughter. A sense of isolation is often felt by the elderly who may be unable to go out and meet people. In Castleford an evening group has been set up to try to alleviate this and give families an evening off from caring for their elderly relatives. In this Joint Care Award entry Malcolm Hornby, hospital social services officer, Wakefield, and Mike Brown, district general administrator, Wakefield AHA, describe how the scheme was set up; its success is self-evident.


Team management in the NHS--what is it all about? Multidisciplinary management teams were a significant new element in the 1974 reorganisation of the National Health Service. It was a development which in the run-up to reorganisation (and since) commanded considerable interest and, in some cases, scepticism. (R.G.S. Brown et al, 1973, 40.) Although there had been experiments in team management before the change, particularly in hospital authorities, there was no national blueprint describing their composition and method of working. This was the new factor introduced in 1974 and management teams were established at region, area and district levels. Management teams are now five years old. Most had their first meeting before the appointed day in April 1974 and there is now a fair body of experience on which to draw to make a considered evaluation of their contribution to the management of the NHS.


Time for a rethink on planning emphasis. For administrators who joined the service before reorganisation, the temptation to look back affectionately at times when planning followed the local authority model is often too difficult to master. Here, Steve Taylor, research assistant with Clwyd AHA, looks again at the corporate planning mechanisms in local government and argues that they still hold lessons which the NHS may need to re-learn in the future.


A resting place for pilgrims as life's pilgrimage ends. Hospital life goes down that long, dark corridor to the end of life to become, for this week at least, Hospice life. At St Mary's in Birmingham a belief in man's dignity and destiny informs its every act in lightening that shadow which, as Ernest Becker put it, haunts our most sun-filled days--some people's days more than others. Derek Spooner, St Mary's administrator, takes up his pen at this ultimate watershed in our lives when curing is over and caring begins.


Remember, 'a little learning is a dangerous thing'.


League for a ball game with a difference. The report in last week's Journal on the financial state of the Thames regions and Oxford RHA showed that many London AHAs are under severe pressure. This week Stephen Halpern looks at the rest of the English regions where cash problems are less critical. Growth money is helping to cushion much of the cash limit squeeze and most places look able to survive the year without too many cuts although at a few places severe cuts or deliberate overspending have occurred. The important thing is that the position could get worse this year. Cash shortfall estimates have been made on the assumption of an inflation rate of 17 1/2 per cent but it could end up much higher. Other problems faced by health authorities include increased fuel costs, implementing the Clegg report and the DHSS not playing ball by deciding that calculations of the cost of pay awards are too high. All these factors will combine to guarantee that life will not be too boring in the treasurer's department over the coming winter.


Sharing fifty-fifty all the way for Hastings.


Fighting the common enemy.

Fighting the common enemy. The painful effects of budget lopping in one hard hit health district are explained. Author looks at Medway Health District through the eyes of district administrator Peter Griffiths who hopes that the 'spirit of co-operation' will remain with the staff when the war is won.


This is no way to run a whelk stall, let alone a health service. The works officer. The last of the big spenders? Today's man for whom tomorrow never comes? The victim of a policy of make do and mend and let mañana take care of itself? Author, declaring that maintenance is a quality not a quantity job, fears the cart is being put before the horse and that any amount of oats will not change the breed.


Ambulance services: clarion call for action. Ambulance transport is scarce and expensive but there are many ways in which it can be used more economically. Alison Norman, assistant secretary, National Corporation for the Care of Old People, poses some questions about service abuse.


Skin diving for pearls in the murky depths of the DHSS.


Joint care: the seeds of support are sown and the harvest is strength. Caring for people at home is one way of keeping them out of hospital, or allowing them to leave as soon as possible. But if such care is to be effective for a significant number of patients it must be intensive and professional. In this Joint Care Award entry, Neville Millward, community care officer for the London borough of Barnet, describes a scheme to provide the necessary care and support to both the patient and his family.


Engagement in activities by old people in residential care. A major task facing the staff of residential homes for the elderly and of geriatric hospitals is to organise the environment so that the best interests of the elderly residents are met. Such organisation will assist each resident to solve particular problems or to meet the therapeutic goals for which the person was admitted. In addition, and equally important, staff will arrange the day-to-day environment to ensure that all residents have the opportunity to engage in a wide range of activities in order to maintain those abilities they possessed upon admission, together with their health and their interest in life. Ideally, too, the staff will include each resident in the deliberations and decisions about his or her therapeutic goals, and will involve all residents in planning their chosen activities or in making changes to encourage greater participation in the activities available.


Women in NHS management: still a long way to go from limbo to equality. Women working in the health service, and in other professions, have to combine shopping bags with briefcases. Jacqueline  Brooks, deputy hospital secretary, Bromsgrove Hospital, says that there needs to be a change of attitude by both the female employee and the employer if her right to equal career opportunities is to be fulfilled.


A rap over the knuckles from the professor. When local industrial relations are, in the eyes of NHS managers, like walking on eggshells, it is perhaps understandable that an AHA should have decreed to keep an important inquiry report hush-hush. So that managers elsewhere may know what went wrong and what to watch out for on their own patch, we summarise, in the first of a two-part series, Professor Roger Dyson's review of the problems at Westminster Hospital and his proposals for improvements.


Your local white elephant?

Your local white elephant? Salford Community Health Council carried out a survey to discover what consumers think of health centres. Sally Burningham has been reading its report 'Healthy Centres?' which indicates that people feel centres could offer more than they do although some seem not to make full use of what is available.


The future of the ambulance service.

The future of the ambulance service.


It really doesn't make much difference: survey on mixed sex wards.


Seeing inside with outside eyes.

Seeing inside with outside eyes. Hospital visiting by community health councils is usually accompanied, traditionally, by a certain amount of tension and anxiety. Some NHS staff retain the old image of the hospital visitor as a benevolent busybody while the CHC member may view any defensive attitudes of hospital staff as attempts to camouflage. Alison Hyde reports on her talks with CHC secretaries and administrators in Northumberland, Nottingham and Kent.


Developing a communication and control system--1.


Tip-toeing over the minefield of union rivalry. Time off for voluntary union officials, the role of Acas, solving inter-union rivalry by sole negotiating responsibility: these are topics looked at in the second part of our summary of the Dyson review of industrial relations at Westminster Hospital. Professor Dyson calls for the underresourced and badly deployed district personnel department to be moved urgently to the main hospital site and for its staff to be strengthened.


Ambulance training and equipment in West Germany--2.


Health administration: devolution philosophy heads towards a better tomorrow. Reorganisation preached it; the Royal Commission commended it, the new Government has welcomed it. But the 'greater degree of delegation of authority and responsibility' that is the devolutionist's dream has already come true for Claybury Mental Illness Hospital on London's periphery. What Claybyry does today others might wish to try tommorrow. Authors believe they have seen that tomorrow--and it works.


Hospital life: when it works it works well. Although it is now generally accepted that the best place to treat old people is in their own homes it is sometimes necessary for them to have some sort of institutional care. This poses the question of whether it is better to care for them in hospital, in old people's homes, or with community support, in day hospitals and day centres. Tony Whitehead looks at schemes in East Sussex which cover a catchment area including Brighton.


A hat-trick of model teams.

A hat-trick of model teams. You have seen your team in action and found out what the score is. Now you must interpret that score, build on the facts you have gleaned from the game so far. Certain concepts come into play if your managerial dossier is to do its analytic bit properly. Michael Walton and Graham Smith, continuing their team management saga, help make you aware of these concepts, as you must be in pondering the game's latest phase.


Thinking about retirement? Pay now and you may live a little more freely later. Money, money, money. The favourite soft toy of a well-heeled few can be a cross that the less gilded carry through their working life into retirement. Author doles out some advice for the pension conscious, especially those who have just stumbled on the fact that retirement is upon them, in fact just around the next corner.


Hong Kong's new control system.

Hong Kong's new control system.


Buying guides: simple tools with many uses.


HPM price indexes can measure your performance.


Purchasing ethics extends beyond simple honesty.


Power failure in management circuits.

Power failure in management circuits. When one thinks of "power", one often assumes that a person is the source of it and that some mystical charismatic element is at work. Of course, with some people this is undoubtedly so; they derive power from how other people perceive them. In organizations, however--says this author--power is not so much a question of people but of positions. Drawing a distinction between productive and oppressive power, the author maintains that the former is a function of having open channels to supplies, support, and information; the latter is a function of these channels being closed. She then descriges three positions that are classically powerless: first-line supervisors, staff professionals, and, surprisingly, chief executive officers. These positions can be powerless because of difficulties in maintaining open lines of information and support. Seeing powerlessness in these positions as dangerous for organizations, she urges managers to restructure and redesign their organizations in order to eliminate pockets of powerlessness.


NAHPMM code sets guidelines for purchasing ethics.


Human resources in the 1980s.

Human resources in the 1980s. As the decade of the 1970s closes, new trends in human resources will test the ingenuity of corporate planners to produce policies for the 1980s that will match changing corporate demands with changing employee expectations. The 1970s have produced much-publicized problems--for example, the introduction to the work force of larger numbers of minorities and women--that are not yet fully resolved and that can be expected to continue. But the 1980s will bring their own special challenges. Shifting populations (such as legal and illegal immigrants), the women's movement's demand for equal pay for work of comparable worth, and the push for civil liberties at the workplace are all factors that will dramatically change the business climate. With these factors in mind, the author examines the 1980s' business environment, takes a backward look at planning policies in the 1970s, and shows how the priorities of those policies will have to be reevaluated to meet the challenges of the future.


The importance of being earnest about planning.


We are not criticising clinical decisions but...the Health Service Commissioner and clinical autonomy.


Notes for students: data routinely collected in a medical records department.


The continuing education of administrators--a small contribution to debate.


Who speaks for patients?

Who speaks for patients?


Study rates chlorhexidine superior to three other handwashing agents.


Post-op pneumonia said not reduced by anesthesia filters.


Infection control for burns.

Infection control for burns.


Workable employee health program.

Workable employee health program.


Architectural designs support IC: a case history.


Architectural designs support IC: sound systems the key.


Management of hospital maintenance and operations services.


Low temperature preparation of frozen red blood cells.


Hospital fire precautions: towards cost effective design.


Waste heat recovery system at Farleigh Hospital.


Energy conservation at Wandle Valley Hospital.


Preparing the young child for hospitalization.


An operating theatre air conditioning installation incorporating heat recovery and user experience of it.


Report on a plate-type heat exchanger installed on a hydrotherapy pool ventilation system at Leybourne Grange Hospital.


Energy conservation at Winford Orthopaedic Hospital, Bristol.


Question: do you feel that hospitals should assume the primary responsibility for health education in the community? Is this feasible?


Applying child education techniques in the hospital.


Engineering improvements at Monsall Hospital, an infectious diseases hospital, with the objective of achieving a reduction in energy consumption.


Energy conservation at Hackwood Road Hospital--time clock control of heating services in intermittently occupied buildings.


Boiler combustion optimisation by means of oxygen control.


Energy conservation at Thistle Hill Hospital, Knaresborough.


Energy conservation at Newmarket General Hospital.


Energy conservation at Ormskirk District General Hospital.


The progress of energy conservation within the National Health Service since 1974.


QA/RM program streamlines work, merges functions.


The "new" accountability and the role of the nurse administrator.


Determining proper use of ICUs.

Determining proper use of ICUs.


A new method--Morie Fringe.

A new method--Morie Fringe.


Catastrophic health insurance: who wants it?


Squaring off on the Voluntary Effort.

Squaring off on the Voluntary Effort.


A cost conscious approach to medical care.


Getting out of Social Security: would it be right for your hospital?


More emphasis should be on working capital management.


Communicating with medical staff and employees helps hospital to control patients' costs.


"Weekend" investments could be beneficial for hospitals' excess cash.


Centralized scheduling allows for "weekends off".


Ambulatory care--designed for patients to receive better care at acceptable cost.


Easing the trauma of retirement.

Easing the trauma of retirement.


Older trainees.

Older trainees.


Around-the-clock administration.

Around-the-clock administration.


Harnessing the workaholic's energy.

Harnessing the workaholic's energy.


How to evaluate attitudes.

How to evaluate attitudes.


Effective counseling techniques.

Effective counseling techniques.


Making hospital preparation child-centered (with a little help from Emily). Helping youg children learn about the hospital shoould, ideally, involve a multifaceted approach that utilizes tools appropriate to the child's age and needs. The hospital preparation process at Alberta Children's Hospital that has attempted to achieve this end through the coordinated efforts of the Recreation/Child Life and Nursing departments is discussed. Our preparation process consists of several phases, commencing prior to admission and carrying  right through until discharge, with the "thread" that draws it all together being a whimsical kitten named Emily.


Parents' meetings in a pediatric unit: helping parents cope with their child's hospitalization. The various ways of helping parents of hospitalized children to cope with this situation, highlighting a method utilized at Sinai Hospital of conducting biweekly meetings for parents is addressed. Ways in which the parents have utilized the meetings, issues that have been explored, and suggestions for handling parental concerns are the focus of the paper.


The informal rationing of primary medical care. All social services are rationed, yet the effects of such rationing on the client are rarely fully explored. This article reviews the evidence on the existence of informal rationing devices in general practice. It examines the effects on patients of a wide range of informal rationing devices now used by individual general practitioners. Various suggestions for reforming the present rationing of primary medical care are evaluated and the likelihood of any reform being carried out is assessed. Although this article concentrates solely on rationing in the primary care sector of the National Health Service, the issues discussed are relevant to most welfare agencies as they are presently organized.


Representing the interests of the public?: the case of the local health council in Scotland. The statutory function of local health councils in Scotland (and of community health councils in England and Wales) is to represent the interests of the public in the health service. This article, based on data from a four-year research project financed by the Scottish Office, examines official and participants' assumptions and claims about the legitimacy of health councils, as at present constituted, to carry out this function. Clarification of the basis of their legitimacy would assist, it is argued, in the resolution of a central dilemma: How are councils to represent the interests of the public? The conclusion is reached that inadequate thought was given to developing theoretically sustainable arrangements. Several interpretations of representation are admixed in the rationale for the present system and they cannot be aggregated to produce a coherent defence of it.


The hospice movement in the United States.


Ethnic music in music therapy: a program for Jewish geriatric residents.


The House Select Committee on the Aging.


Executive housekeeper suggests methods of employee training.


Overburdened maintenance staff blamed for inefficient laundry.


IFI education director discusses national hospital laundry averages.


Theft detection systems for libraries revisited: an updated survey.


Baptist center renovates laundry; improves efficiency, linen quality.


Checkpoint theft detection systems.

Checkpoint theft detection systems.


Laundry to serve 2nd hospital with new distribution system.


Gaylord/Magnavox book security system.

Gaylord/Magnavox book security system.


Big business turns up the heat on doctors.


3M Tattle-Tape brand book detection systems.


Try this filing system for retrieving medical pearls.


We don't need this kind of emergency medical service.


Knogo book detection systems.

Knogo book detection systems.


Where do doctors stand in a nurses' strike? Right in the middle!


The law & medical electronics: leasing medical equipment.


Soft-film vs hard-cover electronic thermometers.


Company health-care management.

Company health-care management.


The 'conspiracy' in health care: good intentions gone awry.


Chinese medicine turns to U.S. again.

Chinese medicine turns to U.S. again.


Litigation as a strategy.

Litigation as a strategy.


Government regulations interviews.

Government regulations interviews.


Preservation prescription given for academic health care centers.


HIA raps both Carter and Kennedy proposals on nat'l health insurance.


Plans revealed for development of 'unique' HMO plan.


Improving my materials management IQ.

Improving my materials management IQ.


The Ohio story: the three E's in modern management.


Designating the resource hospital: part III.


The workload recording committee and its liaisons.


Pathologists in New Jersey--an endangered species. Pathologists in New Jersey are compensated in accordance with the rate established by the state's rate review commissions. The author of this article, while granting that the theory is a worthy one, explains that in practice the reimbursement procedure is causing the decline of the quality of health care in New Jersey.


Proposed standards: standards for utilization of interlaboratory (proficiency) testing programs in the CAP I&A program.


"Deny free enterprising at your own risk!".


HEW spurs HMO development.

HEW spurs HMO development.


Georgians study free enterprise in medicine.


Revised medical reimbursement plan (section 105H).


Tips on repackaging unit doses in institutional settings.


Ethnicity and clinical care: Puerto Ricans.


Court orders written consent for drugs.

Court orders written consent for drugs.


Residents' forum: careers in a general hospital setting.


Hospital libraries: filling the need to know.


Education: changing the future.

Education: changing the future.


Health Planning Act--some MH progress.

Health Planning Act--some MH progress.


Judge puts Alabama hospitals in receivership.


Age limit for elderly patients said unrealistic.


How much should you expect from your designer?


What they're saying about annual reports.


On the evaluation of medical imaging systems: some basic considerations.


Economics as a tool in managerial decision making.


HCF-EMA voluntary certification program.


Ancillary audits in the radiology services: improving patient care.


Respiratory therapy in nursing homes.

Respiratory therapy in nursing homes.


Revitalizing employee benefits programs.


New, machine-dominated era of health care is coming.


Transplant technology today: a scorecard + the outlook.


A social-psychological profile of a respiratory therapy unit.


Holistic medicine.

Holistic medicine.


A place for on-the-job training.

A place for on-the-job training.


Respiratory therapy's Russian roulette.

Respiratory therapy's Russian roulette.


An innovative approach to selecting an executive director. As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.


Abortion work: strains, coping strategies, policy implications. As a result of the moral and social conflicts surrounding abortion, workers involved in counseling potential abortion recipients are subject to certain strains. The author uses observations made at one abortion clinic to support her conclusion that these strains, as well as the methods of coping developed by staff and administration, must be considered in formulating any policy on abortion. Focus is on the strains associated with abortion work, some of the devices used by abortion counselors to offset these strains, and some of the costs associated with these humanizing measures.  The information was drawn primarily from a year -long participant-observation study of "Urban Clinic" during 1976-1977.  Urban is a private, nonprofit, family planning clinic in a large Northeastern city.  Among its other services, the clinic offers 1st trimester abortions on an outpatient basis.  About 150 abortions are performed each week.  Attention is on the 8 abortion counselors who work at Urban and 3 middle managers -- the clinic director, the associate director, and the head counselor.  Counseling tasks include giving information and counseling prior to the abortion and accompanying patients through the procedure itself.  Managerial duties are primarily administrative and supervisory but also include some direct service in the abortion clinic.  The strain associated with abortion-related work derives from several different sources: the larger social and political climate surrounding abortion, the moral dilemmas raised by their own involvement in the abortion procedure, and the behavior and the perceived attitudes of abortion recepients.  The responses of counselors to the strains of working with abortion can be divided into 2 categories: "ideological" and "structural." Among the most important ideological devices used by counselors are honoring the principle that the major purpose of abortion counseling is to facilitate decision-making for the client and an elation counselors experience upon encountering a wanted pregnancy, either among clients at the clinic or among their own associates.


A very special patient and very special care.


Prescription for success: the New Jersey program of pharmaceutical assistance to the aged.


Deinstitutionalization: those left behind. Whether a retarded child can be cared for at home depends primarily on the ability of his or her family to function as primary caretakers. Not surprisingly, then, the rate at which retarded children are deinstitutionalized is being slowed by this country's failure to emphasize programs that are supportive of these children's families. After examining the discrepancy between the needs of families with retarded children and services currently being provided, the author proposes various changes in policy to increase assistance and support to the family as a unit.


Michigan's public health code.

Michigan's public health code.


Specialization: a growing trend.

Specialization: a growing trend.


Standardizing respiratory care in the home.


The need for qualified respiratory therapy personnel in the small hospital.


Respiratory therapists on transport.

Respiratory therapists on transport.


Facing up to the enemy--Interview by David Cassak.


What is a patient representative?

What is a patient representative?


Hospitals are saving more than lives--the Texas voluntary effort.


TIES brings quality educational programs to hospitals.


Some thoughts on establishing an education department.


Cost containment ideas...the nursing department.


Unit dose system for smaller hospitals.

Unit dose system for smaller hospitals.


Before renovation: 'fit' of environment to patients, staff studied. Before undertaking a hospital or clinic renovation project, "expert" opinions are usually gathered from architects, administrators, trustees, etc., but what about the opinions of those who will be most directly affected--the staff and the patients? This article talks about a study, funded by the Regenstrief Institute, which investigated the benefits to be gained by asking questions of that often-ignored group.


Hospital self-insurance offers some advantages. Practically all large employers are faced with the problem of providing economical employee insurance in its benefits program. Hospitals have some unique advantages over some other employers in terms of being able to provide self-insurance and eliminate most of the costs of sustaining an insurance carrier.


A new emergency ambulance service that flies.


Hill-Burton: no defense.

Hill-Burton: no defense.


Health manpower shortages promise to worsen.


How the AHA meets the challenge of change. The American Hospital Association and its member institutions have always adapted, and must continue to adapt, to change. Socioeconomic developments that must be reckoned with include the energy crisis, an economic recession, and the growth of consumer consciousness. Political developments include the growing similarity of the two major political parties, increased fiscal conservatism, and an antigovernment mood.


Contractor must know healthcare and construction. A successful contractor-hospital relationship in a building project requires more than willingness and knowledge of one's own craft from both parties. As Touro Infirmary's Robert Arnold found out, it helps if the contractor has an intimate understanding of the priorities and problems in providing health care, as well as knowing his own territory.


A management contract for your CEO?

A management contract for your CEO? A task force of the Massachusetts Hospital Association has recommended that hospitals consider strengthening the management role of their chief executive officers by providing them with job security in the form of a management contract; by establishing a well-defined job description that clearly identifies the CEO's role in the management of the hospital; and by developing an annual set of goals and objectives that the CEO is expected to accomplish.


Dollarsense: industry's role in health care cost containment and the business perspective on the Voluntary Effort.


Changes in the national health planning law.


Report from Washington: increasing distaste for federal regulation.


GAO hits DoD's plan for contingency beds.


AFGE consolidation issue: VA union vote will include MDs.


NAVAP secures AFGE's backing.

NAVAP secures AFGE's backing.


CHAMPUS covering nurse midwife services.


Israeli hyperbaric unit treats civilians most.


A matter of image.

A matter of image.


Something Xtra in Xray.

Something Xtra in Xray.


A penny saved...

A penny saved...


Riding back to health.

Riding back to health.


Pediatrics orientation: two variations on a theme--UTH goes to school.


21st International Hospital Congress, Oslo, Norway, 24-29 June 1979.


Developing effective volunteer services.


Assessing skills as a volunteer administrator: a new approach to certification.


The organization and integration of services for emergencies in São Paulo.


The role of the hospital in a changing world.


The use and abuse of accident and emergency departments--the Stockholm experience.


The organisation of emergency medical services based on a teaching hospital (Rouen).


Bringing down-to-earth medical care to areas without doctors.


The organisation of medical services at the site of a disaster.


The planning and management of community and hospital services for children.


Hospital-based initiatives in Canadian child health.


The role of children's hospitals as child health centres.


Planning local health services for children.


Innovations in child health services in Nigeria.


'Medicine of the family and the family of medicine'.


The Child Safety Centre--a new concept in child accident prevention.


The roots and practice of voodoo medicine in America.


Manners are good business.

Manners are good business.


How to dissuade some people from looking for work.


Surface data and deep structure: observing the organization of professional training.


Rising costs concern physicians...

Rising costs concern physicians...


Rising costs concern physicians...and the general public.


The occupational physician: 'company man' or workers' ally?


New corporate physician: "a burr in the conscience of management".


Keeping workers healthy: trouble at Willow Island.


Doctors in hard hats.

Doctors in hard hats.


VA hospital documents sought: suit threatens peer review privacy.


After hospital nursery 'inspection': four jailed in feminist controversy.


As medical gains prolong life, new dilemmas arise for courts.


Disaster plans not adequate for mass evacuation, officials say.


Hospital price policy change asked by AMA.


Scotland's death rate among Europe's worst.


HCA opens hospital at Orange.

HCA opens hospital at Orange.


Autocaf is a goer.

Autocaf is a goer.


Comparing hospital costs.

Comparing hospital costs.


A note on objectives for regional hospital planning.


Medibank Mark II: peer review.

Medibank Mark II: peer review.


Patient handling systems compared.

Patient handling systems compared.


The reorganization of DHEW: what happened, why, and so what? This is a case study of the restructuring of the Department of Health, Education and Welfare that was announced by the Secretary, Joseph Califano, in March 1977. Balutis addressed the question: Did the reorganization accomplish the Secretary's purposes? Of the 12 goals outlined by Califano, the author feels that only those seeking to consolidate supervision over fraud and abuse were achieved. As a result of the reorganization, both Medicare and Medicaid are reviewed by a single staff, a change designed to achieve a "more balanced, integrated, and active" effort. Two of the purposes for restructuring were: improvement of internal efficiency and cost-savings; it is difficult to discern real progress in these areas. The author terms the overall effect "traumatic" because the process remains incomplete and other changes appear emminent. He concludes that reorganization is useful only for addressing the "fragmentation of related programs among different organnizational units." Balutis argues that reorganization in and of itself is not likely to increase efficiency or reduce government costs, and may in fact, be counterproductive to these objectives.


"Conflict management" and "conflict resolution" are not synonymous terms. Robbins sees functional conflict as an absolute necessity within organizations and explicitly encourages it. He explains: "Survival can result only when an organization is able to adapt to constant changes in the environment. Adaption is possible only through change, and change is stimulated by conflict." Robbins cites evidence indicating that conflict can be related to increased productivity and that critical thinking encourages well-developed decisions. He admits, however, that not all conflicts are good for the organization. Their functional or dysfunctional nature is determined by the impact of the conflict on the objectives of the organization. The author identifies several factors underlying the need for conflict stimulation: (1) managers who are surrounded by "yes men"; (2) subordinates who are afraid to admit ignorance or uncertainty; (3) decision-makers' excessive concern about hurting the feelings of others; or (4) an environment where new ideas are slow in coming forth. He suggests techniques for stimulating conflict; manipulating the communication channels (i.e., repression of information); changing the organizational structure (i.e., changes in size or position); and altering personal behavior factors (i.e., role incongruence). Robbins stresses that the actual method to be used in either resolving or stimulating conflict must be appropriate to the situation.


Preferential treatment: diagnostic photography comes first at this medical center.


Directional signals: paramedics receive emergency assistance from doctors via a radio network.


Remedies as ills.

Remedies as ills.


Quality health care in a regulated society.


In California: new doc on the Hill.

In California: new doc on the Hill.


Health maintenance organizations; July list--Public Health Service, HEW.


Executive Order 12184 of December 17, 1979, relating to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.


Statement of organization and functions of the commission: United States Commission on Civil Rights. Final rule.


Maryland: system criticized--but supported.


Health Resources Administration: notice of health planning agency responsibility for review of hospital applications for assistance for energy conservation measures under the National Energy Conservation Policy Act, Pub. L. 95-619.


Office of Federal Statistical Policy and Standards, Department of Commerce: notice of final standards for establishing metropolitan statistical areas following the 1980 census.


A novel approach to the subject of health care cost control.


Health plug: exercise and a check.

Health plug: exercise and a check.


Hospital liability: increasing awards push premiums up.


Prompt reports shield against false claims.


Doctors kill Colorado HMO.

Doctors kill Colorado HMO.


Health premium tax: Ullman bill sells quack medicine, underwriter says.


The crisis of the nonprofits.

The crisis of the nonprofits.


Fooling ourselves with child autonomy and assent in nontherapeutic clinical research.


Parental consent: its justification and limitations.


The college presidency: life between a rock and a hard place. Hesburgh, the President of Notre Dame, draws on his experience to write a very human account of what makes a good college president. He suggests that the basic cause of most presidential failure is the inability to realize that all constituencies cannot be satisfied all the time. Hesburgh advises that criticism is a far greater part of presidential life than plaudits and gratitude. He acknowledges that decisions should be based on what is right, given the alternatives, not what is least costly or most popular. The author suggests ways to satisfy the various constituencies of the college president (students, faculty and trustees) and says that "effective leadership means getting the best people you can find to share the vision and help in achieving it".


Hospital social work: a valuable community service.


Protection of elderly research subjects.


DRG: a new concept in reimbursement.

DRG: a new concept in reimbursement.


Hospitals, consumers and advertising.

Hospitals, consumers and advertising.


Medical center devises plastic card system to identify and bill outpatients.


Microfilming: a unique shared service.

Microfilming: a unique shared service.


Strengthening internal controls.

Strengthening internal controls.