Better than well: American medicine meets the American dream: Carl Elliott. (378 pages, US$26.95.) W. W. Norton & Company Ltd, 2003. ISBN 0-393-05201.

Are you comfortable with who you are? Have you realized yourfull potential? Shouldn't you be taller, thinner, sexier, moreself-confident? If you answer yes to any of these questionsand you are a (wealthy) American, the chances are, accordingto the     

The art of settling in nicely

You are a manager and you are moving to another job. What steps would you like your new authority to take to ensure that you become an accepted and valued member of the staff and that your needs are being met?     

Special report. Patients in possession of illegal drugs: what can you do about it?

Illicit drug use affects every area of the hospital/health care setting and presents thorny legal dilemmas for security directors and risk managers when patients are found using and/or attempting to sell controlled substances. Should you handle it privately or should you call in the police? Do local law enforcement and prosecutors really want to be bothered with every $25 worth of cocaine seized from a patient? If you inform the police and arrests are made, could your hospital develop a reputation as a drug-infested combat zone? If you handle it privately, are you at risk for litigation because of invasion of privacy or an illegal search? On the other hand, if drugs are reported and you do nothing, are you liable for a negligence lawsuit? Clearly, there is a need for proactive planning and policy development prior to being confronted with patient drug possession. In this report, hospital security directors discuss how they handle this situation at their facilities and how they formulate policies and procedures. We'll also offer advice from legal experts on patient privacy issues and interacting with local law enforcement.     

New wine in new bottles

This is the first issue of the 15th year of the European Journalof Public Health. If you are reading the print version of thepaper you will have noted immediately that the journal has beennewly designed. And if you are reading the on-line version ofthe journal you will see even more changes, which all contributeto greater functionality. These changes are part of a range     

How to present the findings of research.

Providing an account of research involves telling a story during which four key questions are answered: why did you start, what did you do, what did you find out and what does it mean? It is the third of these--what did you find out--that is at the heart of any research paper. Ensuring that the key messages emerge from the data is the duty of the author and requires considerable skill and craft.     

When dangerous employees cause harm

What happens when you have a dangerous employee in your workplace? How can you tell? What can you do about it? What does the law require? If you manage to get rid of the dangerous employee, are you off the hook? These questions are defining the cutting edge of employment law as it is currently developing in the courts. And these developments have recently hit home--in a big way--in the healthcare arena. This article is devoted to fully understanding the nature of the problem, with the ultimate goal of developing a framework for resolving it.     

Bringing it to the next level: how to make your EMR implementation a success

Electronic medical records (EMRs) are the wave of the future. Is your practice ready to join in? This article will guide you through the steps to take to determine what EMRs can do for you and how you can start the process. Establishing goals and policies as well as providing adequate training are just as important in transitioning from paper records as the hardware and software of the system you choose.     

Gaining momentum in the long, uphill battle to "get to zero"

I am truly privileged to be addressing you for the first time in the Journal of Healthcare Risk Management. I'm looking forward to getting to know you and working with you. I want to learn more about all the great ways that each of you has been making a difference in keeping our patients safe and building trust in our healthcare systems. As you know, the ASHRM Board is completely committed to finding solutions through the empowerment of our members. We believe in you. In that spirit, we are coming up with new ways to fund research and make critical connections that will fuel ideas.     

Clinical staffing patterns

When choosing a method of calculating clinical staffing, you should evaluate several models and collect data to determine what your current staffing pattern is providing. You should also evaluate your service performance to determine whether you are doing the correct tasks. If you have the data to compare your staffing to your facility standards of care and several other comparable facilities, you will have a greater confidence level when you report that your staffing is based on requirements for efficient services to meet your patient needs.     

Moving up to high performance

The case for changing to a high-performance culture is simple. Figure 7 suggests a fairly simple decision-making approach. Analyze your current business results. If you are completely satisfied, then celebrate and communicate your good fortune. If you are less than satisfied, look at each of the eight systems of work. Is your organization achieving the results its design dictates? If you want another result, you probably need to alter the organizational design that produces that result.     

Jacob and the preacher: Conversations in context,part I

“You're the child care worker. Right?” “I'm the child care worker.” “So, wadda you want? I told the old lady I'd see you because she was freaking out. I got ten minutes. Talk.” “I want to buy you a cup of coffee and tell you how to save your life.” “I don't drink coffee.” “So? What about your life?” “What are you, a missionary from the local church? Or are you just an asshole?” “If I gotta make a choice, I'd rather be an asshole. What about you?” “You're fucking crazy, man. Me, I wouldn't make a choice like that.” “That's the problem. You're not making choices. That's why your life is going to hell. And that's why I'm here: to give you the choice of saving your life. Now. Do you want to do it or don't you?” “Are you paying attention here, preacher?” “Sorry, Jacob. I was thinking about your history.” “Who gives a shit? Pay attention. I was asking you if you wanted to go over to the park with me. I got something I gotta do.” “Is it safe for me?” “Sure. Don't worry. I'll look after you. Nobody's gonna touch you if you're with me. The only thing is, you gotta do what I tell you.” “I'm glad you're looking after me, son. It always feels good to know somebody's taking care of you.”     

Get what you want in 2008: five steps to success

Whether you are a large, multi-practitioner operation, or a small, solo practice, the question is the same: What can you do now that will ensure greater success for you in 2008? There is so much to look at when strategizing for the future, that it's easy to overlook key areas that might need attention. Even the most organized, well-staffed practices often miss crucial areas where a small intervention would yield a significant increase in their success. In this article, you'll discover the five critical steps to take to move your medical practice from where you are to where you want to be.     

How (and why) to shop the stop-loss insurance market

Stop-loss insurance is capitation's "escape clause," which permits you to assume risk without risking ruin. But which stop-loss coverage is right for you? Here are 11 questions to ask before you decide.     

Wading through computerese

Minicomputers, microcomputers, supercomputers, disks, disk drives, diskettes, bits, bytes, input, output, COBOL, FORTRAN, RPG, memory, "K", CRT, CRU, etc., etc. What does all this mean, and more importantly, what can it do for you, the medical group manager, possibly faced with your first hard decision regarding the use of computers in the day-to-day business of running your medical group? The author provides a glossary of these and many other terms for you and puts them in proper perspective so you are more easily able to wade through the morass of computerese jargon. Further, a number of considerations are presented which will give you a base from which to operate, and a series of questions are presented relative to each of the considerations. Your answers will generate enough information relative to any system to enable you to make a reasoned decision about that system. It is not the intent of this article to tell you which system is best--you must judge that for yourself as you evaluate the questions and considerations presented in the light of your unique setting.     

Positive politics: playing corporate games with personal integrity

The desire for power is personal. Competence and political intelligence are the prerequisites for handling power in a healthy manner. Politics is not a nasty word or a set of behaviors that inevitably turns you into a shady character of whom your mother would be ashamed. You need never divorce your own morality from the situation. The choice to improve your political functioning is yours. You always retain the right to play, and you retain the right to decide when to play. But you are a better manager, a better professional, and a more educated person if you can identify what others are doing and how their behavior will impact you. It is not just for success, it is for survival--success and survival on your own terms.     

On-line vs. in-house. Which billing system is right for your practice?

With medical billing becoming more difficult and confusing, you may decide that automated billing and collecting is just the answer you have been looking for to help take the mystery out of receivables. Currently, there are a myriad of in-house systems available to the physician while only a limited number of on-line systems exist. Which computer system is right for your practice? To answer this question, you will need to answer a series of other questions first. To help define your business problem, you must fully understand your practice. The following questions will allow you to analyze your office.     

Editorial – A parliamentary spotlight on prevention

It can be a disconcerting experience as a health promoter when the question comes up “So …what do you do”. In reply you might say: “I manage health promotion projects”, or “I am a health promotion researcher”. The smile that you receive indicates that your interlocutor likes the sentiment of what you are saying, but the quizzical furrow on her or his brow suggests a lack of certainty about what it is you mean. If you are in the mood you might go on to discuss what health promotion is all about, but the experience serves as a reminder that it is not a widely recognised field of work. But things may be changing. The reports of the Preventive Health Task Force and the debate around the Australian National Preventive Health Agency (ANPHA) Bill 2009 in Parliament have brought an unprecedented level of attention to our field. The Hansard related to the ANPHA Bill provides a window into how our elected leaders understand health promotion and whether they consider a greater investment in this endeavour to be worthwhile.     

Using journal alerts to support your continuing professional development

Abstract

There are many ways to keep up to date with research that affects your role and personal development. You can regularly use PubMed or Scholar to find recent papers using keyword searches, you can rely on others to do the work for you with literature reviews, share the job with Journal clubs or using Journal alerts you can have the papers and research you want delivered to your inbox.     

Using third-party financing to help today's patient pay for treatment and care

Patients walking into your practice today are different than the ones you saw a few years ago. Larger deductibles and out-of-pocket costs may cause many of them to put off recommended treatment. What can you do to ease patients' cost concerns and help them move forward with the care they want and need? Creating a comprehensive financial policy that includes a third-party patient financing program is a good place to start. Here's how to ensure that you select the best program for you.     

Creating a vision for your medical call center

MCC technologies and applications that can have a positive impact on managed care delivery are almost limitless. As you determine your vision, be sure to have in mind the following questions: (1) Do you simply want an efficient front end for receiving calls? (2) Do you want to offer triage services? (3) Is your organization ready for a fully functional "electronic physician's office?" Understand your organization's strategy. Where are you going, not only today but five years from now? That information is essential to determine your vision. Once established, your vision will help determine what you need and whether you should build or outsource. Vendors will assist in cost/benefit analysis of their equipment, but do not lose sight of internal factors such as "prior inclination" costs in the case of a nurse triage program. The technology is available to take your vision to its outer reaches. With the projected increase in utilization of call center services, don't let your organization be left behind!