The physicians practice profile: a piece of the quality puzzle

In responding to a New York State law and regulations that essentially mandated high quality and required hospitals to implement a system of physician practice profiles, Genesee Memorial Hospital involved the medical staff at all stages and made heavy use of computers for the ultimate system. The result is a profile system with the backing of physicians and with easy access to maximum amounts of information. Still, the author asserts, such profiles are at best an imperfect response to issues of quality.     

Compliance with patients' end-of-life wishes by nursing homes in New York City with conscience policies

Nursing home patients have a constitutional right to refuse treatment. The Patient Self-Determination Act confirmed that right. State laws address the obligations of health care providers and facilities to honor that right. The New York State law is more specific than those of many other states. It allows exemptions for "reasons of conscience" and imposes a number of requirements on nursing homes claiming such an exemption, including the transfer of a patient to a home that will honor an end-of-life wish. This study, conducted by FRIA, investigated the refusal of some nursing homes in New York City to carry out patients' end-of-life wishes because of conscience-based objections. The study also investigated the willingness of homes which did not have such policies to accept patients transferring from a home with a policy so that the patient's end-of-life wishes would be honored. Implications for administrators, policy makers, and regulators are discussed.     

I was a medi-cop

When I became an inspector for the New York State Health Department, I realized that I would not win any popularity contests, but I believed that I would be improving the quality of care in the 32 hospitals controlled by our area office. I decided to take the job in a desperate move to escape from primary care responsibilities that had been growing more onerous daily. This article tells of my experience as a health care regulator and why I returned to work for a health care provider.     

Quantitative Risk Assessment of the New York State Operated West Valley Radioactive Waste Disposal Area

This article is based on a quantitative risk assessment (QRA) that was performed on a radioactive waste disposal area within the Western New York Nuclear Service Center in western New York State. The QRA results were instrumental in the decision by the New York State Energy Research and Development Authority to support a strategy of in‐place management of the disposal area for another decade. The QRA methodology adopted for this first of a kind application was a scenario‐based approach in the framework of the triplet definition of risk (scenarios, likelihoods, consequences). The measure of risk is the frequency of occurrence of different levels of radiation dose to humans at prescribed locations. The risk from each scenario is determined by (1) the frequency of disruptive events or natural processes that cause a release of radioactive materials from the disposal area; (2) the physical form, quantity, and radionuclide content of the material that is released during each scenario; (3) distribution, dilution, and deposition of the released materials throughout the environment surrounding the disposal area; and (4) public exposure to the distributed material and the accumulated radiation dose from that exposure. The risks of the individual scenarios are assembled into a representation of the risk from the disposal area. In addition to quantifying the total risk to the public, the analysis ranks the importance of each contributing scenario, which facilitates taking corrective actions and implementing effective risk management. Perhaps most importantly, quantification of the uncertainties is an intrinsic part of the risk results. This approach to safety analysis has demonstrated many advantages of applying QRA principles to assessing the risk of facilities involving hazardous materials.     

The reporting of grief by one newspaper of record for the U.S.: the New York Times

One source people can rely on for clues on how to grieve a loss is through accounts of such experiences reported in the mass media. This research examines how grief has been reported at one newspaper of record for the U.S.: The New York Times. Using theories of social construction and the sick role, this exploratory study attempts to observe whether grieving is portrayed by media as a social problem, particularly as a health or medical issue which can be treated and cured, and also discusses those who are not identified in the mourner role in newspaper reports.     

Source Credibility in Environmental Health – Risk Controversies: Application of Meyer''s Credibility Index

This article applies an existing five-item index for measuring source credibility in the context of environmental health-risk controversy. Survey data were gathered in five upstate New York communities facing environmental health-risk issues. Analysis of the five case studies and a combined dataset (N = 870) show that the credibility index was consistently reliable across all applications. Use of the resulting index is demonstrated through a comparison of the credibility of the New York State Department of Health (active in each case), the industries associated with each case, and the newspaper providing coverage of each case. The credibility index was used to predict risk judgments in a structural equation model. Overall, the analysis demonstrated that the credibility index performed consistently well across the five cases and illuminated important differences in each. As such, the index should be a useful addition to many environmental health and risk communication studies.     

Palliative care programs: what, why, and how?

Establishing a palliative care service can improve patient care and ease family concerns for patients who are hopelessly ill. For the hospital, such services can improve utilization outcomes. Take a closer look at a palliative care service operating for nearly five years at Mount Sinai Hospital in New York City.     

Building Functional Communities: Concepts for Reframing Social and Fiscal Policy

Given the shrinkage of social service resources in public organizations, a variety of fiscal options to manage costs must be developed to address operational efficiencies and, more importantly, to protect from negatively impacting institutional integrity. The paper which follows addresses a continuum of alternatives which could be considered when examining resource sharing policy options which can build well-functioning communities to the benefit of both the public and private sectors. Data were collected using a case study approach employing focus interviews with school district CEO's, CFO's, business officials and other key public and private sector administrators in thirty-one New York State commmunities and two suburban counties within 25 miles of New York City over a period of three years. An exploratory analysis was used to test a conceptual framework that draws together the literature concerning the types and purposes of interdistrict cooperation. The studies findings concerning cooperative arrangements among organizations led to several conclusions and caveats concerning building functional communities:If sharing is to be supported and developed as a strategy for organizational improvement, organizational leaders will have to be aware of the reasons sharing arrangements are made and the tensions that destroy agreements.If sharing agreements are to be promoted, particularly in the specialized areas that seem to be appropriate for sharing resources, more attention will be needed in identifying likely incentives for mid-level managers, administrators and support staff involved with planning and operating such programs.If sharing is to take place, a common set of data need to be collected and analyzed.If sharing is to get started, pilot programs need to be developed that bring diverse organizations together on a regular basis with a specific sharing agenda.     

Urban housing & energy efficiency: a pollution prevention opportunity

In 1999, the New York Power Authority (NYPA) received the annual Governor's Award for Pollution Prevention for its Energy Efficiency Refrigerator Replacement Program, conducted in cooperation with the New York City Housing Authority (NYCHA). There are over 180,000 refrigerators in operation at NYCHA residences. In this article the authors describe how NYPA offered to design, finance and implement a program to replace inefficient refrigerators with more efficient models, recouping the cost of the program through energy savings. NYPA worked in partnership with major appliance manufacturers to develop refrigerators that fit the NYCHA space requirements while providing sufficient energy savings to pay for the program. In addition, refrigerant gas, compressor oil, mercury switches, PCB- and non-PCB capacitors, and metals are all recycled at a dedicated facility under the program; the shipping containers from the new refrigerators are also recycled.Since program inception, almost 48,000 refrigerators have been replaced, weighing an estimated 8.5 million pounds. To date, the program has recycled approximately 14,000 pounds of CFC-12 gas, 215,000 pounds of aluminum, 36,000 pounds of copper, and eight million pounds of steel. From an energy efficiency standpoint, energy consumption has been reduced by 62,000 MWH, which has eliminated air emissions totaling ninety-five tons of SO2, seventy-eight tons of NOx and 52,000 tons of CO2 (using metropolitan New York generation profiles). Likewise, partnerships have been developed with the US Department of Housing and Urban Development and the U.S. Department of Energy.     

Difficulties in the transition from clinician to manager

Medical clinicians have for many years been managers. However, this management role has most often been in groups of other clinicians and other health personnel. Only recently have increasing numbers of medical clinicians been asked to accept responsibilities for managing hospital and health services divisions that carry financial and administrative responsibility in addition to traditional clinical responsibility. In these circumstances, it is appropriate to seek to gather information about the various issues that surround the transition from clinician to manager in a systematic way and to begin to explore the issue and any actions that might be taken to ameliorate transitional problems. Such a study was undertaken by the School of Health Services Management at the University of New South Wales, Sydney, Australia, and is reported in this article.     

OBTAINING AND PARAMETERIZING MULTIPERIOD PORTFOLIOS WITH DESIRABLE CHARACTERISTICS UNDER LOGNORMAL RETURNS

The expected geometric mean has been shown to be a valuable criterion in ranking portfolios of assets. For example, under certain conditions the maximum expected geometric-mean portfolio minimizes the expected time to amass a fixed level of wealth as wealth becomes “large.” This paper develops a simple algorithm for obtaining such portfolios when portfolio returns are assumed to be lognormally distributed. The risk-return characteristics of portfolios are derived and illustrated using data from a subset of stocks found on the New York Stock Exchange.     

Re-engineering high risk, high complexity industries through multiple level technological learning A case study of the world nuclear power industry

Applying lessons learned at the national, the utility, and the plant level, from selected segments of the world-wide nuclear power industry, might facilitate an environmentally acceptable renaissance of the U.S. nuclear power industry through re-engineering it. Elements of this learning from experience process can be found: (a) at the national level in Europe, Japan, and the U.S., (b) at the utility level in two New York State nuclear power utilities, Niagara Mohawk and New York Power Authority, the Tenessee Valley Authority, and Duke Power and Light in the U.S., in Ontario Hydro in Canada, and in the Electricité de France (EdF) in France, and (c) at the plant level in several of these utilities. At the core of all the continuous quality improvement and re-engineering programs, lies this twofold mission: (a) to insulate society from foreseeable and unacceptably high environmental risks, and (b) to continuously improve the design and management of nuclear technology (including nuclear waste management and environmental risk management systems) by learning, learning how to learn, and learning to learn-how-to-learn, both explicitly and tacitly, through feedback from individual and organizational experience.     

Communicating Contaminant Risks from Sport-Caught Fish: The Importance of Target Audience Assessment

A fish consumption health advisory has existed for New York Lake Ontario sport-caught fish since 1978. Our study objectives were to evaluate the effectiveness of the advisory for reaching potential target audiences and to identify appropriate advisory content, style, and dissemination methods using a risk communication planning model as an evaluation framework. We used a combination of mail surveys and personal interviews with three target audiences (opinion leaders among recreational anglers and charter boat operators, migrant farm workers, and low-income individuals) and two communicator groups (fishery experts and health care experts). The New York Lake Ontario advisory appeared to be successful in reaching and encouraging risk-mitigating fish consumption behavior in recreational angler opinion leaders and low-income individuals but not in migrant farm workers. The advisory may not be reaching two sensitive subpopulations, women of childbearing age and children. Communicators and target audiences differed in their assessments of important information to include in an advisory. The health advisory could be improved with additional information such as risk-reducing cooking and cleaning methods and by diversifying the dissemination methods to reach the variety of audiences who potentially consume Lake Ontario fish.     

OR/MS modeling in long range bank planning

For over 10 years, The Bank of New York has conducted formal Long Range Planning, to insure profitable long term growth. The planning system developed by the Bank relies heavily on Financial Planning and OR/MS Modeling has been an important part of this system. This paper describes the approach taken by the Bank to develop their system and the experience gained through managing the system.     

Linking fuel cell technology with environmental strategy: The plug power story

The technology of fuel cells—electricity-producing devices that promote energy efficiency and lowered emissions—has been studied and researched for more than a century. Only recently, however, has enough progress been made in fuel cell research to allow for the mass production of home fuel cell units. With recent technological advances, a number of companies have entered the fuel cell industry, both as start-ups and as established corporations interested in diversifying their product line.Among the fuel cell start-ups is New York State-based Plug Power, LLC. Founded to develop a residential fuel cell for mass production, Plug Power has become a major player in the burgeoning fuel cell industry. The company recently formed a joint venture with GE Power Systems, linking the producer to the distributor in order to ensure consumers access to this innovative technology. The success of the company in working with non-profits, government and the private sector shows that great strides can be made through public/private partnerships.     

Status quo won't work

The division between those who provide health care services and those who pay for them may be widening. Costs continue to rise, quality remains ill-defined, and there don't seem to be any easy answers to the dilemma. Joseph W. Duva, Director of the New York Region Health/Welfare Benefits Consulting Practice of Ernst and Young, believes the answer has been found. While Director of Employee Benefits at Allied Signal Corp., he was instrumental in the formulation of a total managed health care plan for employees. He recently founded the Managed Health Care Association to share the experience at Allied Signal with others and to provide a business forum for exploration of the managed care concept. Duva's views on managed care as a cost containment strategy were the subject of an interview conducted by Physician Executive at the National Conference of Physician Executives in San Antonio in May.     

The medical examiner and deaths in the hospital setting

There has been a perceived increase in the number of medical negligence claims in recent years. The modern metropolitan medical examiner is increasingly called upon to deal with numerous medical, legal, social, and ethical issues. Nowhere is the role of the medical examiner more important than in the investigation of deaths related to surgical, diagnostic, anesthetic, or therapeutic procedures. Medical examiners have an important role in the investigative process. Through utilization of the offices and services of the medical examiner, questions raised by families, physicians, and other hospital employees may be satisfactorily answered a priori, and litigation may therefore be averted.     

Strategically integrating hospital/home care services for improved profitability

Because hospitals and home health agencies have been predominantly separate organizations, coordination of their efforts has not been optimized. However, with the recent proliferation of hospital-based home health agencies, opportunities to integrate these health care service delivery systems have increased. Bethesda Memorial Hospital, Boynton Beach, Fla., is a 362-bed not-for-profit community hospital with a Medicare-certified home health agency organized as a department of the hospital. Until recently, the home health agency was generally perceived as a separate entity whose services were distinct from hospital services. Progress toward integration of hospital and home care services was given impetus through collaboration of the home health agency administrator and a newly appointed director of medical affairs who was given the responsibility as medical director of the home health agency. A prime responsibility of the director of medical affairs was to reduce length of stay and hospital costs through appropriate resource management.     

Diagnosis related groups: product line management within hospitals.

The hospital is viewed as a human service enterprise whose primary function is the provision of diagnostic and therapeutic medical services. Its products are the specific sets of services provided to individual patients. A system for defining hospital products based on the characteristics of patients receiving similar sets of services has been developed and is referred to as Diagnosis Related Groups (DRGs). The system is described, and its implications for improved hospital management are discussed.     

A Game‐Theoretical Model to Improve Process Plant Protection from Terrorist Attacks

The New York City 9/11 terrorist attacks urged people from academia as well as from industry to pay more attention to operational security research. The required focus in this type of research is human intention. Unlike safety‐related accidents, security‐related accidents have a deliberate nature, and one has to face intelligent adversaries with characteristics that traditional probabilistic risk assessment techniques are not capable of dealing with. In recent years, the mathematical tool of game theory, being capable to handle intelligent players, has been used in a variety of ways in terrorism risk assessment. In this article, we analyze the general intrusion detection system in process plants, and propose a game‐theoretical model for security management in such plants. Players in our model are assumed to be rational and they play the game with complete information. Both the pure strategy and the mixed strategy solutions are explored and explained. We illustrate our model by an illustrative case, and find that in our case, no pure strategy but, instead, a mixed strategy Nash equilibrium exists.