Accounting for the transition from inpatient to outpatient surgery

This article reports on some of the factors that have advanced and impeded hospital progress in moving from inpatient to outpatient surgery. Early on, patients, physicians, and hospital administrators all agreed that outpatient surgery had an intuitive appeal. Patients liked it because they didn't have to go in the hospital. Physicians liked it because they could get in and out of the outpatient surgery center more easily than the main hospital operating room. Administrators recognized the inherent appeal of outpatient procedures but were unable or unwilling to switch services from inpatient to outpatient for a variety of reasons. First, empty hospital beds and diminished scope of inpatient operations are a threat to the power of administrators. Moving surgery from inpatient to outpatient settings reduces inhouse operations. Second, reimbursement incentives were definitely in favor of continued inpatient care long after technology was in place for outpatient care. The third and most critical reason was that cost data on outpatient operations were just not available for making decisions on when to move into the outpatient setting. This review of the literature was intended to document the lack of relevant cost-based accounting. Instead, many other factors that more directly slowed progress were encountered. More than anything, this illustrates the erratic course of progress in health care reform.     

Physicians in transition

The study of physicians as managed care executives has been relatively recent. Much of what was written in the past focused primarily on doctors who had taken hospital-based administrative positions, especially as medical directors or vice presidents of medical affairs.1 But the '80s brought rising health care costs and the emergence of the "O's"--HMOs, PPOs, UROs, EPOs, PHOs, H2Os, and Uh-Ohs--in response. It also brought a growing number of physicians who traded their white coats and their particular "ologies" for the blue suits of executive management. I am convinced that it is important now, and will be increasingly important in the future, to better understand that transition. That belief led me to undertake, with the help and support of ACPE, the survey that is reported in this article. A questionnaire was sent in 1994 to a random sample of 300 managed care physician executive members of ACPE. Responses were returned by 225 members, a response rate of better than 80 percent. Twenty-five of the responses were not applicable, having been returned by physicians who had never made a transition from clinical careers. The remaining 230 responses form the basis for this report.     

Power, Politics, and the Framing of Environmental Illness

The medical community, along with other government agencies, has created its own frame of environmental illness. This frame has been generally accepted by the American public. In this paper we discuss framing in general and the factors related to how the environmental illness frame has been constructed and maintained. We offer a brief history of the medical institution and illustrate the frame with its definitions of environmental illness. Qualitative data from a study of Oak Ridge, a contaminated community located in Tennessee, are examined to analyze the consequences of challenging the environmental illness frame. Implications for future research are discussed.     

Identity and Boundary Tensions When Educators and Mental Health Professionals Collaborate: Between Wish and Reality

Schools are centers of collaboration in promoting the development and learning of children and adolescents. They seek to develop cultures of collaboration not only within their walls but also among constituencies with similar interests. These efforts, unfortunately, all too often prove frustrating and disappointing to all concerned. Yet, the need for interdisciplinary inquiry is greater today than ever before. This is particularly true considering the complex, diverse, and multifaceted nature of today's schools. No one professional can address all of the problems confronting education, particularly those of urban schools. For decades mental health and education professionals have joined together around their similar interest in promoting children and adolescent development. One such initiative is a program that fosters educators' development. This program, named the Teacher Education Program, began under the auspices of the Chicago Institute for Psychoanalysis and evolved into the Human Development and Learning Program when a partnership was formed with DePaul University's School of Education. From the program's 34-year history, the authors highlight specific tensions they experienced as directors of this collaborative initiative, and how these challenges either were or were not anticipated and/or addressed. The aims are to put a human face on the challenges and struggles encountered in the relationship between education and mental health professionals, and to identify common ground between educational and psychoanalytic theories and practices.     

Exploration to Foster Career Development

Responses to the Adult Career Concerns Inventory (ACCI: Super, Thompson, Lindeman, Myers, & Jordaan, 1988) were organized through cluster analysis to identify different ways in which adults use exploratory behavior to cope with career development tasks. Significant differences in life-role salience among the types of adult career explorers identified were also investigated. Findings indicated a variety of ways in which adults use exploratory behavior. However, no significant differences were found in life-role salience among the types of career explorers. The discussion explains how career counselors can interpret their clients' ACCI profiles to select appropriate career interventions.     

Social remittances: migration driven local-level forms of cultural diffusion

"Many studies highlight the macro-level dissemination of global culture and institutions. This article focuses on social remittances--a local-level, migration-driven form of cultural diffusion. Social remittances are the ideas, behaviors, identities, and social capital that flow from receiving- to sending-country communities. The role that these resources play in promoting immigrant entrepreneurship, community and family formation, and political integration is widely acknowledged. This article specifies how these same ideas and practices are remolded in receiving countries, the mechanisms by which they are sent back to sending communities, and the role they play in transforming sending-country social and political life." The data concern migrants from the Dominican Republic to the Boston area of the United States.