Pilot study results: the psychiatric RN case manager.

1. It is important to examine client and staff satisfaction with the RN case management (RNCM) model to enhance the quality of care in psychiatric settings. 2. Ninety-two percent of clients surveyed ranked the RNCM care as "excellent" or "above average." Clients valued most the humanistic role of the RNCM and repeatedly commented on the importance of the nurse being caring, genuine, and supportive. 3. RNCMs expressed high satisfaction with their role, which they described as collaborative with the psychiatrist, yet also professional and independent. Psychiatrists expressed a high degree of confidence that clients were receiving excellent care by competent nurse professionals.     

A peer supervision group: put countertransference to work.

1. As the nurse-patient relationship evolves through a series of ongoing interactions, both participants become "known" and stir in each other a range of positive and negative emotional reactions. 2. When working with severely psychologically disturbed patients, the nurse's affective and behavioral response can be valuable clues to understanding the patient's early experiences that contribute to the pattern of relatedness and to the formulation of change, enhancing therapeutic interactions. 3. The goals of the countertransference peer supervision group were to recognize unconscious countertransference reactions; unravel the origin and meaning of those countertransference reactions; and collaboratively develop therapeutic nursing interventions.     

Helping oneself by helping others: evaluation of a service credit banking demonstration

Between 1987 and 1990, the Robert Wood Johnson Foundation funded six service credit banking demonstration programs among the elderly in which participants delivered services in return for credits, entitling them to later service. This evaluation of the demonstrations found that these six sites successfully attracted elders for the delivery of household support services to a relatively old, frail population with potentially limited social networks. Evidence on the significance of the "credit" in attracting volunteers was mixed, but the programs have attracted new volunteers, and have not substituted for other volunteer activities. Program development has entailed considerable staff investment in volunteer support; programs are better understood as community membership organizations than as mechanical exchanges.     

Sucker bet or sure thing: A critical analysis of sports lotteries

A paradox currently exists regarding legal sports gambling in North America: various forms are flourishing in Nevada, Oregon, and several Canadian provinces, while at the same time the United States Congress is conducting hearings on two bills that would prohibit any new state-sponsored sports gambling initiatives. This study examines the issue of why some jurisdictions are enthusiastic about legal sports gambling while others strongly resist the concept. In reviewing these divergent viewpoints, a case study of the newfledged Canadian Sport Select gambling format is presented. This example is used to highly the perils and payoffs of a typical state-sponsored sports gambling scheme, with a view toward broadening our understanding of how they work and how they might be fairer to the public.     

Brief case: managing inputs

Jane Carmichael's views on Managing Inputs provide a further interesting contribution on a topic, strategic control, that we have covered on several occasions in this column. Carmichael's approach is to dig back behind the results being achieved to the 'inputs' on which they depend. But, while this may unearth causes of performance that can often be missed by a bottom-line orientation, results must ultimately remain vital; a business that is on track with all its input measures, but is missing its output goal is still in trouble. We continue to be interested in hearing from readers with views on strategic control processes, particularly those who have found productive ways of setting input and output targets.     

National Practitioner Data Bank--incomplete and future cloudy

Nearly six years after the National Practitioner Data Bank was authorized by Congress in the Health Care Quality Improvement Act of 1986, and more than a year after its actual creation, the device is still only partially operational. What is more, the success of even those limited efforts is being questioned, and the timetable for future developments remains to be firmed up. Also, the costs are much higher than estimated.     

Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.