The Problem-Oriented Method of Health Care Administration

Abstract

In 1968, Dr. Lawrence Weed^1,2 described the problem-oriented medical record as a basic tool in medical education. The authors attempted to adapt the “Weed System” for use in health care administration. The aims of the modification were to facilitate participative management in problem solving, and to formulate quality decisions by the consensus of an interdisciplinary group of managers.

Thirteen Department Heads were introduced to the Problem-Oriented System as described by Weed.^1,2 The Problem-Oriented Method of Health Care Administration (POM/HCA) was described by the Director as an extension of Weed's system.³

Weed's categories of Subjective, Objective, Assessment, and Plan (SOAP), were given for each problem presented at Department Heads' Meetings. The subjective information for the particular problem was derived from the felt or perceived needs, or the immediate pressures that so often arise in a multidisciplinary health care setting. Objective data came from identification and analysis of information about the problem. The assessment section was used by the Director to outline his thinking on the issue. The plan-for-decision section indicated the desired level of staff involvement in the decision-making process, by giving a numerical value to the area of freedom for the staff (adapted from Tannenbaum and Schmidt).⁴

Each Department Head was interviewed by the Management Consultant to find out how he or she experienced POM/HCA, their reactions to the numerical system for designating staff involvement in the decision-making process, and what he or she saw as the impact, advantages, and limitations of this method.

“Blood Doping:* An Update,” M.H. WILLIAMS. The purpose of this paper is to review the literature relating to the use of blood doping* in an attempt to improve the performance of an aerobic endurance athlete such as a five or ten km. runner or a marathoner. An earlier review of the literature by the author in 1975 concluded that there was not sufficient objective evidence to support the use of blood doping to increase endurance capacity. However, contemporary research demonstrates that when properly done, blood doping does significantly increase endurance performance in sports that are dependent on sustained, high levels of oxygen. The author also calls attention to the medical, legal, and ethical problems related to the practical application of blood doping. (The Physician and Sports Medicine 1981, July;9(7)59–64.)

* Blood doping is the process of removing blood from an athlete, usually an endurance-related sports participant, saving the blood and then about two weeks later, prior to competition, retransfusing into the system, to increase the oxygen capacity.

Contributed by John M. Miller, M.D.