Purchasing practices in a hospital environment: an ethical analysis

The critical state of the hospital industry, as previously described, generates a difficult decision environment for the materiel manager and those in the purchasing function. The unique life- and death circumstances of hospitals impose a further onus on those who manage them. In the name of saving lives, they can find a convenient excuse to disregard all moral principles, forgetting the Socratic dictum "it is not enough that one lives, but that one lives well." Without the moral "right stuff," they can easily give in to the seductions of momentary gains and glory through ethical short-cuts. There is wisdom and consolation in the words that "nice guys may appear to finish last, but usually they're running in a different race." Studies have established a direct relationship between corporate excellence and ethical values. The reality of competition in the hospital industry dictates that the integration of ethics into the life of the organization should happen by design and not by accident. This is what is meant by strategy. If hospitals would strive for excellence to survive and grow, they should have a strategy with a mission statement that also embodies its moral values and moral agenda. Such an approach does not guarantee that an organization will become immune to moral contamination, but it does provide an antidote.     

Body support testing and rating

The REF, C, and score are a means to give quantitative values for product performance. Other product variables defined as humidity control factor, shear control factor, differential temperature control factor, product life factor, and cost factor were not addressed as part of this study. Additional variables include delivery, maintenance, and warranties. These components can be added to the score in some weighted manner as they become clinically founded. Interface pressures and shears were not measured for beds that are gatched. Each product tested will have characteristics pertinent to its own design that must be addressed to minimize sacral and coccyx skin breakdown when subjects are in this posture because some pneumatic pads bottom out to give excessive sacral and coccyx pressure while others wrinkle when used in this position. This is of major concern when one considers that the coccyx is more susceptible to pressure than any other bony prominence. There may be some aversion to labeling support product performance because it will allow the purchaser to know what is being bought. This initial study indicates the feasibility of quantitating what all patients require: a valid interface support surface for each specific need. The user can be adequately informed before the purchase as to a product's merits without being influenced by the results of inadequate testing, referrals, or sales media influences. Although cushions, shoes, or other prosthetic/orthotic devices were not part of this study, it is appropriate to rate all these devices in a similar manner by simply comparing pressure relief attained to that desired, expressing the result as a percentage of the worst case, and then labeling the product accordingly. Those subjects with sensation can rate comfort as part of the overall score. For cushions, ischial tuberosity pressure relief can be expressed as a percentage of the maximum attainable relief. Metatarsal head relief during gait as well as during static testing can be measured, and claims can be made for shoes and sneakers. Where impact loads and shear forces are paramount, the score must comprise appropriate parameters. Similarly, amputee distal stump relief as a percentage of worst case could be specified by the fitter. Iliac crest relief as a percentage of worst case can also be specified by the fitter. In all instances the score is not a subjective rating but one that can be measured correctly. All body support products can be given an REF, C value, and score as well as other qualifying values where appropriate instrumentation and sufficient subject sampling is used.     

Policies for economic growth

Summary The old growth theory of the 1950s led to certain conclusions about the sorts of economic policies that would promote economic growth, and also about their limitations. The new growth theory of the 1980s makes much stronger assumptions and leads to correspondingly stronger conclusions about the scope of growth-promoting policy. This article argues that: (1) empirical work so far has neither confirmed nor denied the strong assumptions underlying the new theory; (2) the theory is worth pursuing because of its intrinsic interest and the possibilities it opens up; (3) whatever the final verdict on the new theory, both theory and evidence support the belief that significant long-run gains, even if not permanent changes in the growth rate, can be achieved by increased investment in the broadest sense, including human capital, technological knowledge, and industrial plant and equipment.Fifth Tinbergen Lecture delivered on October 4, 1991, in Amersfoort for the Royal Netherlands Economic Association     

Yes, the market can curb health costs

Memo to Clinton's transition team: forget those tough expenditure ceilings you're considering. Look instead at what managed competition is already accomplishing.     

Integration of collective bargaining and formal worker participation processes: Boon or barrier to worker rights?

Many employers are extending workplace rights by allowing for more employee voice in decision making. Numerous unionized organizations have established formal worker participation processes to help achieve this end and to improve organizational performance. Based largely on theory, such processes are normally designed to operate independently from the bargaining process. The purpose of this study was to examine the relationship between participation and bargaining processes, and the effect of this relationship on workplace satisfaction. A total of 712 Midwest union officials were surveyed, and the results indicate that the processes tend to become integrated in the workplace. Further, union officials' workplace satisfaction was greater where formal worker participation is institutionalized within the bargaining process.     

Local and National Impacts from Landing North Sea Gas in Western Norway

A bstract . A simple framework is presented for the analysis of the local employment, income, sales , and local government impacts of landing North Sea gas at either of two Norwegian kommunes (municipalities). These impacts indicate the different forms of economic change arising from a major economic development event. The average annual net change in these economic measures is estimated for the operational phase of a gas terminal. The analysis indicated substantial differences in local and regional net gains. Both sites yielded positive neteconomic gains, which means noneconomic and national considerations become key decision determinates. These national issues provide the setting to judge the local/regional net gains. The unresolved questions include the national benefits and costs of the landing decision given the small scale of the Norwegian economy, potential future gas finds, and a fully employed economy.     

HUMAN RESOURCE MANAGEMENT AND INDUSTRIAL RELATIONS[1]

Human resource management (HRM) is a term which is now widely used but very loosely defined. In this paper it is argued that if the concept is to have any social scientific value, it should be defined in such a way as to differentiate it from traditional personnel management and to allow the development of testable hypotheses about its impact. Based on theoretical work in the field of organizational behaviour it is proposed that HRM comprises a set of policies designed to maximize organizational integration, employee commitment, flexibility and quality of work. Within this model, collective industrial relations have, at best, only a minor role. Despite the apparent attractions of HRM to managements, there is very little evidence of any quality about its impact. Furthermore very few UK organizations appear to practise a distinctive form of HRM, although many are moving slowly in that direction through, for example, policies of employee involvement.     

Are robust estimation methods useful in the structural errors-in-variables model?

Summary In this paper it is investigated whether robust estimation procedures for the parameters of a regression model are also applicable when the observations are generated by the errors-in-variables model. Specifically, attention is paid to bounded-influence estimators, i.e. estimators that are constructed in such a way that the influence of a single observation on the outcome of the estimator is bounded. Both the classical errors-in-variables model and models with contaminated observational errors are considered.The authors are indebted to a referee for his valuable comments on an earlier version of this paper.     

The occurrence of outliers in the explanatory variable considered in an errors-in-variables framework

Summary The problem of estimating the slope of a linear relationship between two jointly normally distributed random variables is considered when outliers may occur in the explanatory variable. It will be studied as a special case of an errors-in-variables problem where the explanatory variable is measured which a nonnormally distributed error. In this more general model and under certain conditions a consistent estimator can be given with a normal limiting distribution. Applications to cases of outliers in the explanatory variable will be presented.     

Health and development∗

The linkage between development and health is clearly spelt out in the definition of primary health care by the World Health Organisation. There is a widespread and growing disillusionment with the traditional Western approach to health care which fails to meet the real demands of the Third World situation.

This paper looks briefly at conditions in the developing world and the strategy proposed by the W H O to attempt to meet the objective of health for all by the year 2000 and refers to the South African situation.