A fragmented patient safety concept: the structure and culture of safety management in health care

The uniform and visible commitment to safety management is a cultural and structural change that health care organizations have not typically attempted. Committee structures are just one example of how culture drives structure in managing health care safety. The question is: "Are we interested in making nonpatient safety programs as well understood and as culturally significant as patient safety programs?" Models exist to institutionalize safety management in health care. We need only look to the JCAHO or OSHA and other high-hazard industry models for examples of safety management. Change requires a focus on safety, not occupational safety or patient safety, but just safety. In health care, safety would be a key characteristic of organizational culture. The organizational expectation is then that all employees will work safely and practice safety. Employees will apply safe practices when handling chemicals, in lifting, and when giving medications. Only when safety imbues the work and decisions of each employee in this way will the highest level of safety be attained.     

The Mortgage Acquisition Process: A Comparison of VRM and FRM Borrowers*

In recent years a number of alternative types of residential mortgage plans (i.e., alternative to the fixed-rate level-payment mortgage) have been proposed, and some of these have been available in various parts of the country. The most often proposed innovation has been the variable rate mortgage (VRM). The most widespread use of the VRM has been in the State of California, starting in early 1975. This paper discusses some of the results of a survey of over 1,700 homeowners in California that examined consumer reaction to the VRM. Specifically, this paper looks at the impact of the VRM on the mortgage acquisition process and the features of mortgages demanded by consumers. The data seem to indicate that the process of acquiring a mortgage has not been affected significantly by the availability of the VRM. However, the existence of alternative mortgage plans means that consumer choice can be broadened to include type of mortgage as well as lending institution.     

Accidental injuries among the elderly within the Vienna community: Epidemiology,risk factors and preventive measures

Abstract

Unintentional injuries ('accidents’) among elderly people are a significant burden in public health because such accidents happen frequently and because the proportion of older age groups in the population will continue to rise during the coming decades. One aim of this study, which was done in Vienna, the capital of Austria, was to broaden the preventive concept, adding lifestyle and living conditions to already well-known risk factors following the health promotion approach. Furthermore, characteristics that predispose older residents to accidents should be identified in order to design preventive measures for reducing injuries in this age group.

809 interviews with people 60 years of age and over were conducted, concerning accidents, outcomes of accidents, physical fitness, drug intake, type of house or dwelling, equipment in the household incorporating safety features, psychological well-being and social relations. The information collected was used to draw cross-sectional comparisons between participants who reported having experienced at least one accident in the previous 12 months and those who did not. Furthermore, the accident incidents were classified into 2 groups: incidents without injuries and injurious accidents. The latter served as a base for the epidemiology of injuries for people 60 years of age and over within the Vienna community.

20% of all senior citizens suffer at least one unintentional injury every year, in addition to which 8% experience critical incidents (mostly falls) without injury. Most accidents occur at home or involve pedestrians in public traffic areas. Over 90% of all accidents are falls, and 20% result in fractures. The most important risk factors for accidents in the elderly are gender, increasing age, poor physical fitness and low physical activity, the type of household and household equipment, poor psychological well-being, low income and loneliness.

The findings regarding falls suggest some possible opportunities for reducing the risk of falls by improving buildings and dwellings of the elderly. A promising attempt at practical implementation of these findings is being conducted by the Vienna-based Austrian Institute for Home and Leisure Safety in cooperation with the Vienna City Council. These two organizations are implementing a long-term program that aims at mobilizing institutions and organizations involved in working with the elderly.     

Diminishing Returns and the Limit of Athletic Performance

The purpose of this paper is to estimate athletic performance profiles over time, to establish that diminishing returns is a characteristic of performance functions, to measure the rate of the marginal decline, and to measure the upper (lower) bound or limit of performance. The empirical results yield estimates of the limiting value of athletic performance and the frontier maximum (minimum) record. Since lower bounds in the running events have been shown to be sensitive to choice of the nonlinear model, logistic and an exponential model for the men's running and distance events are estimated as a cross-check on my differential equation model. The issue of the gender gap (whether women will ever catch men) in athletic performance is also explored.     

Local public goods and private suppliers: Musical suburbs replayed

This paper deals with the existence of private market suppliers in a standard local public goods model. The result of this modification can be a cycling process instigated by rich households rather than poor households. The theoretical model provides empirical implications for capitalization studies and policy implications for the provision and financing of local public goods including education.     

What mbo really is: Results require a complete program

Management by objectives (MBO) is commonly described too narrowly; firms that report unsuccessful experiences have been practicing a limited program. To clear up the confusion that beclouds MBO, the authors first describe the concept and its emphasis on results (the achievement of objectives) and on human behavior and motivation (fulfillment of needs and participation). The MBO system is then examined. The system has four basic components: setting objectives, developing action plans, conducting periodic reviews, and appraising annual performance. Many firms have found that MBO plays the leading role in the managerial process of achieving corporate objectives. The authors list seven major benefits that an organization can expect.