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Bibliography Series

 

Services Shared by

Health Care Organizations:
An Annotated Bibliography

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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US. DEPARTMENT OF
HEALTH. EDUCATION,
AND WELFARE

Public Health Service

Health Resources Administration

The Division of Planning Methods and Technology,
BHPRD, through the National Health Planning
Information Center, is a primary resource for
current information on a wide variety of topics
releVant to health planning and resources devel-
opment. To facilitate the dissemination of
information to health planners, the Center will
publish selected monographs and bibliographies
in three series: '

1. Health Planning Methods and Technology

 

This series will focus on the technical and
administrative aspects of the health planning
process, including Such areas as methods and
approaches to the various aspects of the

health planning process, techniques for ana—
lyzing health planning information and problems,
and approaches to the effective dissemination
and utilization of technical information.

2. Health Planning Information

 

This series will focus on data and information

to Support the health planning process, including
sources of information and data for use in
health planning.

3. Health Planning Bibliography\

This series will focus on general and specialized
bibliographies that relate to topical subject
areas in health planning.

Services Shared by Health Care OrganiZatiOns: An
Annotated Bibliography is the third publication in
the Healtthlanning Bibliography Series.

 

Services
Shared by
Health Care
Organizations:
An Annotated
Bibliography

Developed by:

Health Services Research Center

of the Hospital Research and Educational Trust
and Northwestern University

Under Contract No.
HRA 230-75-0062

March 1977

US. DEPARTMENT OF HEALTH, EDUCATION; AND WELFARE
Public Health Service

Health Resources Administration

Bureau of Health Planning and Resources Development
Division of'Planning Methods and Technology

National Health Planning information Center

DHEW Publication No. (HRA) 77-14552

HRP—030030l

wane 4
HEALTH .3

w 77 70% /

FOREWORD

There is an increasing interest in and concern with the sharing of
institutional health and health support services in this country as a
means to increase efficiency and to restrain cost increases. Public
Law 93-641, the National Health Planning and Resources Development Act
of 1974, established 10 National Health Priorities, of which two address
the development of such sharing arrangements.

This bibliography was designed to a531st planners at many levels in
gaining access to knowledge which will enhance their efforts to achieve
new or expanded arrangements of service sharing. While the primary
audience is intended to be health planning agencies and institutional

planners, other groups associated with shared services may find the
bibliography useful.

This annotated bibliography covers the literature on shared services
and closely related topics for 1970 to 1975. It was developed for the
Bureau of Health Planning and Resources Development, Health Resources
Administration, under Contract No. HRA 230-75-0062, by Health Services
Research Center of the Hospital Research and Educational Trust and
Northwestern University.

,% . «4%

Frank . Morrone, Jr.

Acting Director, Division of
Planning Methods and Technology

Bureau of Health Planning and
Resources Development

iii

PREFACE

The concept of shared services represents a broad topic within the
published literature. There are no clear boundaries to the concept,
and semantic ambiguity abounds. There are many descriptions of
ongoing shared services and many normative statements about ideal

ways to share. The different types of arrangements possible within
any one given definition of shared services are numerous, and various
attempts at surveying the frequency of sharing in different geographic
areas have been made. The breadth of the topic of shared services is
evident from even a cursory reading of the proceedings of conferences
on shared services.

The basic organizing principle of this bibliography is utility to the
reader. Entries have been cross—referenced to as many categories as
the material warrants. The annotation for an entry is placed in that
section where, in the reviewer's judgment, the main focus of the publi-
cation lies. The decision may seem arbitrary at times, but the
cross-referencing of entries serves to correct potential errors of
judgment. Not all entries in the bibliography are annotated. There
are two reasons for this: the material in many of the documents may
already be covered by other references, or the Substance may be
tangential to the topic and of limited, specialized interest. It is
hoped that the annotations in and of themselves will be educational,
but there is no substitute for reading the original documents.

Case studies which are not annotated are followed by a brief descrip—
tive phrase indicating the name of the shared services organization
and/or the area of the country which is the focus of the study.

With few exceptions, the references selected for this bibliography
have been published in the United States since January 1970. For
additional material on shared services, the reader is advised to
conSult the bibliographies listed on page 15 of the present work.

iv

 

Foreword .

Preface. -

CONTENTS

0 o n a . o o n a n o u o o o o o

o o a o o o a o o o o o u n o a a

General and Overview Topics. . . . . . . . . .
Semantics: Definitions and Classifications
Guidelines and General. . . . . . . . . .
Surveys . . . . . . . . . . . . . . . . .
Conference Proceedings. . . . . . . . . .

Bibliographies. . . . . . . . . . . . .

Specific Services and Facilities . . . . . .
Medical/Clinical. . . . . . . . . . . .
Manpower. . . . . . . . . . . . . . . .
Administrative/Supportive . . . . . . .

Purchasing . . . . . . . . ._. . .
Education and Training. . . . . . . . .
Disciplinary Studies . . . . . . . . .,. . .
Tax and Legal . . . . . . . . . . . . .
Organization Behavior . . . . . . . . .
Economics . . . . . . . . . . . . . .-.
Process—Oriented Studies . . . . . . . . . .
Planning. . . . . . . . . . . . . . . .
Feasibility . . . . . . . . . . . . . .
Implementation. . . . . . . . . . . . .
Evaluation. . . . . . . . . . . . . . .
Rural and Small Hospitals. . . . . . . . . .
Related Pertinent Basics . . . . . . . . . .
Index. . . . . . . . . . . . . . . . .
Addendum

Accounting and Information Systems
Central Service. . . . . . . . . .
Dietary. . . . . . . . . . . . . .
Equipment. . . . . . . . . . . . .
Laundry. . . . . . . . . . . . . .
Library. . . . . . . . . . . . . .
Medical Audit and Medical Records.

Page
iii

iv

12
14
15

l6
16
24
30
30
34
35
36
37
44
45
45
49

55
55
57
60

63
63
66
69
71
73
76

78

 

 

GENERAL AND OVERVIEW TOPICS

SEMANTICS: DEFINITIONS AND CLASSIFICATIONS

Shared services in the health delivery arena occupy a middle ground

between institutional autonomy and total merger., This section of the
bibliography provides a variety of definitions and classification schemes
which demonstrate the complexity of the concept of sharing and the lack of
concensus concerning the boundaries of shared services.

1.

Bailey, D. R. Hospitals can, must influence change. Hospitalsz J.A.H.A.
47:55-59, Sept. 1, 1973.
(Annotation, 17)

Clark, W. E. More on semantics. Health Serv. Res. 7:153-154, Summer
1972.

The semantics of multihospital aggregations. Health Serv. Res.
6:198-203, Fall 1971.

Multihospital relationships may be differentiated by geographic pattern

or by organizational structure. Physical arrangement alternatives.in—
clude distributed networks, neighborhoods, campuses, and condominiums.
Organizational alternatives include associations, consortiums, federations,
and mergers. Certain combinations of organization and physical arrange-
ment are seen as intuitively more appropriate than others. Shared service
functions can be replicated, assigned, pooled, or purchased. The organi-
zational and physical implications of the various alternative shared ser-
vice models are discussed.

Cook, H° F. Shared services--complex, but rewarding. Hospitals, J.A.H.A.
47:81-81,86-87, Feb. 1, 1973.

The author reviews and describes alternative organizational structures for
shared services (associations, consortiums, federations, and mergers) and
alternative methods of providing services (replication, assignment, pooling,
and purchasing). He cites ten principles for developing cooperative pro-
grams: "The joint venture should perform services that the individual hos-
pitals cannot do as well or as inexpensively on their own; the goal of the
cooperative effort should be to produce increased income, to decrease
expenses, and/or to increase the quality or scope of service provided to
the community; participation in the project should not freeze hospitals
into future conformity to past patterns; the shared service's board of
directors must continually maintain meaningful control of the program; the
shared service should be economically self-supporting; the project should
not effect the sponsor's fiscal independence; participants should enter
shared service programs on a voluntary basis only; the medical or other
affected staffs of the individual hospitals should be involved as early in
the development stage as possible; an organizational structure that best

10.

11.

fits the individual program should be designed; the financing mechanism
should be suited to the individual project."

Davis, R. N. Survey analysis: sharing in New York State. Hosp. Forum

(New York}. 41:11-12, Mar. 1973.

Five sharing formats are presented in order of approximate difficulty to
achieve: ad hoc purchase, trading, endorsement, association service, and
joint venture. Each model is described, the advantages and potential
disadvantages of each are noted, and examples are provided.

DeVries, R. A. Kellogg‘s role in fostering shared services. Hospitalsz

J.A.H.A. 47:86-87, Feb. 1, 1973.

(Annotation, 33)

Health Services Research Center. Guidelines for Health Services Research &
Development: Shared Services. Washington, DC: National Center for Health
Services Research and Development. DHEW Pub. No. (BRA) 74-3023, 1972.
(Annotation, 44)

Holland, D. C. Legal and tax aspects of shared services. In: American
Hospital Association. Shared Services in Health Care Institutions“
Chicago: AHA, 1975, pp. 11-16.

(Annotation, 429)

Sabichi, F. D., and Long, T. L. Association serves 17 hospitals. Hospitals,
J.A.H.A. 481101-102, June 1, 1974.

Midtown Hospital Association of Denver, CO, is a voluntary, not-for-

profit corporation currently providing 20 shared services for 17 hospitals.
Four types of shared services offered by the Association are described:
departmentalized shared services; contracted shared services; coordinated
hospital resources; and ”status quo services," or feasibility investigations
of possible shared services even when existing services are found to be
preferable.

Starkweather, D. B. Beyond the semantics of multihospital aggregations.
Health Serv. Res. 7:58-61, Spring 1972.

. Health facility mergers: some conceptualizations° Med. Care.
9:468-478, Nov.-Dec. 1971.

The author uses a number of classification schemes to conceptualize health
facility mergers and combinations. The first scheme identifies seven dimen-
sions, each of which can be viewed as a spectrum from pluralism to fusion:
organizational patterns, legal bonds, nature of combined services, stages
and forms of production, geography of population served, facility location,
and organizational impact. From five to eight points are identified for
each dimension, representing actual or hypothetical health care facility
arrangements. The second scheme emphasizes the dynamics of health facility
combinations and the dimension of time. Seventy-two variables are arranged
according to five stages of the merging process: pre-existing conditions,
initiating forces, enabling factors, dynamics of execution, and stabiliza-
tion. The schemes are intended to facilitate understanding of the dynamics
of health facility inter-organizational relationships.

GUIDELINES AND GENERAL

This section provides a broad overview of shared services including some

case studies of shared services programs encompassing a multitude of activi-
ties as well as some attempts at synthesizing these experiences into some
generally applicable principles. Many of the entries here could have been
annotated in other sections. Empirical wisdom is not confined to these ref-
erences.

‘12.

:13.

‘14.

‘15.

16.

An alliance for sharing. Hospitalsz J.A.H.A. 47:51-53, Dec. 16, 1973.
(Rural Health Care Alliance, southeastern Oklahoma and north central Texas)

American College of Hospital Administrators. An Examination of Shared Ser-
vices. Chicago: ACHA, 1974.

In five parts: (1) "Introduction," including a brief discussion of existing
pressures for the effective implementation of shared services and a review

of the formation of the task force, (2) "Economic principles and the health
care industry (with special reference to shared services)," addressing cost
factors and economies of scale, considerations of status, prestige and auton-
omy, and the lack of incentives for lowering cost production, (3) "Answers

to pertinent questions about shared services,” examining the comparative
efficiency of various kinds of shared services, the most effective administra—
tive approaches to sharing, the possibility of defining cost saving expec-
tations for particular types of services, and the comparative efficiency of
contracts with investor-owned companies vs. interhospital arrangements,

(4) "Case studies,” focusing on printing, data processing, central laundry
operations, and credit and collection, and (5) ”Statement of principles
underlying the successful operation of shared services.

American Hospital Association. Guidelines for Hospital Involvement in
Comprehensive Health Delivery Systems. Chicago: AHA, 1973.

"These guidelines are intended to provide the hospital with a perspective
and a process by which it can examine its present service role and the
alternatives to that role in relation to changing community needs.... Health
delivery systems in the context of these guidelines can be defined from

the narrow sense of a sharing of services between hospitals to the broad
integration of patients or consumers and health care institutional and
professional providers and managers into a single organizational structure
providing comprehensive health care services."

. Shared Services in Health Care Institutions. Chicago: AHA, 1975.

A collection of selected articles and original papers focusing on major
issues in shared services. Contents: Association serves 17 hospitals,

F. D. Sabichi and T. L. Long; Wide range sharing for two hospitals,

J. W. Owen; Legal and tax aspects of shared services, D. C. Holland; The
changing anatomy of an academic health center, J. C. Donaher Jr.; Financing
shared services programs_in a multihospital system, J. A. Skarupa; Cost
saving and other measures of shared service effectiveness, P. E. Ludwig.

American Hospital Association group to recommend voluntary chains! Mod.

3

17.

18.

19.

20.

21.

Hosp. 115:108, April 1970.

Bailey, D. R. Hospitals can, must influence change. Hospitals, J.A.H.A.
47:55-59, Sept. 1, 1973.

Examines four activities through which administrators can enable hospitals
to adapt to and influence imminent changes in the health care system: de-
veloping a planning process, meeting community health needs, coordinating
regional services, and sharing services. The actions are interdependent
and, taken together, form an integrated planning process. Four formal
hospital grOupings which facilitate regional coordination are described:
associations, consortiums, federations and corporations.

Bauer, K. G., and Densen, P. M. Some issues in the incentive reimbursement
approach to cost containment: an overview. Med. Care Rev. 31:61-100,
Jan. 1974.

The authors review existing incentive reimbursement plans and examine
the cost effectiveness of each.

Bieter, J. T. Four options for cooperation: implications for Catholic
hospitals. Hosp. Progr° 51:64-65,101, Mar. 1970.

Four categories of hospitals based on cooperation level are described and
evaluated in terms of comparative difficulty to achieve. They are: no
cooperation hospitals, administrative cooperation hospitals, cooperatively
planned hospitals, and merged hospitals. Catholic hospitals are at a dis—
advantage in implementing the more complicated types of cooperative arrange—
ments because of their peculiar organizational structure. The distance of
a Catholic hospital from its ownership base, the rotation and change of
administrators in Catholic hospitals, questions of title to property, re-
ligious mission, and the practice of sharing certain services with order
hospitals over a wide geographic area all may contribute to the difficulty
of forming cooperative arrangements with local non-Catholic hospitals.

Blumberg, M. S. Shared Services for Hospitals. Chicago: AHA, 1966.

This report, which is based on a study conducted between July 1963 and June
1964, is one of the most comprehensive early reviews of the status of shared
services in U.S. hospitals. Information for the study was obtained by sur-
veys of selected organizations, personal interviews and a literature search.
Particular emphasis is placed on defining shared services and on identifying
a few specific illustrative examples of each, rather than on collecting and
reporting statistical data on the availability of shared services. Shared
services are considered in the broadest sense as "any service or product

that a hospital purchases or obtains from an outside agency" although major
emphasis is placed on shared services which have been established as coopera-
tive ventures and which are not universal. Examples of shared service arrange-
ments are organized in 12 major categories. The report includes a checklist
of hospital activities subject to sharing by several hospitals and a 147-item
bibliography covering the early literature on hospital shared services.

Boone, C. C. Sharing: a way of life. Hosp. Admin. 18:53-60, Spring 1973.

Case study and evaluation of services shared by several North and South Carolina

4

22.

23.

24.

25.

26.

27.

28.

 

29.

30.

31.

 

hospitals. Consideration is given to the philosophy behind sharing and
its implementation in the areas of shared food services, group purchasing,
joint departmental meetings, shared data processing services, and shared
industrial engineering services.

Borgess and Bronson hospitals make joint-effort to increase health care
services. Mich. Hosp. 7:17, Aug. 1971.
(Kalamazoo, MI)

Boston, J. R., and Edwards, S. A. Hospital mergers: a model for third-
party funding. Hosp. Admin. 19:42-48, Summer 1974.

Brown, M. H. Current trends in cooperative ventures. Hospitals, J.A.H.A.
48:40-44, June 1, 1974.

Central Pennsylvania consortium seeks to fill gaps, avoid duplication.

Hospitals, J.A.H.A. 49:95, Jan. 1, 1975.
(Susquehanna Valley (PA) Health Care Consortium)

Chicago: shared laundry, purchasing gather steam. Mod. Hosp. 114:104,
Apr. 1970.
(Chicago-area shared services arrangements)

Citizens League urges hospitals to share services--and they do. Mod. HOsp.
118:39, May 1972.

Hennepin County General and the Metropolitan Medical Center in Minneapolis
expect to consolidate over 30 services including pediatrics, obstetrics,
newborn intensive care, and emergency services, as well as laundry, dietary,
central supply, and power services. The impetus for this cooperative
arrangement came at the suggestion of the Citizens League which was studying
the proposed separate projects of the neighboring hospitals.

Communication lines tie nine rural hospitals into network. Mod. Hosp.
118:93-95, Apr. 1972.

Nine hospitals in southeastern Oklahoma have formed the Southeastern Oklahoma
Health Care Alliance to extend the use of health manpower in a rural area

and to contain costs. The Alliance accomplished these goals by sharing a
number of services including coronary care, blood bank, medical library,
speech therapy, nurses aide training, and continuing education for all
members of the hospitals' health care teams. The hospitals also cooperate
with post-secondary schools in training health manpower. The article in-
cludes a detailed description of the use of a teleconference network which

is used in continuing education programs for hospital personnel, in patient
education, and in emergency assistance.

Cook, H. F. Shared services--complex, but rewarding. Hospitals, J.A.H.A.
47:81—82,86-87, Feb. 1, 1973.
(Annotation, 4)

Davis, R. N. Survey analysis: sharing in New York State. Hosp. Forum
{New York). 41:11-12, Mar. 1973.
(Annotation, 5)

Deane Jr., A. S. Consortium achieves mutual goals. Hospitals, J.A.H.A.

32.

33.

34.

35.

36.

48:95-96, June 1, 1974.

Case study of the lB-member West Suburban Hospital Association which serves
communities west of Greater Boston. The study includes a list of goals

of the association as incorporated in the bylaws and reviews the activities
of the Consortium for Information and Training which was developed to
serve nurses and allied health personnel of the member hospitals through
both library information and continuing education programs. Eight projects
currently underway are being coordinated by a part-time director. These
projects include the implementation of some shared services, research and
feasibility studies of others, and liaison with state and regional health
agencies. '

DeHoff, J. B. Health care consortiums--new roles for local health depart-
ments. Amer. J. Public Health. 63:672-674, Aug. 1973.
(Baltimore City Health Department)

DeVries, R. A. Kellogg's role in fostering shared services. Hospitals,
J.A.H.A. 47:86-87, Feb. 1, 1973.

Shared services are defined as "those clinical or administrative functions
that are common to two or more institutions, that are used jointly or co-
operatively by them in some way for the purpose of improving service and/or
effecting economies of scale, and that hold all participating parties at
risk in the sharing venture." The foundation favors investments in shared
services models for five major reasons: "these models may lead to new de-
livery forms; they may aid in the control and containment of costs; they
may directly improve care to patients; Kellogg assistance may mean the
difference between launching a project with federal aid or not; and, finally,
new and experimental models might not be launched were it not for private
philanghropy."

Doody, M. F. Guidelines for implementing cooperative programs. Hospitalsz
J.A.H.A. 48:55-58, June 1, 1974.

Examines health services consortiums, corporate consolidations and mergers,
'multihospital systems, and health maintenance organizations as responses

to both internal and external pressure to control health care costs and

to increase service capabilities. The author offers observations about

the future of cooperative programs and lists ten principles useful for
achieving cooperative programs.

. Shared services and the Association. Newsletter Hosp. Manage.
Systems Soc. 12:4-5, Nov.-Dec. 1973.

 

Describes the functions and activities of the Division of Health Delivery
Systems which was established by the American Hospital Association within
the Bureau of Management and Planning Services in October 1972.

Dunn, D. W., and Willits, H. M. Through the strength of many. Hospitalsz
J.A.H.A. 48:99-100, Oct. 1, 1974.

Examines the role of state hospital associations as facilitators of coopera-
tive arrangements, particularly among small and rural hospitals. Examples
of shared services arrangements conducted or sponsored by state hospital

 

 

 

 

37.

38.

39.

40.

41.

associations include joint purchasing, collective insurance programs,
shared management engineering, centralized accounting, central data col-
lection, insurance programs, manpower recruitment, collective legal ser—
vices, public relations efforts, and so forth. The authors review various
programs of the Iowa Hospital Association.

Edwards, S. A., and Astolfi, A. A. An incentive program for shared services.
Hosp. Forum (New York). 4127-8,15, Mar. 1973.

An experimental approach to rationalizing shared and consolidated services
is proposed. In accordance with the theory of group incentives, providers
implementing cost-effective shared or consolidated services programs would
be entitled to receive incentive payments from the federal government that
are stipulated in reimbursement contracts for federally financed health
care services. The basic structure of the program and its implementation,
from initiation of an individual project through project evaluation, is
outlined. Primary advantages of the proposed approach are increased pos-
sibility of realizing sharing objectives, lucrative return on capital in-
vested by the government, provision of improved and extended services,
facilitation of planned growth on a national level, and stimulation of a
cooperative union between public and private resources.

Four New York hospital presidents form consortium. Hospitals, J.A.H.A.
46:25, Feb. 16, 1972.

The Iroquois Hospital Consortium, Inc. was formed to "foster and en-
courage cooperation and consultation among hospitals and to improve

the quality of hospital service provided for patients." The Consortium
plans to sponsor cooperative programs, explore and develop new concepts

in health care, and develop new techniques in hospital procedures, admini-
stration, and service.

Freeman, J. R., and Zaldivar, M. F. A Generalized Model for Planning
Shared Health Services (Technical Report no. 4). Gainesville: University
of Florida, Health Systems Research Division, 1969.

 

 

The author uses four kinds of costs--excess capacity, unit labor, trans—
portation, and change-over--in formulating a decision rule which can be
used along with non-monetary criteria to determine the desirability of
sharing services.

Friedland, M. Detroit: sharing to stay alive and move toward merger.
Mod. Hosp. 114:102-104, Apr. 1970.
(Detroit-area shared services arrangements)

Goudreau, W. J., and Lowery, G. E. Shared services—-a new involvement
for hospital administration. Mich. Hosp. 10:4-7,26, Feb. 1974.

A set of monitoring criteria is proposed for use by administrators of in-
dividual institutions to assure effective and meaningful involvement in

shared service programs. The criteria include drawing up articles of as-
sociation, designating an operating or management committee, establishing

a chart of accounts, preparing an annual budget projection, a monthly finan-
cial statement, and an activity report, establishing personnel policies and

a personnel budget, deciding on a meeting schedule for the operating committee

42.

43.

44.

45.

46.

47.

48.

and a formal communication procedure, arranging for periodic site visits,

and preparing an audio-visual presentation for use in explaining the pro-

gram's operation to appropriate groups in the hospital. Important factors
to be considered in implementing each of the criteria are noted.

Hartshorn, T. Government incentives for shared services. Pt. 1. Hosp.
Manage. 109:74-76, Mar. 1970. Pt. 2. Hosp. Manage. 109:91-92, Apr. 1970.

Describes various governmental incentives for sharing services which were
created to promote health services management effectiveness: experimental
incentive reimbursement programs, Section 402 of the Social Security Amend-
ments of 1967; Regional Medical Programs, Public Law 89-239; tax-exempt
status for shared services organizations, Section 501(e) of the Internal
Revenue Code; and the authority of the Medicare Program to limit cost
reimbursement to reasonable levels.

Health resources association seeks synergy in services. Mod. Hosp.
118:44,46, June 1972.

(North Suburban Association for Health Resources, Chicago's northern
suburbs)

Health Services Research Center. Guidelines for Health Services Research &
Development: Shared Services. Washington, DC: National Center for Health
Services Research and Development. DHEW Pub. No. (HRA) 74-3023, 1972.

These technical guidelines are based on a review of current information on
shared services and are intended primarily for use by institutions which
are interested in initiating or joining a shared service project. Four
general categories of shared service organizations are identified including
referred, purchased, multiple-sponsored, and regional services; the possible
impacts of a shared service on both the institution and the environment

are enumerated; and the advantages and disadvantages of shared services
programs are examined. The activities involved in developing a shared
service are described in detail from the preliminary through the focused
analysis and into the implementation stage. A final section of the guide-
lines is devoted to the evaluation of shared services and includes recom-
mended procedures for evaluation based on financial characteristics and

on the comprehensiveness, availability, and acceptance of care.

Hospital Association of New York State program for shared services. Hosp.

Forum (New York). 41:13-14, Mar. 1973.

Kansas City (KS) area hospitals form group purchasing service to combat
costs. Amer. Family Physician. 3:169-170, Mar. 1971.
(Kansas City (KS) Area Hospital Association)

Lauzen, E. Seattle: hospitals write new formula for central supply.
Mod. Hosp. 114:100-102, Apr. 1970.
(Seattle-area shared services arrangements)

Lewis, H. L. A togetherness spirit in Connecticut. Mod. Healthcare.
2:25-29, July 1974.

Eight hospitals in the Greater Hartford, Connecticut area have formed the
Capital Area Health Consortium ”to coordinate and further the healthcare

49.

50.

51.

52.

53.

54.

55.

56.

delivery, medical, educational, research, administrative and other activities
of its members." The objectives of the Consortium and the obligations

of its member hospitals are described and the author notes external
environmental factors and events which preceded and promoted the consortium
arrangement. The Consortium is in some ways a natural outgrowth of close
working relationships which had existed earlier among several of the hospitals
in such areas as ambulatory care planning, fund raising, purchasing, and

the development of special programs. The Consortium is presently considering
exchange of medical staff privileges.

Lombardi Jr., T. Comments on shared servides. Hosp. Forum (New York).
41:3-4, Mar. 1973.

Long, S. D. Two hospitals share administrative services. Hospitals,
J.A.H.A. 48:121-122,175, Oct. 1, 1974.
(Shared Services System, Omaha)

Lusk, E. J. Regionalization: a framework for control. Hosp. Admin.
20:60-68, Spring 1975.

McSwain, B. G. Opinion [largest savings can come from regional management].
Hosp. Financ. Manage. 5:7, Jan. 1975.

The author recommends regionalization of more than 25 functions associated
with 5 hospital divisions--nursing, professional services, nonprofessional
services, fiscal services, and personne1--as a means of saving money while
maintaining institutional identity.

Massachusetts Hospital Association. Shared Service Programs. Burlington,
MA: Massachusetts Hospital Association, 1972.

Booklet briefly describes the following shared service programs which are
available through the Massachusetts Hospital Association: shared computer
program, utilization information service, shared microfilming program,
manpower information service, systems engineering program, wage and salary
program, management development and education program, labor relations
program, group tax-deferred annuity program, group life and accidental
death and dismemberment program, group long-term disability program, and
group liability/workmen's compensation and safety program.

Musser, M. J. A public-private consortium. Hospitals, J.A.H.A. 47:35-37,
Aug. 16, 1973.

The author proposes cooperative efforts by governmental and private institu—
tions as a partial solution to solving the problems of high costs, mal-
distribution of services, uneven quality of services, and increasing demand
for services. Ten examples of cooperative working relationships which have
been established between the Veteran's Administration health care system

and community health care services and facilities are described.

New federation of hospitals created for Cleveland area. Osteopathic Hosp.
16:22-24, July 1972.
(Federated West Shore Hospital System)

Oakland (CA) hospitals save with shared services. Hosp. Forum (Western).

9

57.

58.

59.

60.

61.

14:18, Sept. 1971.
(Administrative Hospital Services, Inc.)

Owen, J. W. Wide-range sharing for two hospitals. Hospitals, J.A.H.A.
482105-107, June 1, 1974.

Case study of the New Jersey Hospital Service Corporation which coordinates
group purchasing, printing, and credit and collection for two urban New
Jersey hospitals. Shared warehousing, medical record activities, and
laundry services may be instituted in the future and the feasibility of
several other shared services including a day care center, daily menu
planning and food purchasing, a combined security force and motor pool,

and shared transportation for faculty and students of the schools of
nursing affiliated with each institution are presently under investigation.
The purchasing program is described in some detail and steps taken to
preserve autonomy, quality, and cost control are outlined. A lZO-bed
suburban hospital recently joined the program and is participating on an
Ed Egg basis. A network of such programs is envisioned, with each program
serving hospitals on a regional basis.

Payne, T. T. A multi-hospital model: one alternative to merger. Master's
thesis, Xavier University, Cincinnati, 1974.
(Tri-County Hospital Group, Ohio)

Performing major surgery on hospital costs. Bus. Week. No. 2381:149,152,
May 19, 1975.
(Capital Area Health Consortium, Greater Hartford, CT area)

Platou, C. N., and Rice, J. A. Multi-hospital holding companies. Harvard
Bus. Rev. 50:14-18, May-June 1972.

The hospital holding company is an organizational form modeled after the
bank holding company with its characteristic advantages of local board
autonomy, centralized/decentralized management, and economies of scale.
The hospital holding company provides a central locus of control while
maintaining community integrity through local directors and managers.

Its advantages include economies of scale resulting from superior manage-
ment and from the centralization of specialized activities, a broadened
range of services and facilities for the local health institution resulting
from centralized service management and research, and improved capital
resources which protect the stability of each local unit. The ownership,
local management, board, and central management of the hospital holding
company are described and the author notes a variety of expensive or pre-
viously unavailable services which the holding company could provide to
its member institutions.

Project RAISE. Regional Cooperation:‘ A Design for Sharing among Health
Care Institutions. 1971.

Describes "the concept and practice of regional sharing among health care
institutions as developed and utilized by the health care institutions com-
prising Project RAISE--what such a regional sharing venture can accomplish,
for whom it is intended, why it is a viable alternative to the present
health delivery system of independently operated health care facilities

in many small communities, and finally how other interested health care
institutions may establish their own regional sharing ventures."

lO

62.
63.
64.

65.

66.

67.

Ross Jr., A., and Boyle Jr., R. L. Urban-rural exchange programs.

Hospitals, J.A.H.A. 46:55-59, July 16, 1972.
(Virginia Mason Hospital, Seattle)

Sabichi, F. D., and Long, T. L. Association serves 17 hospitals.

Hospitals, J.A.H.A. 48:101-102, June 1, 1974.
(Annotation, 9)

Schilling, S. W. Cost containment through sharing. Hospitals, J.A.H.A.
49:48-51, Jan. 16, 1975.
(Affiliated Hospital Services, Inc., Minneapolis-St. Paul)

Shared services program approved. Hosp. Forum (New York). 38:14, Dec. 1970.
(New York Statewide Shared Services Program)

Six hospitals to share their resources, but not medical staffs. Mod.
Healthcare. 3:67, Jan. 1975.
(Susquehanna Valley (PA) Health Care Consortium)

Starkweather, D. B. Mergers and shared services: annual administrative
review. Hospitals, J.A.H.A. 47:67—70, Apr. 1, 1973.

This review of the 1972 literature on mergers and shared services identifies
an underlying theme of conflict between fundamental organizational identity
and efforts to share services or merge institutions. Other trends in the
literature include a return to basic definitions and simple classifications
of shared services, a continued questioning of the true value of mergers,

a general lack of sound empirical articles, and increased interest in the
creation of corporations which span but do not replace existing institutions.

Smejda, H. A. Shared services. Hosp. Financ. Manage. 5:10-11,l4-15,63,
Mar. 1975.

 

Explores the advantages and disadvantages of shared services, their current
and future status, and the implications of shared services for financial
managers. Briefly describes the various organizational structures which
have developed for providing shared services as well as those factors

which have combined to bring pressure on hospitals to share. The author
also reviews the progress of a current American Hospital Association project
which involves the development of methodologies for health planners to
evaluate services shared by health care organizations.

Stolfi, J. E. Reducing the cost of medical care. Bull. Amer. Coll. Physicians.
112140-141, Mar. 1970.

Successful multi-unit systems show how shared services can help raise
productivity, lower costs. Mod. Hosp. 121:41, 43, July 1973.

Tennessee Hospital Association. Shared Services in Review; report to
W. K. Kellogg Foundation. Nashville: Tennessee Hospital Association,
1973.

 

The Tennessee Hospital Association reports briefly on shared services
programs which it has sponsored in dietary, medical records, social ser-
vices, and management engineering. The report also outlines two special

11

72.

73.

74.

75.

76.

projects: a cooperative effort by 17 hospitals to explore shared group
purchasing, educational programs, and other services; and a shared com-
puter project through which 28 hospitals have purchased computer time
from Blue Cross to handle patient billing, payroll, inventory control,
accounts payable, and several other projects.

Tibbitts, S. J. What Trustees Should Know About Shared Services and
Mergers (Tape cassette, 47 min., 50 sec.). Chicago: Hospital Research
and Educational Trust, 1974.

A general discussion in question and answer format which examines the
advantages and disadvantages of shared services and mergers, problems
of implementation, factors contributing to successful programs, and
the role of the trustee.

Twenty hospitals form group to establish shared services. _flospitals, J,A,H,A.
45:103, June 16, 1971.
(CINDAY Shared Services Committee, southwestern Ohio and northern Kentucky)

Wagner, C. J. Association concept promotes sharing, preserved independence.
Hospitals, J.A.H.A. 43:47-50,52, Mar. 16, 1969.

Examines the concept of a multiservice health facility association as a
means of coordinating a full range of community health services without

the loss of institutional identity which can result from mergers and
satellite programs with similar objectives. Characteristics of effective
programs achieved through such associations are noted and the necessary
formal arrangements are identified. The Multiservice Health Facility
Association concept is seen as sufficiently flexible to allow for various
kinds of association based on physical proximity, provision of complementary
services, uniform standards of care based on comprehensive plan, and so
forth.

SURVEYS

American Hospital Association. American Hospital Association Guide to the
Health Care Field, 1974 edition. Chicago: AHA, 1974.

Shared services organizations are identified in the 1974 Guide in the listing
of "State and Provincial Organizations and Agencies," pp. 436-453. The
organizations identified include "freestanding shared services organizations
sponsored by hospitals or by a hospital association that operates shared
services programs for hospitals, shared services programs that are part

of a state or metropolitan hospital association, [and] health services con-
sortiums that are formed by several hospitals to plan and facilitate the
sharing of services, the consolidation and coordination of clinical-medical
services, and the joint planning for future development of services within
an identified area.” The shared or consolidated programs listed are coded
according to 63 shared service categories.

Astolfi, A. A., and Matti, L. B. Survey profiles shared services. Hospitals,
J.A.H.A. 46:61-65, Sept. 16, 1972.

12

77.

78.

79.

80.

This article reports the results of a national questionnarie survey of
shared services which was submitted to 5,727 short-term community

hospitals in the United States in the summer of 1971. Survey results

(82.5 percent of the respondents completed the questionnarie) indicate

the extent of present sharing arrangements (29,419 instances of sharing
reported), satisfaction with these arrangements (70 percent of respondents
reporting satisfaction), assessment of the potential for expansion of
existing cooperative arrangements (10,111 instances of services considered
expandable), and interest in joining with other hospitals to share services
(29,890 instances of interest expressed in sharing a service). Responses
to each of the questions regarding use, satisfaction, potential, and in-
terest are tabulated by four major service categories: medical facilities
and care, manpower resources, administrative and other services, and con-
tinuing education and inservice training programs. Tabulated data in-
clude a summary of overall responses to the survey, a listing of shared
services reported in each of the service categories, a comparison of shared
purchasing activities for New York State in 1970 and 1971, and listings

of the 10 most frequently shared services and the services eliciting the
highest interest in sharing. Survey results strongly suggest the potential
of sharing as a major method of delivery of health care services.

Blumberg, M. S. Shared Services for Hospitals. Chicago: AHA, 1966.
(Annotation, 20)

Delaware Valley (PA) hospitals interested in shared services. Mod. Hosp.
115:31, Dec. 1970.

Ninety-four of 96 short-term general hospitals surveyed by the Delaware
Regional Medical Program in late 1969 reported having developed some kind
of affiliation either to obtain or provide services. Respondents were
queried concerning 29 services. Of these services, each hospital had an
average of 12 services within the hospital, supplied four services to
other hospitals or organizations, was equipped to supply up to six ser-
vices to other hospitals, obtained six services, and wished to obtain 10
services. The survey covered the Delaware Valley Region but excluded
Philadelphia.

Denver meeting told: hospitals sharing everything--inc1uding the doctors.
Mod. Hosp. 119:114,117, Sept. 1972.

This brief report of the Midtown Hospital Association shared services
conference includes a list of services shared by organizations reporting

to the conference and a profile of 24 shared service organizations repre-
sented at the conference. The profile is broken down by number of hospitals
participating in the shared services organization, proximity of participating
hospitals (close, rural, entire state, two or more states), age of shared
service organization, number of employees, source of initial funding, and
types of programs shared.

Gerber, N. M. Health facilities planning for hospitals in the Passaic
Valley Region of New Jersey. Unpublished report, George Washington
University, Washington, DC, Dec. 1970.

Study examines the extent and origin of sharing agreements among seven
short-term general hospitals in the Passaic Valley Region of New Jersey.

13

81.

Although sharing was not found to be common in the area, the sharing
agreements which were in effect were found to have been initiated more
often by councils of local administrators than by the Health Facilities
Planning Council.

Member hospitals surveyed regarding shared services. Hos . Forum New
York). 38:10, Sept. 1970.

Brief report of results of a May 1970 survey of members of the Hospital
Association of New York State regarding shared services. Nine-hundred

and ten instances of sharing were reported; 733 sharing arrangements were
regarded as satisfactory; hospitals indicated interest in sharing arrange-
ments in 985 instances; and 159 hospitals indicated that current in-house
capabilities could be expanded to share with others. A list of possible
sharing arrangements is provided.

CONFERENCE PROCEEDINGS

Published proceedings often provide a reader with a broad exposure to a

multitude of issues. While some survey the whole field of shared services,
others focus on a narrower subsumed topic. Frequently the presenters at
these conferences represent different disciplines--sociology, economics,
health care research--as well as operational experience.

82.

83.

84.

Brown, R. E., editor. Economies of Scale in the Health Services Industry;
proceedings of an invitational seminar, May 10-12, 1971, Chicago. Rockville,
MD: National Center for Health Services Research and Development. DHEW
Pub. No. (HSM) 73-3009. [Reproduced and distributed by National Technical
Information Service, Springfield, VA, 1972].

Partial contents: Marketing research and development: problems posed by

the health services market; Hospital associations and economies of scale;
Shared services--their production and coordination by hospital associations
and their effect on economies of scale; Health systems development and
economies of scale; Health services planning and economies of scale; RMP role
in the development of economies of scale.

Martin, J. C., editor. Evaluation Methodologies for Shared Services in the
Health Care Field; proceedings of a seminar, Dec. 2-4, 1974, Montreal.
Montreal: Montreal Joint Hospital Institute, 1975.

General presentations: State of the art--Canadian; State of the art--American;
Summary of the project--seminar on evaluation methodologies for shared ser-
vices in the health care field; Feasibility studies for shared and consolida-
ted services; Concepts and strategies of evaluation; Evaluation and economic
analysis; Environment for evaluation; Experiences with shared services and
approaches to their evaluation. Evaluation methodologies: Laundry; Generalize
model; Group purchasing; Inservice education; Management engineering. Ref-
erence data: Administrative review of shared and consolidated services, 1973.

Midtown Hospital Association. Health Organizations Shared Services; pros

14

.85.

88.

89.

ceedings of a conference, March 15-17, 1972, Denver, Colorado. Denver:
Midtown Hospital Association, 1972.

Contents include: Shared health services--their role and direction, by
Robert DeVries and presentations by officials of the following organiza-
tions: North Suburban Association for Health Rescurces, Northbrook, IL;
Hospital Shared Services Association, Seattle; New Jersey Hospital Ser-
vice Corporation, Princeton, NJ; Ohio Hospital Association, Columbus, OH;
South Carolina Hospital Association, Columbia, SC; Centralized Hospital
Services, Greensburg, PA; Connecticut Hospital Association, New Haven, CT;
Midtown Hospital Association, Denver; American Hospital Association, Chicago;
Massachusetts Hospital Association, Burlington, MA; Northwest Allegheny
Hospital Corporation, Pittsburgh; Western Kentucky Hospital Services, Inc.,
Madisonville, KY; Idaho Hospital Research and Education Foundation, Inc.,
Boise, ID; Hospital Association of New York State, Albany, NY; Affiliated
Hospital Services, Inc., Minneapolis. Four task force reports examine

the future of shared services, the exchange of information among shared
service organizations, the legal and legislative considerations facing
shared service organizations, and the role of shared service organizations
in relation to health care corporations and health maintenance organiza-
tions.

White, P. E., and Vlasak, G. L., editors. InterHOrganizational Research
in Health; conference proceedings, January 1970, New York City. Washington,
DC: National Center for Health Services Research and Development, 1970.

Major papers include: Health facility merger and integration: a typology
and some hypotheses, D. B. Starkweather; Coordination and inter-organiza-
tional relations in health, by B. J. F. Mott; Inter-organizational coopera-
tion: a review and critique of current theory, by W. J. Reid; Alternative
strategies of inter-agency planning, by R. L. Warren.

BIBLIOGRAPHIES

Blumberg, M. S. Shared Services for Hospitals. Chicago: AHA, 1966.
(Annotation, 20)

Health Services Research Center. A bibliography on mergers and related
interorganizational arrangements. In: Health Services Research Center.
Demonstration and Evaluation of Integrated Health Care Facilities,
Samaritan Health Service, Phoenix, Arizona. Vol. 1. Chicago: Health

 

Services Research Center, June 28, 1972, pp. 243-257.

Starkweather, D. B., and Taylor, S. J. Health Facility Mergers and Com-
binations: An Annotated Bibliography. Chicago: American College of
Hospital Administrators, 1970.

Tarver, B. M., and Check, M. J. Annotated Bibliography: Shared Services.
Denver: Midtown Hospital Association, 1972.

15

SPECIFIC SERVICES AND FACILITIES

 

The services, facilities, and resources that have been and can be shared
among health care institutions have been divided into four basic categories:
(1) medical/clinical services, (2) manpower services, (3) administrative/sup-
portive services, and (4) education and training programs. The reader is
reminded that these categories are not rigorous. A shared education program
frequently involves the use of some shared manpower, administrative/supportive
services generally also contain an educatibnal component, and so forth. The
references here have been organized on the basis of the primary emphasis of
subject matter. No reference should be viewed as belonging absolutely or
exclusively in any one section.

MEDICAL/ CLINICAL

90. Aronson, S. M. Toward a state-wide bloodbanking system. Rhode Island
Med. J. 57:129-130, Apr. 1974.
(Community Associated Blood Banks of Rhode Island)

91. Bastnagel, Sister G., and others. Hospitals consolidate medical services.

Hospitalsz J.A.H.A. 47:33-37, July 1, 1973.
(Quadrangle of Metropolitan Northwest and Detroit Hospitals)

92. Baumgartner Jr., R. P. A regional concept of hospital pharmacy services.
Amer. J. Hosp. Pharm. 28:670i679, Sept. 1971.

This article describes a regionalized system of hospital pharmacy service.
Background information is given on Appalachian Regional Hospitals, a system
of nine hospitals with a total of 1,026 beds in the mountain areas of West
Virginia, Kentucky, and Virginia. Overall administration and organization
of the hospital system is described with particular emphasis placed on
pharmaceutical services. The scope and standards of pharmaceutical ser-
vices and communications among the several hospital pharmacy departments

are described. Group purchasing, administration, the prescription division,
and warehousing (all functions of Central Pharmaceutical Services) are
discussed. The clinical implications of this regionalized system of pharmacy
services are explored. (Journal summary)

93. Bilinsky, R. T., and others. Satellite dialysis-~an economic approach
to the delivery of hemodialysis care. J. Amer. Med. Assn. 218:1809-
1813, Dec. 20, 1971.

Case study of Memorial Hospital in Springfield, Illinois which established
five satellite hemodialysis centers, each contractually part of the main
unit at Memorial Hospital, in private medical buildings and small community
hospitals in squthern Illinois. Ten specific advantages of the program

are listed including care for an increased patient load, reduced travel
time, and significant cost savings. Cost-accounting data is provided.

94. Bloom, B. S., and others. Radiation therapy in New Hampshire, Massachusetts

16

4.95.

9.6 .

and Rhode Island. New England J. Med. 286:189-194, Jan. 27, 1972.

Box, R. H. Large pharmacy fills small hospital's orders. Hospitals,
J.A.H.A. 45:70,72,74,76, Oct. 16, 1971.

Jane Phillips Episcopal-Memorial Medical Center in Bartlesville, Oklahoma
shares pharmacy services with a small general hospital in Nowata, Oklahoma.
Although the smaller hospital had some token consultation in the past, it

had no pharmacy of its own, no routine inspection of drugs, and no established
control over drug abuse items other than narcotics. Inventory prepacking

and drug distribution in the shared service program are described. The
recipient hospital pays an established fee to the service hospital including
the various expenses involved in prepacking and delivery of drugs. A separate
fee is paid to the pharmacist, who is director of pharmacy at the recipient
hospital. Advantages to the smaller hospital include a controlled drug

and intravenous solutions inventory with a hospital pharmacist on call at all
times for consultations, a precise breakdown of pharmacy operations, dollar
saving resulting from reduction in inventory, and a reduction in drug costs
resulting from volume purchasing.

Brissenden, A. Combining the psychiatric resources of neighboring general
hospitals. Hosp. and Community Psychiat. 28:348-349, Nov. 1972.

Pending the development of comprehensive mental health programs at
neighboring Brooklyn hospitals, a custodial-type inpatient unit for
private patients in one of the units was developed into an intensive
treatment service to admit indigent patients as well. The program was
combined with that of an outpatient clinic in another hospital. (Journal
summary)

Burkholder, D. F., and others. Coordinated program development for shared
pharmaceutical services in an urban community. Amer. J. Hosp. Pharm.
272395-399, May 1970.

This paper describes a multi~hospital program whereby the staff of the
Center for Pharmaceutical Practice, an arm of the School of Pharmacy of
SUNY Buffalo, coordinates pharmaceutical services for three large urban
hospitals. This activity has the characteristics of a group pharmacy
practice. The Director of the Center serves as director of pharmaceutical
services in the associated hospitals and the chiefs of each specialty
area (manufacturing, control, drug information, and clinical practice)
are responsible for that specialty area in each hospital. The advantages
of this approach with respect to opportunities for shared services and
for diversified education and training of pharmacy students and residents
are discussed. (Journal summary)

Carlquist, J. H. Interhospital computerized quality control system.
Pathologist. 24:191-193, June 1970.

(Inter-Hospital Computerized Quality Control Program, Salt Lake City,
UT area)

Citizens League urges hospitals to share services--and they do. Mod. Hosp.

118:39, May 1972.
(Annotation, 27)

17

100.

101.

102.

103.

104.

105.'

106.

107.

108.

Clay, C. C. Shared services yesteryear. Hospitalsz J.A.H.A. 45:20,24,
Mar. 16, 1971.

The author describes a shared laboratory service which was in operation

in Yonkers, New York as early as 1932. Three not-for-profit hospitals

all utilized services which were proveded under contract by the city

health department laboratories and two full-time pathologists. Routine

lab work such as blood counts and urinalyses were performed in each hospital,
while bacteriological and more complicated services were supplied by the
central laboratories. Sometime after 1934 the arrangement with the health
department, although successful, was discontinued and each hospital de-
veloped its own services under a pathologist. If the example set by the
Yonkers hospitals and others with comparable services had earlier stimulated
widespread adoption of such plans, the hospital field would be much further
ahead.

College of radiology offers consultation service. Hosp. Week. Vol. 6,
Sept. 4, 1970.

(American College of Radiology in cooperation with 55 regional medical
programs throughout the country)

Computerized radiation system links hospitals. Hospitalsz J.A.H.A.
45:30,34, Mar. 1, 1971.
(western Pennsylvania)

Crevasse, L. E., and Ariet, M. New scalar computer EKG program for on-
line central EKG processing. J. Florida Med. Assn. 60:28-29, May 1973.
(Florida Regional Medical Program at the University of Florida College
of Medicine)

DeView, L. Hospitals are learning to share. McCall's. 98:48, Feb. 1971.
(Detroit Quadrangle)

Donaher Jr., J. C. The changing anatomy of an academic health center.
In: American Hospital Association. Shared Services in Health Care
Institutions. Chicago: AHA, 1975, pp. 11-16.

(Detroit Medical Center)

Emergency medical services. Hospitals, J.A.H.A. (Special Issue). 47:
May 16, 1973.

Fischerer., E. F. and Sherrick, J. C. An Annotated Bibliography on the
Sharing, Centralization, and Consolidation of Health Facility Laboratories
and Related Diagnostic Services. Chicago: Health Services ReSearch Center,
1971.

 

Four small hospitals take a giant step. Chicago Med. 762980, Nov. 17, 1973.

Four neighboring hospitals on Chicago's north side have operated a joint
laboratory program efficiently and to their mutual satisfaction since 1967.
The idea for the shared facility was first discussed in 1964 and took nearly
three years to implement. Geographical location and a combined size of about
600 beds were major factors in formulating the initial proposal. By combining
forces, the four hospitals expected to reduce the cost of overhead and increas
purchasing power. The plan resulted in segregation of responsibilities whereb

l8

109.

110.

1'111.

112.

113.

114.

115.

3116.

each hospital performed certain procedures for itself and all other
members of the group. The benefits of this shared services program in- _
clude stabilization of laboratory charges to patients, ability of the
group to lease or buy modern automated equipment which could not normally
be afforded by a small hospital, availability of the full-time services
of a qualified bacteriologist and biochemist, and development and use of
exact billing and cost allocation procedures.

Freedman, T. J. A review of the experience of the in-common laboratory
in the development of joint laboratory services. Master's thesis,
University of Toronto, Toronto, 1970.

In addition to a review of the experience of the in-common laboratory
established at the Mount Sinai Hospital in Toronto, the author provides

a literature review and detailed account of the joint laboratory with
special attention to the concept and functions, organization, personnel,
physical facilities, tests and equipment, communications, research and
development, finances, opposition to and future of the in- common laboratory.

Gal, K., and Hanok, A. Saving through centralization. Hospitals, J.A.H.A.
44:60-62, 64-65, Dec. 1, 1970.
(Annotation, 513)

Gnau, T. R., and Maynard, C. D. Reducing the cost of nuclear medicine:
sharing radiopharmaceuticals. Radiology. 108:641-645, Sept. 1973.

Gregorio, Sister M. P. Shared services with emphasis on "the Quadrangle
Hospitals" in Detroit, Michigan. Master's thesis, Xavier University,
Cincinnati, 1973.

Hain, R. F. The community core laboratory: the laboratory of the future.
Southern Med. J. 65:379-380, Mar. 1972.

The community core laboratory can help to resolve many of the problems
which afflict medicine in general including shortage of manpower, maldis-
tribution of services, lack of uniformity in the quality of services,

and spiraling costs. The core laboratory can achieve these ends by creating
adequate volume to permit intelligent use of auotmation and electronic
equipment, by conserving manpower, by providing a complete service which
allows the exploration of a given patient's speciman to the totality of

its useful medical information, and by creating a mechanism for inter-
convertibility of laboratory information. By supervising the quality
control programs of the peripheral facilities and by conducting continuing
education programs for their technical and medical staffs, the core labora-
tory can also insure that the laboratory results found in these facilities
are reliable and provide useful information. The economic impact of such

a laboratory on the total cost of health care and the problem of acceptance
by the medical community are considered.

Hanlon, J. J. Emergency medical care as a comprehensive system. Hgalth
Serv. Rep.. 88:570-587, Aug.-Sept. 1973.

Hassan Jr., W. E. Merging pharmacies could cut cost. Drug T92; 115:
16, Aug. 30, 1971.

Health Services Research Center. Consolidation of Clinical Laboratory

19

117.

118.

119.

120.

121.

122.

Facilities: An Evaluation. Chicago: Health Services Research Center,
1974.
(Annotation, 571)

Institutions in the Detroit Medical Center agree to shared medical services
plan. Mod° Hosp. 121231-32, Dec. 1973.

The Detroit Medical Center Corporation has developed a long-range pro-

gram for coordination and consolidation of clinical/medical services

among several hospitals in the Detroit area. Under the program, "centers
of excellence" would be established at participating institutions and
patients would be referred to these for specialized services. 'Pediatric
services have already been consolidated and consolidation of general medi-
cal and surgical services, emergency and trauma services, and outpatient
and rehabilitation services is planned. The goals of the Corporation as
set forth in the report to the planning committee of the Greater Detroit
Area Hospital Council are: to provide the highest quality health services
within the present and future capabilities of the center institutions; to
engage in joint planning to design an over-all service program for the
center; to concentrate like services in order to avoid unnecessary duplica-
tion of facilities and personnel and to maximize utilization of available
resources; to coordinate the planning and service capabilities of the
center with other outside institutions in cooperation with the appropriate
public and private health planning agencies; and to be committed to the
concept that the center will become a coordinated health care system which
includes specialized, primary and preventive health services to meet the
health care needs of the greater Detroit area.

Joint laboratory makes specialized service possible. Mod. Hosp. ll4:91,.
Apr. 1970.

The San Diego Institute of Pathology is a private commerical enterprise
which currently serves more than 19 hospitals as well as walk-in patients.
Pathologists at the Institute are responsible for general pathology work

at one area hospital, but also use their special expertise by troubleshooting
problems in their particular field for all hospitals. The Institute has

its own centrally located laboratories with modern laboratory equipment

and full time staff, including a number of pathologists who work only at

the central facilities. The organization plans to standardize prices for
all users in order not to be in competition with the hospitals.

Judge, D. Shared facility bridges hospital buildings and mediCal services
gap. Mod. Hosp. 114:96-100, Apr. 1970.
(Metropolitan Medical Center, Minneapolis)

Katz, S. H., and others. Regionalization of laboratory services. Health
Laboratory Sci. 10:287-293, Oct. 1973.
(Annotation, 519)

Kratz, R. L., and Garner, D. D. For stat orders, faster is better.
Hospitals, J.A.H.A. 46:76,80,82, May 16, 1972.

McCracken, R. C. An analysis of sharing agreements between Veterans Admini-

stration, community and university medical center hospitals. Master's
thesis, Duke University, Durham, NC, 1973.

20

123.

124.
125.
126.
127.
128.

129.

130.
131.

132.

Metamorphosis of a satellite health center. Group Pract. 20:18—19,
Apr. 1971.

(Hunterdon Medical Center satellite--Phillips Barber Family Health
Center, NJ)

Missouri establishes bone tumor center. J. Mississippi State Med. Assn.
13:15, Apr. 1972.
(University of Missouri Medical Center, Bone Tumor Referral Center)

Massachusetts Hospital Association. Feasibility of Shared Drug-Related
Functions. Burlington, MA: Massachusetts Hospital Association, Manage-
ment Systems Planning, 1971.

 

Morse, E. E. Connecticut Regional Medical Program. Connecticut Med.
35:138-139, Feb. 16, 1971.
(Blood Bank Survey and Supporting Services Program)

Mungerson, G. W. A shared radiation therapy center. Hospitals, J.A.H.A.
47:54-55,96, Dec. 16, 1973.
(Harvard Joint Center for Radiation Therapy)

New Jersey establishes statewide blood exchange. Hospitals, J.A.H.A.
45:133, Feb. 16, 1971.
(New Jersey Blood Exchange)

Norgren, W. High-pressure technique pays off. Hospitals, J.A.H.A. 48:
75-76, Aug. 16, 1974.

A description of the Charette planning technique which was used by planners
and architects of a proposed medical center to be shared by two large
hospitals, one public and one private, in Minneapolis. The hospitals
wished to maintain their separate identities, medical staffs, and pro-
grams, but were committed to architectural integration of their institu-
tions and the cooperative use of approximately 30 treatment services.

The week long Charette planning sessions included the administrators of
each hospital, selected staff members from each institution, and the
architects of the proposed center. The program also provided for input
from physicians, community groups, and public officials. Marathon meetings
were combined with the purposeful elimination of comfort in order to force
planning decisions regarding the services to be shared, their design, and
their location in the medical center.

O'Donovan, T. R. The Detroit 'Quadrangle.’ Hospitals, J.A.H.A. 47:105-
106,108, Feb. 1, 1973. .

Passavant, Wesley sharing medical staffs. Mod. Hosp. 117:45, Sept. 1971.
(Chicago) ‘

Pearson, R. E. Shared drug information services. Amer. J. Hosp. Pharm.
31:399-400, Apr. 1974.

 

This paper describes the use of pharmacists from multiple institutions
to help staff a drug information service Supported by the SUNY Buffalo
School of Pharmacy. The Service is operated 24 hours each day, seven
days a week, and the volunteer pharmacists respond to about 15 percent

21

133 C

134.

135.

136.

137.

138.

139.

of the total calls recieved. The implementation of the program is described
and the methods used by participating institutions to allow pharmacist
participation are outlined. (Journal summary)

Peters, D. S. Shared services: a working arrangement. Mich. Hosp.
10:ll,37,39, July 1974.

(Veterans Administration Hospital, Ann Arbor, and University of Michigan
Hospital)

Provost, G. P. Regional planning and shared/hospital pharmacy services.
Amer. J. Hosp. Pharm. 28:669, Sept. 1971.

 

Ritter, C. A. Physician staffing of a shared emergency unit. Master's
thesis, Xavier University, Cincinnati, 1971.

Provides an analysis of utilization patterns of a shared emergency unit

in order to determine a method for providing physician staffing. Findings
of the study are reported and implications for adequate physician staffing
are discussed. ‘

Robinson, W. M. M. Medical staffs merge. Hospitalsz J.A.H.A. 47:60-65,
Feb. 16, 1973.

Two neighboring Colorado hospitals (Swedish Medical Center, Englewood, CO,
and Porter Memorial Hospital, Denver) merged medical staffs following
consolidation of their pediatrics and obstetrics services. Pediatric
consolidation resulted in a single first-class unit, with the patient volume
necessary to support the skilled personnel essential to high—quality care.
The same is expected of obstetrics consolidation. The merger was effected
because the medical staffs of the two hospitals comprised essentially the
same physicians and because the quality of care did not seem to be in-
fluenced by the repetitive and duplicatiVe organizations and activities.

The reorganized combined medical staff formed an executive committee,

a professional activities committee, a credentials committee, and a sub-
committee on utilization review. The activities of each of these committees
and the organizational efficiencies achieved through the merger are des-
cribed.

Rosenberg, C. L. General hospitals are going the way of G.P.'s. Med° Econ.
49:104-109,113,115, Sept. 11, 1972.
(Greenville (SC) Hospital System)

. This 20-bed hospital has 500 specialists. Med. Econ. 47:160,
June 8, 1970.
(Grand Canyon (AZ) Hospital)

Scardino, V., and Deppisch, L. M. Centralization answer to volume ex-
plosion. Hospitalsz J.A.H.A. 47:50-53, July 1, 1973.

Case study of Centralized Laboratory Services, a central laboratory
facility serving 30 medical groups and one hospital affiliated with the
Health Insurance Plan of Greater New York. Through automation of labora-
tory procedures and electronic data processing, the central laboratory
facility has achieved substantial reductions in costs and greatly in-
creased laboratory work load while maintaining high standards of quality

22

140.

1141.

1142.
143.

144 O

145 .

146.

and responsiveness of service. The study demonstrates the principle of
economies of scale as a rationale for centralizingxhigh-volume ancillary
or supporting services.

Shared medical service: saving or suicide? Mod. Hosp. 114:88-91, Apr.
1970.

Sharing electron volts in Chicago. Mod. Hosp. 114:89, Apr. 1970.

A two-million electron volt linear accelerator used in the treatment

of cancer patients is owned and housed by Chicago Wesley Memorial
Hospital and used regularly for patients of three other institutions
which are parts of the Northwestern University-McGaw Medical Center.

In addition, some other patients are referred from other area hospitals.

Sharing services on the obstetrics ward. Med. World News. 11:34,
Oct. 2, 1970.
(Seattle)

Snider, A. J. Passavant, Wesley adopt joint services. Chicago Daily
News. Aug. 9, 1971, p. 16.
(Chicago)

Terenzio, J. V. Sharing professional services. Hosp. Forum (New York).
41:5-6,15, Mar. 1973.

Notwithstanding inherent constraints, sharing or consolidation of
professional services offers greater potential for hospitals than sharing
of administrative and supporting services. Improvement in professional
care to patients, conservation and allocation of professional personnel,
and dollar savings are likely outcomes. Reduction of capital construc-
tion costs and expensive operating costs is also possible when institu-
tions share or consolidate professional services. Resistance to the
sharing of professional services on the part of hospital administrators,
trustees, and medical staffs is discussed and the most common arguments
against sharing professional services and their counter arguments are set
forth.

Weimer, W. C. Group activity among hospitals, an analysis of the para-
medical service center. Master's thesis, Xavier University, Cincinnati,
1970.

(Ohio Department of Medical Hygiene and Correction, Paramedical Service
Center)

West, J. W. How community pharmacists provide Rx services for two hospitals'
outpatients. Pharm. Times. 41:50-52, Feb. 1975.

(Pharmacy-Shared Services Program, Holland City (MI) Hospital and North
Ottawa Community Hospital, Grand Haven, MI)

Two hospitals share unit-dose service. Hospitals, J.A.H.A.
48:112-114, June 16, 1974.
(Holland City 0H1) Hospital and North Ottawa Community Hospital, Grand
Haven, MI)

23

I

148.

149.

150.

151.

152.

153.

154.

155.

Williams, L. No tired blood. Barrons. Aug. 30, 1971, pp. 5,10,12.

Wyoming hospital linked to Colorado computer. Hosp. Forum (Western).
16:50, April 1973.
(Memorial Hospital, Sheridan County, Wyoming)

MANPOWER

Administrator loaned to rural hospital. Hospitals, J.A.H.A. 46:59,
July 16, 1972.
(University of Wisconsin Hospitals and Community Memorial Hospital, WI)

Banner, M. T. Shared personnel, purchasing, and production. Hospitals,
J.A.H.A. 47:39-42, Nov. 1, 1973.
(Annotation, 252)

Burkhalter, B. R. Cooperative multihospital management engineering pro-
grams (CMMEPS). Newsletter Hosp. Manage. Systems Soc. 11:8-9, Mar.
1972.

The author presents data on current practices regarding cooperation and
competition among Cooperative Multihospital Management Engineering Pro-
grams (CHMMEPS). Data were gathered through a survey of 11 individuals
representing CHMMEPs in 21 states and the District of Columbia. The sur-
vey questions are provided and the replies are interpreted.

Caldwell, A. B. There's good news and bad news about centralized manage-
ment, official of hospital chain reports. Mod. Hosp. 119233-34, Aug.
1972.

(National Medical Enterprises)

Colling, R. L. Shared security works. Security Manage. July 1973,
pp. 30-31.

Case study of the development and operation of a shared security system
planned by the Midtown Hospital Association, Denver, CO. Deployment and
communications systems are described and new preventive components of the
central system and a training program are outlined. Central investigation
and safety engineering have recently been added as functions of the
system. The new system has resulted in increased efficiency as well as
dollar savings for the five hospitals involved.

A cooperative social work services for health care facilities in Hawaii.
Nurs. Homes. 23:17,21, Feb.-Mar. 1974.

The Social Work Resource Center of Hawaii was formed to provide social

work services from a centralized agency on a contractual basis to hospitals
and skilled nursing facilities in Hawaii. The Center provides both general
and technical services to participating institutions and recruits, orients,
assigns, and supervises social work staff. This article describes the
proposed organization of the program and includes a general discussion of the
growing trend toward shared social work services.

24

156.

. 157.

158.

1159.
160.

161.

‘162.

1163.

Dildy, D. B., and Walling, M. F. Hospital improvement team--the shared
management engineer and the hospital management analyst. Tex. Hosp.
28:22,27,36, Mar. 1973.

This article discusses the use of a management analyst in the Texas HoSpital
Association Shared Management Systems Program. The analyst, a full-time
employee of the participating hospital, provides program continuity in

the time lapse between visits of the shared management engineer by
assisting in the implementation of management improvement programs. Through
working with the engineer and dealing with department heads within the
hospital, the analyst gains valuable training experience in the use of
current management engineering tools and techniques. The authors consider
how to select a management analyst and how to develop an effective manage-
ment finprovement program. The advantages of such a program include more
timely completion of projects, improvement in the level of quality, better
methods, improved patient care, and dollar savings.

Downey, G. W. For sale: hospital management. Mod. Healthcare. 1:35—
43, June 1974.

Eberhard, M. J., and Ridgway, M. Development of a biomedical engineering
shared service in southern California. Hosp. Forum (Western). 16:13-14,
Feb. 1974.

The nature and level of the engineering support available to the staff

of an average hospital is far from optimum. In order to help correct this
problem the W. K. Kellogg Foundation has awarded a grant to the Hospital
Educational Foundation of the Hospital Council of Southern California to
establish a shared service program in biomedical engineering. The aim

of the program is to develop the logistics system needed by hospitals to
support technological demands placed upon them by the practice of modern
medicine. The authors consider the dimensions of the problem and describe
in some detail the proposed program of the Hospital Council including
organizational structure, establishment of satellite laboratories, and
relationship of the program to existing hospital staffs and to local bio-
medical engineering resources.

Epperson, R. L. Why SHESS? Tex. Hosp. 30312-13, Oct. 1974.
(Texas Hospital Association, Shared Hospital Electrical Safety Services)

Gustafson heads two hospitals. Mich. Hosp. 7:16, Apr. 1971.
(Oceana Hospital and Lakeshore Hospital, Michigan)

Healey, L. A., and Friedrich, P. Health Services Consortium: good neighbor
policy. Group Pract. 24:19-21,28, Mar.-Apr. 1975.
(Health Services Consortium, Seattle area)

Herring, Sister C. Ohio hospitals‘ quality control and staff utilization
program. Hosp. Progr. 51:38-39,41-44, July 1970.
(Ohio Hospital Management Services)

Hinson, J. W. Continuing education in a rural area. Supervisor Nurse.

4:29,32‘33,36-37, Aug. 1973.
(Annotation, 397)

25

164.

165.

166.

167.

168.

Hospital electrical safety. Tex. Hosp. 30:19, June 1974.

A total hospital electrical program is available on an annual contractual
basis through the Texas Hospital Association Health Services Corporation's
Shared Hospital Electrical Safety Services (SHESS) Program. The program
eliminates the need for an institution to purchase and maintain specialized
test equipment or to assign staff to conduct tests and maintain records.
Services available through the SHESS Program are described.

Hurst-Euless-Bedford Hospital associates with Harris Hospital. Tex. Hosp.
29:23,26, Feb. 1974.
(Fort WOrth area)

Jones, K. B. Shared social services in the Northwest. Hosp. Soc. Work
Directors Bull. 37:3, Nov.-Dec. 1973.

St. Joseph's Hospital, a 103-bed acute care facility in Lewiston, ID, shares
the services of its trained social worker with two nearby rural hospitals.
The social worker makes monthly on-site consultations with the smaller
hospitals and directs training sessions for individuals who have been
selected to deal with-problems of social dysfunction in their respective
hospitals.

Jones, L. S. Certification program set up to insure reliability of bio-
medical instruments. Hosp. Top.. Sl:l9-22,25, Mar. 1973.

This article describes the establishment of an in-house biomedical
engineering group and a comprehensive program for maintenance and
certification of medical electronics equipment in the Dallas County
Hospital District. The author, who is director of engineering service

in the District, describes in detail the decisions involved in defining
which instruments are to be covered, the procedures for setting goals

and inventorying instruments, the procurement of technical manuals and
laboratory test equipment, and the general operating procedures which
apply to the program. The article provides the following: a schedule
for implementation of instrument calibration and certification, a typical
test procedure for a piece of monitoring equipment, and a certification
record sheet for an instrument. The shared program reduced fragmentation
of effort, reduced duplication of personnel, and improved quality control.

Koontz, J. S., and Zylstra, R. L. Rural shared services--an experiment in
cooperation for small hospitals. Hosp. Forum (Western). 15:11-12,24,
Aug. 1972.

Case study of the planning and development of a shared service program
between two rural hospitals in separate districts of Washington's Puget
Sound area. Initially, the hospitals began by sharing the services of

an administrator as well as other selected hospital personnel. Later,
maintenance services and selected fiscal services were shared, but attempts
to share direct patient care services were unsuccessful because of time
lost in travel and difficulty in coordinating schedules. The hospitals
strengthened their complement of medical staff members through a recruit-
ment drive. Equipment is transferred frequently between the facilities.
Although the most suitable organizational structure for the program continues
to be a matter of concern, the boards of the two hospitals are considering

26

169.

170.

1 171.

1172.

‘173.

(174.

(175.

‘176.

‘177.

178.

a merger of districts which would resolve some of these problems. Results
include a broadened base of operations and a wider variety of health care
services, as well as cost containment.

Iaird, S. W. A shared dietitian consulting program. Hospitalsz J.A.H.A.
47:75,78, Nov. 1, 1973.

Two therapeutic dietitians from Wausau Hospital in Wausau, WI, consult
with a nearby 162- bed rural hospital and nursing home. The cost to the
smaller institution includes the dietitians' traveling expenses, salaries,
and fringe benefits for the time spent in direct service. The duties
performed by the dietitians for the smaller institution are itemized.

Latimer, B. W. Hospitals share engineering services. Southern Hosp.
38:37-38,31, Nov. 1970°
(Carolinas Hospital Improvement Program)

LeBoutillier, P. SHIP: shared hospital in-service program. J. Continuing
Educ. Nurs. 3:31-33, July-Aug. 1972.
(southwest Minnesota)

Long, S. D. TWO hospitals share administrative services. Hospitals,
J.A.H.A. 48:121-122, Oct. 1, 1974.
(Shared Services Systems, Omaha, NE)

Ludwig, P. E. Summary of AHA invitational conference on cooperative multi-
hospital management engineering programs. Newsletter Hosp. Manage. Systems
Soc. 923-4, June 1970.

Lutheran Hospital Society to manage Saddleback Hospital. Hosp. Forum

(Western). 13:25, June 1970.

(southern California)

Malm, H. M. Multi-hospital management: analyzing an example. Hosp.
Admin. 18:27-52, Spring 1973.
(Lutheran Hospitals and Homes Society of America)

Management may be the best place to begin saving. Mod. Hosp. 114294-96,
Apr° 1970.

This article presents examples of 11 management engineering programs, many
making use of grants or separate corporations to bring about administrative
innovations. The services provided by each of the programs are briefly
described. They include training supervisors in management techniques,
conducting feasibility studies for additional combined services, assigning
engineers to individual institutions to analyze and implement various improve-
ment techniques, developing programs to effect cost reductions, providing
centinuing education programs and conferences on work simplification, and
sharing personnel, administrators, and boards of trustees.

The multiple hospital is the only way to go. Mod. Hosp. 121:7,10,14-16,
Nov. 1973.

Northwest hospitals cooperate in innovative cost-savings plan. Hosp.

27

Forum (Western). 15:51, Apr. 1972.

The state hospital associations of Washington, Oregon, and Idaho have
developed a "Systems Program for Hospitals" which is designed to provide
hospital administrators with the information necessary to make better
management decisions about internal hospital operations. The program,
which is financed by the Kellogg Foundation and the Blue Cross Plans in
each of the states, has brought about cost reductions, improved patient
care and staff morale, and greater efficiency for the 40 participating
hospitals. Specific examples of program results and a brief description
of organizational goals and structure are given.

179. O'Neil, D. E., and others. Two hospitals--one administration. Med.
Record News. 44:72-73, Aug. 1973.
(Detroit-Macomb Hospitals Association, Detroit and Warren, MI)

180. Parker, B. Three hospitals share clinical engineering services. Health
Care Eng. 2:19-20, July-Aug. 1974.
(Bronx, NY area)

181. Pearson, R. E. Shared drug information services. Amer. J. Hosp. Pharm.
31:399-400, Apr. 1974.
(Annotation, 132)

182. Rosenberg, C. L. General hospitals are going the way of G.P.'s. Med. Econ.
49:104-109,113,115, Sept. 11, 1972.
(Greenville (SC) Hospital System)

183. . This 20-bed hospital has 500 specialists. Med. Econ. 47:160,
June 8, 1970.
(Grand Canyon (AZ) Hospital)

184. Ross Jr., A., and Boyle Jr., R. L. Urban-rural exchange programs. Hospitals,
J.A.H.A. 46:55-59, July 16, 1972.
(Virginia Mason Hospital, Seattle)

185. Seattle's consortium for education. Mod. Healthcare. 1:120-121, Apr. 1974.
(Health Services Consortium, western Washington)

186. Sharing enters field of biomedical engineering. Amer. Surg. Dealer. 60:
14, May 1973.

Because of the difficulties involved in evaluating, installing and main-
taining biomedical equipment, and in training staff to operate such
equipment effectively, individual hospitals may be expected increasingly
to turn to shared or cooperative ventures in this field. Three such re-
gional programs which are now in operation are noted: the University

of Wisconsin Advisory Center for Medical Technology Systems, the Health
Planning Association\of Northwest Ohio, and the Phelps Memorial Hospital
Shared Clinical Engineering Center.

187. Simmons, J. C. Social work program meets hospitals' unique needs. Hospitalsz

J.A.H.A. 49:64-66, Feb. 16, 1975.
(Hahnemann Medical College and Hospital, Philadelphia)

28

188.

189.
1

190.

191.

192.

193.

194 .

Small hospitals get help in a big state. Mod. Hosp. 115:110-112, Sept.
1970.
(Texas Hospital Association, Shared Management Systems Program)

Tennessee agencies develop hospital cost control program. Hospitals,
J.A.H.A. 45:120, Jan. 16, 1971.

The recently implemented Tennessee Effective Management Program (TEMP)
is a shared management engineering program designed to help hospitals
control rising costs while providing improved patient care. Services
offered by TEMP to participating hospitals are briefly described.

Tolbert, J. H. Biomedical and engineering shared technology of New
Jersey. Clin. Eng. News. 2:7-8, June 1974.
(New Jersey Hospital Association Biomedical and Engineering Shared Technology)

Tripp, L. Specific or total management through affiliation. Hospitals,
J.A.H.A. 47:79-80,82, Nov. 1, 1973.

Nebraska Methodist Hospital, Omaha, has offered general and specialized
management services to area health care institutions on an affiliation
basis since 1968. The hospital provides either total management through
contractual affiliation or temporary service through managerial and pro-
fessional sharing for specific projects. The role of the shared food
service manager under both the general and specific managerial plans is
described.

Turner, W. W. The president's page. Tex. Hosp. 27:4-5, Aug. 1971.

This article describes the Texas Hospital Association's Shared Manage-
ment Systems (SMS) Program which provides Texas hospitals with the con-
sultation required to develop more effective management systems at minimum
cost. This program, which now provides service to about 45 hospitals, was
made possible by a grant of $99,000 over a three year period from the

W. K. Kellogg Foundation. The SMS offers assistance to participating
hospitals by arranging consultation visits by an area management systems
specialist to advise the hospital's systems coordinator on the develop-
ment of management engineering techniques and procedures, by disseminating
to participating hospitals the results of projects in other haspitals
throughout the nation, by developing standards for measurement of depart-
mental performance, and by teaching scientific management techniques to
administrators and supervisors.

Two New Jersey hospitals share food service director. Hospitals, J.A.H.A.

45:65, July 1, 1971. .
(St. Peter's General Hospital and Middlesex General Hospital, New Brunswick,
NJ)

West, J. W. Two hospitals share unit-dose service. Hospitals, J.A.H.A.
48:1127114, June 16, 1974.

(Holland City (MI) Hospital and North Ottawa Community Hospital, Grand
Haven, MI)

29

ADMINSTRATIVE/SUPPORTIVE

Accounting and Information Systems

195.

196.

197.

198.

199.

200.

201.

202.

203.

204.

Advice on computer networks: go ahead, but find out where to. Mod.
Hosp. 114292—93, Apr. 1970.

Anderson, H. L. One computer serves twelve hospitals. Hosp. Financ.
Manage. 25:6-8, Mar. 1971.

Twelve Wisconsin hospitals are receiving accounting and control services
from a shared computer operated by Medistat, a cooperative project of the
Wisconsin Blue Cross Plan and Wisconsin hospitals. Five basic master
files are set up for each hospital before the hospital goes on-line to
the shared system: a hospital profile, a charge description master file,
a room and bed master file, a doctor's master file, and a file with coded
details of the hospital's approved medical insurance plan. After the
hospital begins to participate in the system, a patient master file and
an accounts receivable file are developed and maintained. The author
describes the data input into each of these files, the records produced
by the system, and the economies effected in various hospital procedures
from admitting to discharge.

Andrew, W. F. Advantages of a shared computer. Hospitals, J.A.H.A.
45:59-62, Nov. 16, 1971.
(Annotation, 531)

. Guidelines for evaluation and selection of a shared hospital
data processing system. Osteopathic Hosp. 16:5-12, Oct. 1972.
(Annotation, 532)

How to tell the correct time-sharing. Mod. Hosp. 117:113-114,
Nov. 1971.
(Annotation, 533)

Bickers, C. R. Implementation of shared computer accounting system for
hospitals. Osteopathic Hosp. 18:7-11, Mar. 1974.
(Bay View Hospital, Bay Villiage, 0H)

Brewer, G. M. Processed data and other gods. Tex. Hosp. 25:31-34,
Feb. 1970.

Broomall, C. L. Why hospital changed from in-house to shared computer
system. Hosp. Top. 50:20-22, Nov. 1972.

((Atlantic City (NJ) Hospital)

Butler, G. D. HAS: a management tool for the small hospital. Hosp.
Financ. Manage. 25:4-8, May 1971.

Cardwell, H. M. The Medical Information story. Tex. Hosp. 26:12-14,

Sept. 1970.
(Texas Hospital Association and Medical Information, Inc.)

30

211.

2H2.

Carter, B. J. Credit and collections with Medical Information System.

Tex. Hosp. 26:37,41, Sept. 1970.
(Lutheran General Hospital, San Antonio, and Medical Information, Inc.)

Chicago hospital cuts EDP costs 50-66 percent through time-sharing.
Manage. Advisor. 9:19, Apr. 1972.

Chicago's Northwest Hospital became the 100th hospital to automate ac-
counting procedures by linking data transmission terminals to the McDonnell
Douglas Automation Company's shared computer system in Peoria. Northwest
now receives patient billing, accounts receivable, accounts payable,
general ledger and payroll services through the system while keeping its
data processing costs down to one dollar per patient day.

Computer helps hospitals maintain records on dangerous drugs. Hosp. Top.
49:19, Sept. 1971.

Six hospitals operated by the Franciscan Sisters of the Poor are utilizing

a computer system which provides daily lists of amount of medication adminis-
tered by patient and by type of drug. The hospitals relay information about
patient billing, medications, tests, and internal hospital accounting to

the central computer which provides summary reports, including a narcotics
control list.

Computer system will store psychiatric patient data. Med. World News.
11:42, June 26, 1970.
(Multi-State Information System, New England states)

Cotner, W., and Schoolar, S. Revenue increase by Medical Information System.
Tex. Hosp. 26:18-19, Sept. 1970.

Dance, W. HAS marks 15th year. Hospitals, J.A.H.A. 48:55, Aug. 16, 1974.

Describes the development of AHA's Hospital Administration Services Program
which marked its 15th anniversary in 1974. The main objective of the

HAS program, which began serving six hospitals in 1959 and now serves
nearly 3,000 institutions, is to provide comparative financial statistical
data on hospitals and to compare individual institution performances to
those of the entire hospital field. Some of the services initiated by

the program over the past 15 years include: a cost allocation program;

a budget analysis program; specialized programs for nursing homes, psychiatric
hospitals, and university health centers; special educational services

for managers; publications, and so forth. Services related to HMO's and
other innovative delivery systems are now under study.

, and Schmidt, A. HAS: what it does for a hospital. Hosp. Financ.
Manage. 28:32-35, Aug. 1974.

Fergus, R. M. What kind of computer network should your hospital be using?
Hosp. Financ..Manage. 27:32,34-36, Mar. 1973.

The author explores the evolution of data processing in hospitals and
weighs the advantages and disadvantages of several type of hospital com-
puter networks. He concludes that shared computer networks offer special
advantages and are a viable computer service alternative for hospitals.

31

213.

214.

215.

216.

217.

218.

219.

220.

221.

Foster, C. L. Computer data collection and computer pricing. Tex.
Hosp. 26:22-23,31, Sept. 1970.
(Texas Hospital Association and Medical Information Shared Computer System)

Gouveia, W. A., editor. Computer concepts. Amer. J. Hosp. Pharm. 28:
124-126, Feb. 1971.

Grom, H. S. A shared credit and collection program is at work in Minneapolis-
St. Paul. Hosp. Financ. Manage. 26:24, May 1972.

Affiliated Hospital Services (AHS), a hospital—OWned, not-for-profit,
tax-exempt, cooperative association, was incorporated in 1969 to effect
better and less expensive credit and collections. The management structure
and staffing of ABS, the collection agreement made with participating
hospitals, the procedure for classification and collection of accounts,
and the charge formula are outlined. Six elements of program success

are identified: "(1) a well-defined and mutually agreed upon need, pin-
pointed well in advance of implementation (2) total commitment and support
from hospitals (3) a sound organizational base (4) becoming incorporated
as a separate legal entity not coming under the wing of hospital (5) an
interested and involved board and (6) building a reputation on its own
merits and accomplishments."

Grosjean, D. B. Data processing for smaller hospitals. Tex. Hosp.
26:40,43, Sept. 1970.
(Texas Hospital Association, Shared Hospital Accounts Receivable System)

Haidinger, T. P. Computer timesharing: a primer for the financial executive.
Financ. Executive. 28:26-35, Feb. 1970.

Hammon, G. L., and Jacobs, S. E. Shared computer systems. Part 1. Hospitals
J.A.H.A. 44:50-53, May 1, 1970. Part 2. Hospitals, J.A.H.A. 44:72-76,

May 16, 1970.

(Annotation, 535)

Hartman Jr., J. D. Efficiency with data processing. Southern Hosp. 41:
10-12, May 1973.
(Hospital Data Center, Virginia)

Health care data service keeps records of clients' patients. The Office.
81:50,57, May 1975.
(Medical Computer Systems, Inc., Dallas)

Health Services ReSearch Center. Demonstration and Evaluation of a Shared

Modular Hospital Information System. Chicago: Health Services Research
Center, 1973.

A detailed study of the establishment of a shared hospital modular informa-
tion system (SHMIS) utilizing computer applications based on the Massachu-
setts General Hospital Utility Multipurpose Programming System (MUMPS)
language in a consortium of hospitals. The research methodology includes
the testing, monitoring, analysis, and evaluation with respect to the imple-
mentation, demonstration, evaluation, and application performance of the
SHMIS approach. The evaluation is concerned with manpower utilization,
quality of care, acceptance of the system, and generalizability.

32

222.
223.

224.

225.

226.

22.

228.

229.

230.
231.

232.

233.

224.,

Hospital Financial Management Association. The State of Information Pro-
cessing in the Health Care Industry. Chicago: Hospital Financial Manage-
ment Association, 1970.

Huey, J. P. System cost--old vs. Medical Information System. Tex.
Hosp. 26:20-21, Sept. 1970.

Information systems threatened. Hospitals, J.A.H.A. 46:10,14, Mar. 16,
1972.

(Hospital Information Systems Sharing Group position in regard to auto-
mation in the health care industry)

Kenley, G. Impact of shared data processing. Tex. Hosp. 26:16-17,
Sept. 1970.

Lehman, A., and Weinstein, A. D. Shared services in collection led to
savings, efficiency. Hosp. Financ. Manage. 27:22,24728, Aug. 1973.

Examines the decision-making process which led Midtown Hospital Association
to contract with National Accounting Systems, Inc. for collection of de-
linquent accounts rather than to establish an in-house agency. A criteria
chart used in examining each of the alternatives is provided. The ser-
vices offered by NAS and the savings gained through the contractual ar-
rangement are described. Cost accounting data is provided.

Leighton, E. California's computerized information system for hospitals.
Hosp. Forum (Westerg). 13:6-8,22,24, May 1970.
(California Health Data Corporation)

Lewis, P. M. The Hospital Utilization Project: a modern medical information-
system for Pennsylvania hospitals. Penn. Med. 73:65-67, Mar. 1970.

Malm, H. Computer Applications in a Health Care System. Chicago: American
College of Hospital Administrators, 1970.
(Lutheran Hospitals and Homes Society of America, Inc., Fargo, ND)

Medical Information: Texas Hospital Association Shared Computer Program.
Tex. Hosp. (Special Issue). 26:8-43, Sept. 1970.

Moore, D. L. Shared services--Medical Information style. Tex. Hosp.
26:8,11, Sept. 1970.

Perla, G. G. Purchasing shared computer services. Hospitals, J.A.H.A.
47:70-71, Aug. 16, 1973.
(Anno tat ion , 545)

Picha, N. A study to determine the effectiveness of a shared (off-line)
computer service in the management of accounts receivable in small Texas
hospitals. Master's thesis, Baylor University, Waco, TX, 1972.

(Texas Hospital Association, Shared Hospital Accounts Receivable System)

Rankin, J. W. Four Carolina hospitals go on line with computer. Mod.

Hosp. 111:86, Oct. 1968.
(Medi-Data, Inc., Charlotte, NC)

33

235.

236.

237.

238.

239.

240.

241.

242.

243.

244.

245.

Schmidt, A. HAS-CAP: what do they do? Hospitals, J.A.H.A. 45:21-168,
Sept. 1, 1971.

Schwartz, M. D. Status of hospital information systems. Hosp. Progr.
51:52-60, June 1970.

Shared computer system introduced. Hosp. Forum (Western). 14:18, Feb.
1972.
(Health Data-Net, California)

Singleton, R. Internal controls of the Medical Information system.
Tex. Hosp. 26:34, Sept. 1970.

Sisters of the Third Order of St. Francis. Demonstration of a Shared
Hospital Information System (Final Report). Peoria, IL: Sisters of the
Third Order of St. Francis, 1970.

 

Smith, S. D. A status report. Hospitals, J.A.H.A. 45:62-63, Nov. 16,
1971.
(Lakeland General Hospital, Lakeland, FL)

Soder, E. Service-bureau vs. in-house computer. Hosp. Financ. Manage.
26:22,27, Jan. 1972.
(Annotation, 549)

Survey shows a mixed pattern of computer problems and use. Mod. Hosp.
116:41, Mar. 1971.

Thorpe, L. R. Questions about time sharing. Hosp. Progr. 51:80,82,86-
87, Feb. 1970.

Ulrich, W. Payroll and labor distribution--by products most beneficial.
Tex. Hosp. 26:38,43, Sept. 1970.

Winfield, D., and Baldwin, G. Computerized insurance proration. Tex.
Hosp. 26:29-30, Sept. 1970.

Central Service

246.

247.

Hospitals buy downtown buildings to house central services. Hosp. Top.
49:22, June 1971.
(Baptist Medical Centers, Birmingham, AL)

Jonassen, J. 0. Hospital shared services. Hospitals, J.A.H.A. 45:43-47,
Jan. 16, 1971.

Following a brief review of shared service arrangements in the United
States and in other countries, the author discusses the concept of area
industrial zones, which provide for the separation of non—clinical sup-
port functions from the hospital and the grouping of these functions on
industrial sites. The possibility of implementing this concept in the

34

248.

249.

United States, where hospital ownership and control are diverse and some-
times competitive, and the inherent problems--standardization, large initial,
investments, and administrative reorganization--areidiscussed. In addition "
to reduced costs and increased quality control, benefits of the area indus-
trial zone concept include reduction of the expansion problem in urban

areas, increased design flexibility for both patient-related services

and non—clinical support functions,\and alleviation of maintenance_problems
through joint support of a trained maintenance staff.

Lauzen, E. Seattle: hospitals write new formula for central supply.
Mod. Hosp. 114:190-102, Apr. 1970.
(Seattle-area shared services arrangements)

Ross Jr., A., and Zoellick, R. F. A shared central service department.

Hospitals, J.A.H.A. 44:64,66,68,106, Sept. 1, 1970.
(Virginia Mason Hospital and Doctors Hospital, Seattle)

Dietary

250.

251.

252.

253.

254.

Bailey, D. T., and Bonvicin, M. M. Central source for statewide sharing.

Hospitals, J.A.H.A. 47:57-59, Nov. 1, 1973.

The Division of Management Services of the Rhode Island State Depart-
ment of Mental Health, Retardation and Hospitals operates a centralized
food processing plant at the medical center in Cranston. The Center,
which serves 15 state facilities, has reduced labor costs and increased
productivity. Meat processing, kitchen, and bakery operations at the
central facility are described.

Balsley, M. Hospital mergers and multi-hospital units: impact on food
service and dietetics. J. Amer. Diet. Assn. 66:609-613, June 1975.

Banner, M. T. Shared personnel, purchasing and production. Hospitals,
JnAoHvo 47:39-42, NOV. 1, 1973.

Shared food services can be divided roughly into shared professional

and management expertise, shared food purchasing functions, and shared
food production systems. Various types of arrangements within each of
these categories are described and the present extent of sharing in each
category is reported from a survey of members of the American Society for
Hospital Food Service Administrators. The author examines resistance to
sharing and notes that increasing emphasis on regional and area planning
may create a better environment for the utilization of shared dietary
services. Elements of success in shared dietary service plans are noted.

Brown, B. D., Doyon, P. R. An automatic, electronic food system. Hospitals,
J.A.H.A. 47:63,64,66,68-69, Nov. 1, 1973.
(West Jersey (NJ) Hospital)

Community kitchen. Hosp. World. 2:14, Nov.-Dec. 1973.
(William Beaumont Hospital and Warren Memorial Hospital, Royal Oak, MI area)

35

255.

256.

257.

258.

259.

260.

261.

262.

Houston hospitals plan 'superkitchen: Mod. Hosp. 119:42, Oct. 1972.
(University of Texas Medical School System and affiliated institutions)

Hutchings, B. B. Maintaining menu identity. Hospitals, J.A.H.A. (Special Issue)
47:83-84,86, 136, Nov. 1, 1973.
(Craig Rehabilitation Hospital and Swedish Medical Center, Englewood, CO)

Johnson, C. S. Merger creates satellite service. Hospitals, J.A.H.A.
46:62-66, June 16, 1972.

(Good Samaritan Hospital and Medical Center and the Rehabilitation Institute
of Oregon)

Laird, S. W. A shared dietitian consulting program. Hospitals, J.A.H.A.
(Special Issue). 47:75,78, Nov. 1, 1973.
(Annotation, 169)

Shared food services. Hospitals, J.A.H.A. (Special Issae). 47:39-90,
Nov. 1, 1973.

Contents: Shared personnel, purchasing, and production, M. T. Banner;

Group food purchasing: a status report, L. H. Farevaag and B. D. David;

The technology for improved service, G. Glew; Central source for statewide
sharing, D. T. Bailey and M. M. Bonvicin; An automatic, electronic food
system, B. D. Brown and P. R. Doyon; Council programs group purchasing,

H. H. Hogan; A shared dietitian consulting program, S. W. Laird; Specific

or total management through affiliation, L. Tripp; Maintaining menu identity,
B. B. Hutchings.

Shared food services. Southern Hosp. 42:4, May 1974.

Tripp, L. 'Specific or total management through affiliation. Hospitals,
J.A.H.A. (Special Issue). 47:79-80,82, Nov. 1, 1973.
(Annotation, 191)

Two New Jersey hospitals share food service director. Hospitals, J.A.H.A.
45: 65, July 1,1971.

(St. Peter' s General Hospital and Middlesex General Hospital, New Brunswick,
NJ)

E ui ent

263.

Dean, E. J., and Morton, C. F. Cost saving cues: sharing equipment.
Hosp, Eng. Newsletter. 18:2-3, July-Aug. 1973.

The Maryland Hospital Cost Containment Program_has developed a program
for sharing infrequently used equipment and thereby avoids the expense

of separate purchases. In order to formalize such a sharing program hos-
pitals must overcome reluctance of hospital administrators to allow
hospital assets to leave their control, determine what equipment is to

be shared, establish a policy governing loss or damage of loaned equip-
ment, determine legal aspects of equipment exchange, set up a system for

36

264.

keeping track of equipment, decide how to deal with one-sided exchanges
or reluctance to list sharable items, and deal with changes in depart-
ments or administrations and policy revisions. Loan procedures of the
Maryland program are outlined and the authors provide a listing of some
of the items which are included under each of the five main headings of
their shared equipment list: tools; generators, compressors, and pumps;
communications equipment; test equipment; and vehicles.

Harter, T. R. Can the joint venture save you money? Hosp. Financ.
Manage. 25:34-35, Jan. 1971.

Laundry

265.

266.

267°

268.

269.

Answers to questions involving the tax exempt status of hospitals that
establish cooperative laundry service; and a hospital which establishes
its own laundry facilities and sells the service to other hospitals.
Newsletter Soc. Hosp. Attorneys (Supplement). 3:2-3, Feb. 1970.
(Annotation, 423)

Bartfeld, I. A. Five Connecticut hospitals form laundry cooperative.
Hosp. Progr. 54:98,102, May 1973.

Case study of Hospital Cooperative Services, Inc.,_a not-for-profit, non-
stock corporation which supplies linen and laundry services to five
Connecticut hospitals. Before joining the coop, three member hospitals
were in need of expansion for their in-plant facilities and the other

two were using the services of a commercial laundry. When the idea of

a cooperative was conceived, each of the member hospitals raised $6,000
for a feasibility study, agreed to standardize linen, and agreed to supply
a portion of the linen for the new operation. The planning process and
the laundry production system are described, and some attention is paid

to provisions for expansion, employee transfer, and pollution control.

Bash, R. R. Feasibility of Consolidating Durham County (NC) Hospital
Laundries. Master's thesis, Duke University, Durham, NC, 1973.
(Duke Medical Center and Durham County (NC) Hospital Corp.)

Biggs, E. L., and Farnham, J. B. Evaluating laundry alternatives.
Hospitals, J.A.H.A. 44:130-131, Feb. 1, 1970.

The birth of a central. Amer. Laund. Digest. 38:26-32,34, July 15, 1973.

Case study of the development of Hospital Linen Services, Inc., which
serves member hospitals near Kansas City, KS. Reasons given for joining
the central laundry included dissatisfaction with commercial laundry
service, pressing needs to expand in-plant laundry facilities, and steadily
increasing costs. In order to gather incidental start-up expenses, each
interested hospital was assessed on the basis of $10 per bed. Committees
were formed to handle various details and a number of central laundries
were visited so that committee members could observe and study their
performance. A consultant was called in to analyze individual hospital

37

270.

271.

272.

273.

274.

275.

276.

laundry needs and operational costs and to develop a common plan,
projecting savings and benefits. Complications which arose in the
planning stages are described in some detail and the advantages of the
central laundry facility are noted.

Brousseau, T. G., and others. Birth of a 'minico-op.' Hospitals, J.A.H.A.
48:91-94, Apr. 16, 1974.
(Central Dakota Hospital Laundry, Inc.)

Catania, J. J., and Loucks, J. H. A hospital-based regional laundry.
Hospitalsz J.A.H.A. 44:62-65, Sept. 16, 1970.

The authors describe the planning and decision-making process which led

to the establishment of a hospital-based regional laundry at the Crozer-
Chester Medical Center in Chester, PA. The most important single factor
influencing the final decision was the high cost of having the laundry

done commercially. The problem of high cost was compounded by long-term
contracts which stipulated that charges be renegotiated annually. Other
contract details which posed potential problems of control involved linen
ownership and replacement, quantity of linens used, sterilization of isola-
tion linen, and management of laundry personnel in the hospitals. The
authors describe the preliminary investigation which included an inquiry
into the possible use of disposables as well as on-site visits to operating
commercial and hospital laundry facilities and to manufacturers of laundry
equipment. The work flow, processing costs, inventory procedure, and equip-
ment of the new regional laundry are described. In addition to the pos-
sibility of using modern automated techniques, advantages of the present
facility include management by hospital-based personnel and the use of
services and facilities already available at the Medical Center such as
maintenance service, boiler plant, cafeteria, and employee health services.

Cathey, J., and Giancola, D. M. Shared service. Southern Hosp. 41:14—15,
May 1973.
(Hospital Services Corporation, Columbia, SC area)

Central laundries can save by adding volume and control. Mod. Hosp.
114:84-87, Apr. 1970.

This overview of the status of central laundry services examines some

20 locations throughout the United States in which hospitals are parti-
cipating in, are planning, or have decided against entering shared laundry
service agreements.

Chicago: shared laundry, purchasing gather steam. Mod. Hosp. 114:104,
Apr. 1970. '
(Chicago-area shared services arrangements)

Church, S. T. The co-op that could. Hospitals, J.A.H.A. 45:114-116,
Dec. 16, 1971.

(Hospitals Laundry Association, Inc., Boston, MA area)

The cooperative laundry concept: it's not as costly as you
think. Executive Housekeeper. 20;46,48,50,52, Apr. 1973.

The author demonstrates that chareges of high costs which are the basis

38

 

 

277.

278.

279.

280.

281.

282.

283.

.284.

285.

of much criticism of the cooperative laundry are largely unwarranted.

A method which may be used to calculate the direct labor cost and produc-
tivity index for any hospital laundry operation is described. .The
cooperative laundry is shown to process laundry at an efficiently high
productivity rate and a low direct labor cost. In addition, the coopera-
tive laundry must absorb all operating costs and cannot lean on partici-
pating member hospitals for services such as utilities, maintenance,
personnel, and space° Each of these services entails expenses which are
not necessarily reflected in the in-plant laundry's cost. Today, many
co-ops are multi—service organizations which frequently provide services
likely to effect economies of scale for participating member hospitals,
such as mending or operating room linen pack service. A number of central
laundries are making available services which have nothing to do with
laundry and linens such as data processing, group purchasing, blood and
drug supply, warehousing, and other services which are resulting in
dollar savings.

Cutting laundry costs--thé central laundry concept. Executive
Housekeeper. 21:36,48,50, Mar. 1974.

Through cost reduction and the elimination of large investments, central
laundry facilities can make funds available for purposes more closely
related to patient care. The author describes how the advantages of cen-
tralization are achieved and examines the trend toward hospital shared
services which has encouraged the adoption of the central laundry concept.

Coldewey, G. T. Shared laundry service. Hospitals, J.A.H.A. 44:18,
June 1, 1970.
(Annotation, 425)

Commercial/in-plant battle brewing in Milwaukee. Amer. Laund. Digest.
40:46,49, May 15, 1975.

Commercial laundries block construction of central. Amer. Laund. Digest.
40:44, Jan. 15, 1975.
(Virginia Hospital Luandry, Inc., Richmond, VA)

Co-op laundry set to produce 14,000,000 pounds per year. Amer. Laund.
Digest. 37:44-46,48,50, Sept. 15, 1972.
(Cooperative Hospital Services, Inc., Milford, CT)

Cooperative central laundries form their own association. Amer. Laund.
Digest. 35:10, Jan. 15, 1970.
(Association of Cooperative Hospital Laundries)

Cooperider, N. L. The making of a successful co-op linen service. Executive
Housekeeper. 22:29-30,32e34, Mar. 1975.
(Hospital Linen Services, Inc., Kansas City, KS area)

Court denies revenue bonds for shared laundry service. Hospitalsz J.A.H.A.
49:107-108, Feb. 16, 1975.
(Richmond, VA)

Crosswise work flow speeds linens through central facility. Amer. Laund.
Digest. 35:34-36,38-39,42,44, Dec. 15, 1970.
(Hospital Linens, San Carlos, CA)

39

286.

287.

288.

289.

290.

291.

Danks, R. T. Automation for a new central laundry. Hospitals, J.A.H.A.
45:112-117, Sept. 6, 1971.
(St. John's Hospital, Springfield, IL)

Dobson, R. J. Blueprint for a central laundry. Executive Housekeeper.
l9:22-24,26,28,46, Mar. 1972.

 

The author describes the stages in the development of the Newark Central
HospitaJ.Laundry from the time of the original consultant study through
the planning and design stage and then into construction, equipment pur-
chase, and personnel projections. The laundry serves and is administered
by 10 New Jersey hospitals which formed a not-for-profit corporation known
as the Central Services Corporation of Metropolitan New Jersey. Notable
features of the central laundry include: complete linen supply service
with mending, operating room linen pack service and retail delivery of

the linen, the use of tunnel washing systems and continuous flow processing,
and the use of pneumatic conveyor systems. The laundry's processing

flow, sorting process, finishing procedures, and equipment are described
in detail. An architectural model of the laundry and pictures of laundry
eQuipment are provided.

Field, F. Central 1aundries--the case for de-centralization. Laund.
Cleaning World. l:22,36, Oct. 1973.
(Medical Center of the University of California at San Francisco)

Four Minneapolis hospitals to operate common laundry. Hosp. Top.
48:18, May 1970.

Garry, R. Central laundries: wave of the future? Laund. Cleaning
World. 1:12,l6,31,34, Aug. 1973.

Following a brief overview of the development of the central laundry
concept the author discusses some of the advantages of the central laundry
concept: payment of only a few pennies per pound laundered for capital
funds, savings on investment for individual expansion and modernization,
space savings within the hospital, flexibility and capacity for further
growth, lower laundry costs, high quality, adequate quantity, regular de-
liveries, protection against cross-infection, relief for management,

a combination of internal control with external production, and ability
to expand linen services to the extent desired. The advantages of the
central laundry service are compared with the advantages of in-plant
laundry service, commercial-contract laundry service, and linen supply
service.

Hess, A. E. Is it true what they say about centrals? Amer. Laund. Digest.
38:35-36, Aug. 15, 1973.

Using his own in-plant laundry (St. Luke's Hospital, Kansas City, KS)

as a model, the author challenges seven common claims made for central
laundry facilities: that they increase savings for individual hospitals,
that they reduce laundry and linen costs, that they provide better ser-
vice and quality, that they allow use of space for other purposes, that
they save money on linen replacement costs, that they relieve hospital
administrative staff, and finally that they are unable to find competent
managers for in-plant operations. Hess shows that his in-plant facility

40

saves more than $250,000 compared to what the local central would
charge.

292. Horn, J. R. The centralized laundry concept. Executive Housekeeper.
20:36,86,90, Mar° 1973.

The executive director of the Central Services Corporation of Metro-
politan New Jersey discusses the need for careful study of statistics upon
which the design of a prospective laundry plant is based. He also
addresses the problem of unused or idle capacity in a central facility
which is built to process a larger volume of linen than is initially
needed for member hospitals. The continuous flow production plant at

the New Jersey central laundry facility and the systems devised to con-
trol the distribution of linens to member hospitals, measure productive
efficiencies, and control inventories, are described.

293. Jappy, W. C. Discussion of factors involved when considering participa-
tion in a central laundry. Master's thesis, University of Toronto,
Toronto, 1969.

(Centennial Hospital Linen Services, Inc., Toronto)

294. Kelly, J. C. Workflow par excellence. Laund. Cleaning World. 2:6,8,l6,
May 1974.
(Central Services CorporationIOf Metropolitan New Jersey)

295. Killenberg, G. A. Hospital financial problems. Hosp. Top. 49:56,
Oct. 1971.
(Annotation, 561)

296. Kretschmar, C. G., and Furst, R. w. Should your hospital join a shared
laundry? Hospitals, J.A.H.A. 47:l74,l76,l78,180,182,l84, July 16,
1973.

297. Largest non-profit hospital laundry will service 12 Newark-area institu-
tions. Nurs. Homes. 21:8, Feb. 1972.
(Hospital and Health Planning Council of Metropolitan New Jersey)

298. Lauzen, E. If the laundry won't come to the carts the carts will go to
the laundry. Mod. Hosp. 1142134, Feb. 1970.

Specially built laundry carts used both for transport and storage of

soiled linens have lowered laundry rates for two hospitals sharing a

laundry. In addition, 9,500 square feet of space was freed at one of
the hospitals for future expansion of services.

299. Long, S. D. Two hospitals share administrative services. Hospitals, J.A.H.A.
48:121-122,l75, Oct. 1, 1974. '
(Shared Services Systems, Omaha, NE)

300. Menzel, R. Cooperative central laundry solves problems. Hosp. Manage.
112:27, Aug. 1971. .

301. New corporation to provide shared hospital services. Mich. Hosp. 6:27,

Nov. 1970.
(Metropolitan Detroit Area Hospital Services, Inc.)

41

302.

303.

304.

305.

306.

307.

308.

309.

Nine-year progress. Amer. Laund. Digest. 35:36-38,40-42,47-48, May 15,
1970.
(Hospital Laundry Association, Inc., Greater Boston area)

Oehnel, E. Central hospital laundries. Executive Housekeeper. 18:30,32,
34,36-38, Mar. 1971.

Pertl, D., and Giancola, D. Central laundry irons out linen control
problems. Hospitalsz J.A.H.A. 48:93-94,96,98, May 16, 1974.

The provision of a full and complete linen service together with

exact control of that service can solve many of the deficiencies in cen-
tral laundry operations. If the linen processing and control system is
correctly designed and implemented a full range of services including
linen purchasing, inventory control, linen repair, use area deliVery,
daily delivery requirement calculations, and accounting and control
information may be furnished at a comparatively low price. The authors
note the reasons for failure of traditional linen control systems and
describe a central laundry soiled linen count and even exchange control
system which can solve the problem of balancing supply and demand and

curb linen misuse in member hospitals. The soiled linen count system they
describe, which is used by the Hospital Services Laundry of Columbia, SC,
allows production of the following report data: a daily production report,
daily delivery requirements, bimonthly or weekly billing reports, and
numerous linen utilization and work load analysis reports.

Shared laundry service: development, problems, and needed direc-
tions. Trustee. 27:25—31, May 1974.

Pick, 0. M. A cooperative central laundry. Part 1. Hospitals, J.A.H.A.
45:84,86-87, Feb. 16, 1971; Part 2. Hospitals, J.A.H.A. 45:106-108,
Mar. 1, 1971.

Case study of the development of the Madison United Hospital Laundry,
Ltd., a cooperative central laundry which was built to serve three.
Madison, WI hospitals. The three participating hospitals formed a
not-for-profit corporation which assumed the responsibility for the
planning, design, and construction of a building. The selection of the
construction site and the early work of a linen standardization committee
are described. The author also describes the management structure and
administrative operation of the laundry and explains the detailed record
keeping and billing systems which solved problems of underestimation of
linen needs by member hospitals and hoarding of linen.

Pierce, P. M. .Modern equipment, efficient workflow mark central's success.
Inst. Laund. 15:6,8,22, July 1971.

_(Western Kentucky Hospital Services, Inc.)

Pounds per operator hour up, workforce down. Amer. Laund. Digest. 39:
66-69, Aug. 15, 1974.
(Hospital Cooperative Services, Connecticut)

Ryan, J. P. Outside consultant tells what's right, wrong with central
laundries. Amer. Laund. Digest. 35:34,36,38,40,41, Oct. 15, 1970.

42

310. Schweid, P. The central laundry-eyesterday, today and tomorrow. Amer.
Laund. Digest. 36:64-66,68,70, Feb. 15, 1971.

311. . Co-ops: they're catching on. Hospitals, J.A.H.A. 46:106-108,
111-112, Mar. 16, 1972.

312. Shared laundries form association. Hospitals, J.A.H.A. 45:122, July 16,
1971.

The Association of Cooperative Hospital Laundries was formed in September
1970 to provide a vehicle for the exchange of operational data by its
members. Association membership now includes 20 central laundries in

a the United States and Canada which represent nearly 200 hospitals with
a total of over 50,000 beds. The Association offers its members infor-
mation packets on subjects Such as employee incentive programs, linen
cart services, and financing options as well as sample documents pertinent
to the formation of a cooperative central laundry corporation. In addition,
member laundries may take advantage of a comparative data system which
has been developed with the cooperation of AHA's Hospital Administrative
Services (HAS) program. The Association encourages visits among member
institutions and arranges the exchange of research and survey information
resulting from studies engaged in by member institutions.

313. Shared system starts in Oregon. Hosp. Forum (Western). 15:17, Sept.
1972.
(Portland (OR) Hospital Shared Services Corporation)

314. Shorr, A. S. How to take a hospital to the cleaners. Hospitals, J.A.H.A.
45:97-99, Aug. 16, 1971.
(Associated Hospitals Processing Facility, Detroit)

315. Simon, S. R. PROFILE: Rhode Island Medical Center central laundry.
Laund. Cleaning World. 1:18-19, Apr. 1973.

316. Sixteen Chicago hospitals form shared service laundry. Hospitals, J.A.H.A.
47:176, May 16, 1973.

Hospital Laundry Services (HLS) serves 16 Chicago hospitals with a
total of 5,525 beds. The two plants which handle the laundry are
equipped to serve additional hospitals if the need arises. Savings
for the participating hospitals are estimated at $1 million annually.

317. Take a tour of a central. Amer. Laund. Digest. 38:46-49, Dec. 15, 1973.
(Combined Services, Inc., Miami-Ft. Lauderdale, FL)

318. Taylor, R. A. Financing a cooperative hospital laundry. Hospitals, J.A.H.A.
46:108,110,111, Aug. 16, 1972.
(Annotation, 569)

319. Tri-level production aids efficiency. Amer. Laund. Digest. 39:58-61,
Jan. 15, 1974.
(Texas Medical Center, Houston)

320. Twenty hospitals form group to establish shared services. Hospitals,
J.A.H.A. 452103, June 16, 1971.
(CINDAY Shared Services Committee, southwestern Ohio and northern Kentucky)

43

321.

322.

323.

Virginia shared laundry service target of antitrust suits. Hospitalsz
J.A.H.A. 48:17, Nov. 1, 1974.
(Virginia Hospital Laundry Inc., Richmond, VA)

warm, B. How we meet four merged hospitals' laundry and linen require-
ments. Amer. Laund. Digest. 35:65-66,68, Sept. 15, 1970.
(Wilmington (DE) Medical Center)

which type of laundry service is best for you? Hospitals, J.A.H.A.
47:64-65, Aug. 16, 1973.
(Annotation, 550)

Library

324.

325.

326.

Michael Jr., M. Networking for community hospital libraries. Biomedical
Communications. 1219,41-42, July 1973.

The library system of the Jacksonville Hospitals Education Program (JHEP)
is made up of nine community hospital libraries which pool resources,
coordinate acquisitions, and.share the services of a medical librarian
who coordinates the system from a central facility. The librarian main-
tains a union catalog which duplicates the holdings of the nine libraries,
catalogs all acquisitions, supervises the library assistants in the
hospitals, answers reference questions, and furnishes bibliographic data.
All loan requests are coordinated at the central facility. when requests
can not be filled from the circulating collections of the participating
libraries, the central facility provides photocopies from its own non-
circulating collection which contains back up materials not found in any
of the system's libraries. The central facility also joins a national
network through a teletype unit which can send requests to any of the
libraries in the southeastern group of medical school libraries which
participate in the Regional Medical Library system of the National Library
of Medicine. Thus, the small community hospital library has rapid access
to materials which are collected in local, regional, and national libraries.
The author offers suggestions for improvement of the program and notes
additional services which are planned.

New role for hospital libraries: community health learning centers.
Cross-Reference. 1:9, Oct. 1971.
(Annotation, 414)

Vaillancourt, P. M., and Woods, Sister R. C. Three-pronged approach for
centralized library services. Special Libr. 63:528-532, Nov. 1972.

The Catholic Medical Center of Brooklyn and Queens, Inc. (CMC) developed

a three-phase program which involved drawing together nine small hospital
libraries into a cooperative, functional unit. The three phases described
include: the decision to centralize; the implementation of housing for

the new centralized library and the development of plans for the organiza-
tional structure; and the formulation of long range goals including the
continued exploration of available resources. Elements of good planning and
errors made in each of the developmental phases are described.

44

327.

West Suburban Hospital Association in cooperation with the New England
Hospital Assembly Incorporated Consortium for Information Resources.
Fact Sheet. Newton Lower Falls, MA: Newton-Wellesley Hospital, 1974.

Medical Audit and Medical Records

328.

329.

330.

Bunker, E. /Medical records problems in dealing with two hospitals/.
Med. Record News. 42:60-61, June 1971.
(Martin Place Hospitals East and West, Detroit, MI area)

Fifer, W. R., and Ellsworth, S. J. A shared medical audit program for
small hospitals: meeting the demands for accountability. Hosp. Med.
Staff. 3:1-10, Oct. 1974.

Author describes a regional medical auidt program established by the
University of Minnesota's Area Health Education Center to serve 14
counties in east central Minnesota. The conceptual and operational
problems of medical audit programs are described in some detail with
particular reference to the situation of rural and smaller hospitals.
Methodology, standard setting, committee formation, audit criteria, and
data retrieval for the regional program are described.

Reising, J. H. A unitary medical record data base in Forsyth County,
North Carolina. Master's thesis, Duke University, Durham, NC, 1972.

Includes a cost-benefit analysis of a proposed unitary computerized
medical record data base as well as a discussion of areas of potential
but non-quantifiable savings.

Purchasing

331.

332.

Ammer, D. S. Shared effects of group purchasing. Hospitals, J.A.H.A.
47:81-82,84-85, Sept. 16, 1973.

Hospital involvement in group purchasing offers the opportunity-to
reduce purchasing costs by 10 to 15 percent. The buying power of a
strong purchasing group can force suppliers to-compete and thereby bring
prices down. Changes in the price structure affect members of the group
as well as nonmembers in the same marketing area. Future prospects for
group purchasing are bright--nearly 2/3 of voluntary group purchasing
organizations are less than 10 years old and the volume of purchases
made by these groups is growing at an aCcelerated rate. In addition,
the prudent buyer concept, which is a criterion for reimbursement under
federally financed health insurance programs, is likely to be a potent
force in encouraging the development of group purchasing.

Appalachian Regional Hospitals central purchasing service. Hosp. Progr.
53:38, May 1972.

45

333.

334.

335.

336.

337.

338.

339.

340.

341.

342.

343.

344.

345.

346.

347.

348.

Arizona hospitals form group purchasing cooperative. Hosp. Manage.
111:5, Jan. 1971.
(Cooperative Purchasing Association of Arizona)

Balsley, M. B. Example of a trend: food purchasing program, Chicago
Hospital Council. J. Amer. Diet. Assoc. 66:162-165, Feb. 1975.

Baltimore hospitals cut costs through joint purchasing. Hosp. Purchasing.
14:4, Aug. 1970.
(Hospital Cooperative Services and Supply Center, Inc., Baltimore)

Banner, M. T. Shared personnel, purchasing, and production. Hospitals,
J.A.H.A. 47:39-42, Nov. 1, 1973.
(Annotation, 252)

Barton, J. Cooperative purchasing: quantity gets quality. Mod. Nurs.
Home. 29:33-35, Dec. 1972.
(Nursing Home Cooperative, Chicago)

Brawley, Sister A., and others. The future of hospital purchasing.
Hosp. Progr. 52:32-44, Mar. 1971.

Cabot, E. E. Knowledge and timing are keys to buying by bid. Mod. Hosp.
120:91,96, Jan. 1973.

Change of structure, philosophy doubles group purchasing volume. Mod.
Hosp. 18:2, May 1974.
(Hospital Purchasing Service of Michigan)

Chicago: shared laundry, purchasing gather steam. Mod. Hosp. 114:
104, Apr. 1970.
(Chicago-area shared services arrangements)

Davis, R. R. Group buying? Bonanza or disaster? Amer. Surg. Dealer.
59:32-33, Sept. 1972.

. Hospitals find group purchasing results in big savings. Hosp.
Purchasing. 16:2, Oct. 1972.
(Hospital Association of Metropolitan St. Louis, Shared Services Division)

Farevaag, L. H. Criteria for organizational decision-making about food
procurement in health care facilities. Ph.D. dissertation, University
of Wisconsin, Madison, WI, 1973.

, and David, B. D. Group food purchasing: a status report.

Hospitalsz J.A.H.A. 47:43-47, Nov. 1, 1973.

First quarter 1972 purchasing volume reaches record peak. Hosp. Purchasing.
16:2, Aug. 1972.
(Chicago Hospital Council, Group Purchasing Program)

Fritz, J. T. Group purchasing: does it work in small hospitals? Hosp.
Manage. 110:60-61, Nov. 1970.

Giunta, A. A. Conference report: a look at some group purchasing plans.

46

Nat. Assn. Hosp. Purchasing Manage. Newsletter. 3:12-13, Jan. 1973.
(South Florida Hospital Association shared services.program)

349. Group buying--bonanza or disaster for medical products distributors?
Amer. Surg. Dealer. 59:37-38,40, Oct. 1972.

350. GrOup purchasing. Hosp. Purchasing. 17:10, Oct. 1973.

351. Group purchasing is big and getting bigger, but slowly. Mod. Hosp.
114:80-84, Apr. 1970.

352. Group purchasing units hit new peaks in volume, savings. Health Inst.
Purchasing. 3:9H, Nov. 1972.
(New Jersey Hospital Association)

353. Hahn, C. K., and Hardy, S. T. Factors affecting acceptance of a hospital
group purchasing program. J. Purchasing. 8:54-68, Aug. 1972.

354. Hogan, H. H. Council programs group purchasing. Hospitals, J.A.H.A.
47:7l,74, Nov. 1, 1973.
(Chicago Hospital Council)

355. Holland, S. E. Group purchasing can save time and money. Hosp. Manage.
112:41, May 1971.

356. Holmgren, J. H. Buy together, buy for less. Mod. Healthcare. 3:62,
Feb. 1975.

357. . How purchasing groups are organized, who uses them, and how
they work. Mod. Hosp. 119:60-61, Oct. 1972.

358. . These are the arguments for and against group buying. Mod. Hosp.
119:68, Nov. 1972.

3590 Hospitals form purchasing co-op. Hosp. Top. 48:19, Sept. 1970.
(Hospital Service and Supply Center, Inc., Baltimore)

360. Hutton, D. H. A feasibility study of the southern tier of New York
to determine the advantages of group purchasing. Master's thesis,
Xavier University, Cincinnati, 1971.

Study provides a detailed overview of group purchasing including the
development of group purchasing agencies, types of group purchasing
agencies and their distinguishing characteristics, advantages, disadvan-
tages and inherent limitations of group purchasing, reported savings

and growth rates, and the prerequisites for establishing a grOup pur-
chasing program. The feasibility analysis focuses on problems of
standardization and centralization, determination of groups to involve,
data gathering and analysis and the estimation of savings which could

be realized through the formation of a group purchasing agency. Includes
a 41-item bibliography.

361. Kansas City (KS) area hospitals form group purchasing service to combat

costs. Amer. Family Physician. 3:169-170, Mar. 1971.
(Kansas City Area Hospital Association)

47

362.

363.

364.

365.

366.

367.

368.

369.

370.

371.

372.

373.

374.

Lane, M. M. Nursing home administrators may be well advised to look at
group purchasing. Nurs. Homes. 21:26-27, Feb. 1972.

Levinson, P. Cooperative hospital purchasing. Hosp. Pharm. 6:12-15,18,
Apr. 1971.
(Commodities Purchasing Associates, San Francisco Bay Area)

Long, S. D. Two hospitals share administrative services. Hospitals,
J.A.H.A. 48:121-122,l75, Oct. 1, 1974.
(Shared Services Systems, Omaha, NE)

Maroudas, C. D. The Appalachian Regional Hospitals central purchasing
service. Hosp. Progr. 53:38,40-42, May 1972.

Medical Group Management Association group purchasing plan: how and why
it holds down costs. Med. Group Manage. 21:26-27, Jan.-Feb. 1974.
(Medical Group Management Association, Group Purchasing Plan)

Mills, J. Is group purchasing really a swear word? Amer. Surg. Dealer.
60:28-29, Dec. 1973.

Nelson, P. E. The hospital purchasing service of Michigan: an analysis
of its history, stature and potential. Mich. Hosp. 11:10-13, Jan. 1975.
(Hospital Purchasing Service of Michigan)

New Jersey county hospital joins group purchasing program. Hospitals,
J.A.H.A. 1423, Aug. 1970.
(New Jersey Hospital Association, Coordinated Group Purchasing Program)

Osteopathic Group Purchasing Program expands services. Osteopathic Hosp.
16:29-30, Nov. 1972.
(Prudent Buyer Services, Inc., Park Ridge, IL)

Owen, J. W. Wide-range sharing for two hospitals. Hospitals, J.A.H.A.
48:105-107, June 1, 1974.
(Annotation, 57)

Shreck, I. E. Multi-hospital purchasing: innovative growth in the West.
Hosp. Forum (Western). 16:11-12, Oct. 1973.
(western United States purchasing groups)

Simmons, B. A. Group purchasing--any way you like it. Hospitals, J.A.H.A.
46:90,92,94,96-97, Aug. 16, 1972.

Hospital group purchasing has come to be a widely accepted means of
sharing to keep down costs. The author reviews the various types of

group purchasing arrangements now in operation in terms of their organiza-
tional structure, their administrative arrangements, their financial
mechanisms, and in terms of the kinds of commodities obtained. Includes

a table of purchases and savings realized in 1971 as reported by 24 se-
lected group purchasing organizations.

Six hospitals to share their resources, but not medical staffs. Mod.

Healthcare. 3:67, Jan. 1975.
(Susquehanna Valley (PA) Health Care Consortium)

48

375.

376.

377.

378.

379.

380.

381.

382.

383.

384.

Standardization, contract buying cut costs $250,000. Health Inst.

Purchasing. 1:43-44, June 1970.
(Medical Supply Corporation, California)

Tinnermon, E. Group purchasing. Southern Hosp. 38:10, Oct. 1970.
(Hospital Group Purchasing Symposium, Birmingham, AL)

Widman, P. E. /Advantages of group purchasing/. Hosp. Purchasing.
15:1-2, Sept. 1971.

EDUCATION AND TRAINING

An alliance for sharing. Hospitalsz J.A.H.A. 47:51-53, Dec. 16, 1973.
(Rural Health Care Alliance, southeastern Oklahoma and north central Texas)

Barn raising comes to health education. In-Serv. Training and Educ.
3:13-14,21-22,26, Aug. 1974.

(Regional Approach to Improved Service Through Education, west central
Minnesota) ‘

Bickley, H. C., and Penick, G. D. Economical health science teaching
through cooperative courses. Biomed. Communic. 2224,42-46, May 1974.

Blaine, R. A dream grows in Kansas. In-Serv. Training and Educ.
2:14-16,18, June 1973.

Case study of the Association for Continuing Education (ACE) in Great
Bend, KS, an educational consortium which offers more than 40 education
and training programs to 12 institutions separated by as much as 120
miles. The planning process is described and possible pitfalls in the
planning stage are noted. The author describes ACE staff organization
and policies and lists approximately 20 of the 40 programs offered by
the consortium in its first year of operation.

Brooklyn hospitals share training. Bull. Hosp. Educ. and Training. 14:
4, Nov. 1970.
(Health Careers Training Program, Brooklyn)

Communication lines tie nine rural hospitals into network. Mod. Hosp.
118:93-95, Apr. 1972.
(Annotation, 28)

Conway, B. For educational flexibility, form a coop. Supervisor Nurse.
5:36-37,39, July 1974. / ‘

The membership of the South Florida Consortium for Health Manpower Con-
tinuing Education in Dade County, Florida, is made up of representatives
from a wide variety of community organizations including hospitals and
voluntary associations, the Regional Medical Program, the local Health
Planning Council, the State Board of Nursing, the Florida Nurses' Associa-
tion, the Veteran 3 Administration, the Public Health Department, the
local University and Junior College Allied Health and Nursing Programs,

49

385.

386.

387.

388.

389.

390.

391.

392.

393.

and other health agencies in the area. After pooling resources to pro-
duce a community-wide workshop on leadership as a first project, the
Consortium formulated a list of long-range goals involving coordinated
efforts toward joint programming, matching of needs and resources, data
collection, and the development of a clearinghouse to serve as a personnel
and material resource.

Eight Michigan hospitals form audio-visual cooperative. Hosp. Top.
50:15-18, Nov. 1972.
(Michigan Hospital Audio-Visual Cooperative, southeastern MiChigan)

Eleven hospital cooperative pools training. In-Serv. Training and Educ.
2:14, Oct. 1973. '
(Coordinated Hospital Services, Inc., Knoxville, TN area)

Evaluation report shows that shared training can benefit hospitals and
employees. Bull. Hosp. Educ. and Training. Feb. 1972, pp. 1,3.

A recent evaluation of the Health Careers Training Program of Brooklyn

by the Hospital Research and Educational Trust concludes that ”shared
training is an effective means of providing hospital employees with

increased opportunity to advance to better and more responsible posi-

tions." Advantages of the Brooklyn program, which initiated both centralized
and inhospital programs, include improvement in skills and attitudes

of trainees, improved employee relations, and greater employee loyalty.
Eleven basic committments and conditions necessary for shared training

to be successful are noted.

Evans, V. R. Continuing education in a metropolitan area. Supervisor
Nurse. 5:24,28-29, Mar. 1974.
(Staff Development Council of Greater St. Louis)

Falck, V. T. GRO with continuing education. Tex. Med. 70:84-86,
Sept. 1974.
(Texas Regional Medical Program, Project Grass Roots Organization)

Food handlers use phone for continuing education. Cross-Ref. 4:4-5,
July 1974.
(Medical Products Systems Inc., Bartlesville, OK)

Gatzke, H. K., and Yenney, S. L.' Hospitalwide education and training:
definitions, purposes, models. Hospitals, J.A.H.A. 47:93—97, Mar. 1, 1973.

Examines the need for formalized, centralized, and coordinated educa-
tion and training programs. Five alternative models for organizing such

programs are presented, including a consortium model within which educa-
tion and training are shared by several institutions.

Gelsinger, J. L. Dial L for lecture. In-Serv. Training and Educ. 3:8-10,
12,
(Lakes Area Regional Medical Program, Telephone Lecture Network, Buffalo)

Good neighbors work together: hospitals share training resources. Cross-
Ref. ,2:1l, June 1972.

50

394.

395.

396.

397.

398.

399.

400.

Providence and Bethesda hospitals in Cincinnati developed a joint nursing
aide training program which has resulted in dollar savings for both
hospitals. The program allowed more efficient use of training personnel
and facilities at Bethesda's educational division and filled a manpower
need at Providence, a newly opened hospital with personnel shortages.

Healey, L° A., and Friedrich, P. Health Services Consortium: good
neighbor policy. Group Pract. 24:19-21,28, Mar.-Apr. 1975.
(Health Services Consortium, Seattle area)

Health care institutions share educational services: rural hospitals/
join in Project "RAISE.” Bull. Hosp. Educ. and Training. No. 14:1-2,
Nov. 1970.

In January 1970 a group of small health care institutions in west central
Minnesota joined together in Project RAISE (Regional Approach to Improved
Services through Education), a cooperative association which attempts to
solve some of the problems of continuing education resulting from insuf-
ficient local resources and lack of accessibility to sources of up-to-
date educational programs. The Project and its director of education work
closely with local vocational schools to develop courses which meet speci-
fic needs of personnel in participating hospitals. A number of programs
sponsored by the association are capsulized in this report including hos-
pital accounting, nursing aide and management training, medical library
workshop, emergency rescue procedures, and problems of stroke patients.
The Project is totally supported by participating institutions which

pay a share of the operating expenses based on the number of full-time
employees. The participating hospitals and nursing homes have not

begun purchasing food as a group and are considreing the use of a com-
bined laundry service.

Hendee, W. R. A collaborative program in allied health training. *J. Med.
Educ. 46:658-665, Aug. 1971.
(Denver)

Hinson, J. W. Continuing education in a rural area. Supervisor Nurse.
4:29,32-33,36-37, Aug. 1973.

Case study of the Northeast Texas Council of Health Resources which

was organized by 12 small rural hospitals and incorporated in 1971.

The Coordinator of Health Services Education describes the implementa-
tion of the program which initially placed emphasis on upgrading nursing
departments. Various workshops and seminars, many of which involved

the cooperation of outside institutions, are briefly described and the
benefits derived from the shared training program are noted.

Hospital group makes effective use of TV educational system. Assn. Manage.
27:11-12, Feb. 1975.
(Greater Cleveland Hospital Association)

Hospital Research and Educational Trust. Evaluating results. In: Hospital
Research and Educational Trust. Training and Continuing Education: A
Handbook for Health Care Institutions. Chicago: HRET, 1970, pp. 221-252.

. Supervisory Tgaining: The University, the Community College
and the Hospital. Chicago: HRET, 1971.

51

401.

402.

403.

404.

405.

406.

407.

408.

409.

Reports the efforts of a project conducted by the University of Minnesota
in collaboration with five community colleges to offer supervisory train-
ing to hospital personnel.

The hot line to dietary. Hosp. and Nurs. Home. 6:24-28, Apr. 1970.
(Regional Medical Program of Western New York)

Howell, D. L. The cooperative approach in supervisory training. Personnel.
47:57-62, Jan.~Feb. 1970.
(Annotation,560)

Husted, F. L. Regional solution given for national problem. Penn. Med.
76:54-56, Mar. 1973. '
(Area Health Education Centers, Pennsylvania)

Jones, K. B. Shared social services in the Northwest. Hosp. Soc. WOrk
Directors Bull. 37:3, Nov.-Dec. 1973.
(Annotation, 166)

Keyes, F. Pooling health training facilities in Newark, New Jersey. Amer.
J. Public Health. 64:144-147, Feb. 1974.

The Allied Health Task Force of the Council for Higher Education in Newark
(CHEN) was formed to encounfige faculty and staff at the four member teaching
institutions to think and plan in terms of new and cooperative allied health
offerings. The Allied Health Planner of the Council details the strengths
and weaknesses of the present program and makes recommendations for its
future operation. The report includes a checklist against which the task
force examined allied health jobs and professions in relation to the special
problems and needs of Newark. The author evaluates the New Jersey Health
Professions Master Plan and examines its relationship to the CHEN Allied
Health Task Force planning activities. Proposals include establishing more
cooperative curricular offerings; focusing on an extended geographic area;
establishing a clearinghouse for information on health careers, courses

and licensure; focusing concern on problems on the periphery of allied
health responsibilities such as the high incidence of alcoholism, rat bite,
juvenile delinquency, lead poisoning, and so forth; and expanding the represen-
tative nature of the task force to include more consumer representatives,
blacks, young people, aged,.and representatives of business and industry.
Guidelines for assuring optimum input of the expanded task force are pro-
vided.

King, P. J. A cooperative approach to hospital-management education.
Mich. Hosp. 9:20-21, June 1973.
(Hospital Training Resources Group, east side of Detroit)

A shared hospital management development program. J. Continuing
Educ. in Nurs. 4:31-33, Mar.-Apr. 1973.
(Hospital Training Resources Group, east side of Detroit)

LeBoutillier, P. SHIP: shared hospital in-service program. J. Continuing
Educ. in Nurs. 3:31-33, July-Aug. 1972.
(southwest Minnesota)

Lewis, H. L. Hospitals as classrooms. Mod. Healthcare. 2:57-61, Oct. 1974.
(area health education centers)

52

 

410.

411.

412.

413.

414.

415.

416.

Melick, B. A community plan for coronary care. Amer. J. Nurs. 70:1069-
1070, May 1970.

An International Coronary Care Committee was organized in May 1966 in
Jacksonville, FL "to establish similarity of equipment among hospitals

and to organize interhospital teaching programs for physicians and nurses."
The Committee, which was made up of representatives including the chief

of medicine from each hospital, worked closely with nurse supervisors to
develop a two-week training program for nurses interested in coronary

care. The program now includes an ongoing basic course offered four times
a year.

Mundt, E. L. Four shcools—-one in-service program. Amer. J. Nurs. 70:
1519-1520, July 1970.
(Community Organization of Facilty In-Service, Chicago)

. Lighting the candle--an experiment in cooperative continuing
education. J. Nurs. Admin. 1:37-44, Jan.-Feb. 1971.
(Community Organization of Faculty In-Service, Chicago)

Munshaw, P. K. Some kind of involvement. J. Continuing Educ. in Nurs.
2:42-45, Nov.-Dec. 1971.
(Lansing, MI)

New role for hospital libraries: community health learning centers.
Cross-Ref. 1:9, Oct. 1971.

The Intermountain Regional Medical Program (IRMP) is cooperating with
state hospital associations and individual hospitals in building a net-
work of community health learning centers. The centers bring local focus
to many of the continuing education activities of the IRMP by making
available audiovisual materials and other resources useful for sponsoring
workshops and seminars, in addition to traditional printed matter. In
each of the communities a physician medical education coordinator guides
the continuing education effort.

Perrine, G., and Boudreau, Sister M. C. C.C.U. nurse specialists.
Hospitals, J.A.H.A. 44:49—52, Mar. 1, 1970.
(Nassau County, New York)

Rode III, E. A. Shared training becomes a reality. Hospitals, J.A.H.A.
47:149,152-155, Mar. 1, 1973.

Case study of nine Kansas City (KS) hospitals which signed a one-year
contract with the Kansas City Board of Education to use a local vocational-
technical school for training nursing assistants. The program was initiated
by a training and education subcommittee charged by the Kansas City Area
Hospital Association to seek ways to coordinate the training efforts of
hospitals, schools, and other agencies. The Committee developed a common
curriculum, selected teaching materials, and established and evaluated a
trial training program at the vocational-technical school before the hos-
pitals signed the contract. The present program and plans for expansion
are described. Advantages of the program include horizontal job mobility
(all graduates are recognized as competent by all hospitals), vertical job
mobility (the state nursing board has approved the course for credit toward

53

completion of the LPN course offered by the school), and a decrease in

and leveling off of the turnover rate, which formerly approached 70 percent.
In addition, advertising expenses formerly borne by individual hospitals
have been significantly reduced. Savings of approximately $350 per stu-
dent trainee were realized and nearly 4,500 hours of instruction time

have been freed for more essential activities.

417. Ross Jr., A., and Boyle Jr., R. L. Urban-rural exchange programs. Hospitals,
J.A.H.A. 46:55—59, July 16, 1972.
(Virginia Mason Hospital, Seattle)

418. Seattle’s consortium for education. Mod. Healthcare. 1:120-121, Apr. 1974.
(Health Services Consortium, Seattle area)

419. Simmons, J. C. Social work program meets hospitals' unique needs“

Hospitalsz J.A.H.A. 49:64-66, Feb. 16, 1975.

420. Training goes underground. Mod. Healthcare. 2:49-52, Oct. 1974.
(Memorial Hospital Medical Center of Long Beach, CA and University of
California at Irvine Center for Health Education)

421. Twelve institutions form educational corporation. Cross-Ref. 2:1-4,
Dec. 1972.
(Association for Continuing Education, Great Bend, KS area)

422. Vaun, W. S. Types of associations: the continuing education association.

Assn. for Hosp. Med. Educ. J. 5:33-35, 1972.
(Regional Council on Continuing Education)

54

 

 

 

DISCIPLINARY STUDIES

 

TAX AND LEGAL

The published information on tax and legal issues of shared services

is not very extensive. It is expected that this situation will change as
sharing increases and as health care regulations are promulgated. The
following references represent discussions of the topic rather than legal
resolutions of problems.

423.

424.

425.

426.

427.

428.

429.

Answers to questions involving the tax exempt status of hospitals that
establish a cooperative laundry service; and a hospital which establishes
its own laundry facilities and sells the service to other hospitals.
Newsletter Soc. Hosp. Attorneys (Supplement). 3:2-3, Feb. 1970.

An examination of relevant sections of the Internal Revenue Code which
concern tax exempt status and which describe or specify the kinds of
services exempt from federal income tax. A question and answer format
is used to illustrate the application of the code to various forms of
cooperative and purchased laundry services.

Bernstein, A. H. Taxing hospital real estate. Hospitalsz J.A.H.A. 43:
201-202,205, Apr. 1, 1969.

Reviews recent litigation--Hospital Purchasing Service of Michigan v.

City of Hasging, 161 N.W.2d 759 (MI App., 1968) and Children's Hospital
Medical Center v. Board of Assessors of Boston, 227 N.E.2d 908 (MA, 1967)--
concerning the tax exempt status of not-for-profit hospitals which create

a not-for-profit organization to perform purchasing, laundry, and other
functions.

Coldewey, G. T. Shared laundry service. Hospitals, J.A.H.A. 44:18,
June 1, 1970.

Examines the tax-exempt status of a joint venture, shared laundry opera-
tion, when laundry services are sold to a third institution.

Commercial/in-plant battle brewing in Milwaukee. Amer. Laund. Digest.
40:46,49, May 15, 1975.

Commercial laundries block construction of central. Amer. Laund. Digest.
40:44, Jan. 15, 1975.
(Virginia Hospital Laundry, Inc., Richmond, VA)

Court denies revenue bonds for shared laundry service. Hpspitals, J.A.H.A.
49:107—108, Feb. 16, 1975.
(Richmond, VA)

Holland, D. C. Legal and tax aspects of shared services. In: American

Hospital Association. Shared Services in Health Care Institutions.
Chicago: AHA, 1975, pp. 11-16.

55

430.

431.

432.

433.

434.

435.

Author reviews the legal forms of organization for shared service ven-
tures--business corporation, not-for-profit corporation, cooperative,
joint venture, and contractual arrangement--with particular attention
to limitations of liability, tax consequences, Medicare reimbursement
considerations, antitrust problems, and miscellaneous legal problems
including control of the shared services organization, risk sharing,
and distribution of assets in the event of liquidation.

Horty, J. F. New tax and liability rulings affect hospitals. Mod.
Hosp. 111:54,56, Dec. 1968.

Manke, T. The legal and legislative considerations facing shared services
organizations. In: Midtown Hospital Association. Health Organizations
Shared Services; proceedings of a conference. Denver: Midtown Hospital
Association, 1972, pp. 164-168.

,Melton, H. W. Legal Constraints in the Design of Computer-Based Medical

Information Systems. Evanston, IL: Northwestern University, 1972.

Ross Jr., A. and Zoellick, R. F. A shared central service department.

Hospitalsz J.A.H.A. 44:64,66,68,106, Sept. 1, 1970.
(Virginia Mason Hospital and Doctors Hospital, Seattle)

Tuthill, J. P. Qualifying as a tax-exempt cooperative hospital service
organization. Notre Dame Lawyer. 50:448-456, Feb. 1975.

Author provides a history, a summary, and a detailed analysis of section
501(e) of the Internal Revenue Code.

Virginia shared laundry service target of antitrust suits. Hospitals,
J.A.H.A. 48:17, Nov. 1, 1974.
(Virginia Hospital Laundry, Inc., Richmond, VA)

Recent Cases:

436.

437.

438.

United Hospital Services, Inc. v. United States of America, 384 F.Supp.
776 (S.D.Ind. 1974)

Hospital Purchasing Service of MiChigan v. Cigy of Hastings, 161 N.W.2d 759
(Mich. Ct. App. 1968)

Cardinal Industrial Laundry Corporation v. Industrial Development Authority

of the City of Richmond, Virginia, and Virginia Hospital Laundry, Inc.,
Civil No. 74-0413-R (ED.Va., filed Sept. 24, 1974)

56

ORGANIZATION BEHAVIOR

The study of how organizations behave is an emerging discipline in sociology
and in business administration. Its application to the health care field has
been uneven to date, but it is expected that the discipline will in time make
a significant contribution to health delivery. The references cited here are
but a sampling, chosen for their immediate_re1evance to shared services.

1439. Aiken, M., and Hage, J. Organizational interdependence and intraorganiza-
tional structure. Amer. Soc. Rev. 332912-930, Dec. 1968.

i440. Bennis, W., and others. The Planning of Change. New York: Holt, Rinehart
and Winston, 1961.

441. Bieter, J. T. Four options for cooperation: implications for Catholic
‘ hospitals. Hosp. Progr. 51:64-65,101, Mar. 1970.
(Annotation, 19)

442. Blau, P. M., and Scott, W. R. Formal Organizations. San Francisco:
Chandler Publishing Company, 1962.‘

443. Chowins Jr., R. D. A study of the attitudes of small Minnesota hospitals
toward regional cooperative arrangements. Master's thesis, University
of Minnesota, Minneapolis, 1971.

444. Cihlar, C. Hospitals can and do cooperate. Hospitalsz J.A.H.A. 48:
67-69, June 1, 1974.

i445. Crews, J. C. Human concerns about hospital mergers. Hospitals, J.A.H.A.
48:79‘83, June 1, 1974.

1446. Evan, W. M. The organization-setzv toward a theory of interorganizational
relations. In: Thompson, J. C., editor. Approaches to Organizational

Design. Pittsburgh: University of Pittsburgh Press, 1966.

.447. Franklin, C. L. The urban multi-hospital system: necessary conditions.
Hosp. Admin. 16:25-35, Winter 1971.

448. Georgopoulos, B. S., and Mann, F. C. The Community General Hospital.
New York: The Macmillan Co., 1962.

A classic work which examines some of the key characteristics and organiza-
tional problems of the community general hospital.

1449. Georgopoulos, B. S., and Matejko, A. The-American general hospital as
a complex social system; Health Serv. Res. 2:76-112, Spring 1967.

450. Hahn, C. K., and Hardy, S. T. Factors affecting accpetance of a hospital
group purchasing program. J. Purchasing. 8:54-68, Aug. 1972.

451. Heydebrand, W. V. Hospital Bureaucracy: A Comparative Study of Organiza-
tions. New York: Dunellen, 1973.

57

452.

453.

454.

455.

456.

457.

458.

459.

460.

461.

4620

Johnson, R. L. Governance seen as weak link. Hospitals, J.A.H.A.
48:47-50, June 1, 1974.

Author examines the administrative problems which can result when
managers or administrators of participating institutions form the a
board of a shared services organization.

McGrath, J. H. The reaction of physicians to merging of Wilmington
(DE) hospitals: an initial report. Delaware Med. J. 412113-117,
Apr. 1969.

, and others. Factors associated with the physician‘s vote on
the Wilmington (DE) Hospital merger. Delaware Med. J. 42i35-40,47,
Feb. 1970. .

March, J., editor. Handbook of Organizations. Chicago: Rand McNally,
1965.

Neuhauser, D. Organizational Behavior Literature in Health Administra;
tion Education: An Indexed and Annotated Bibliography of Books in Use
by Graduate Programs in Hospital and Health Administration. Washington,
DC: Association of University Programs in Hospital Administration, 1972.

. The Relationship Between Administrative Activities and Hospital
Performance. Chicago: Chicago Center for Health Administration Studies,
University of Chicago, 1971.

Perrow, C. Hospitals: technology, structure, and goals. In: March, J.,
editor. Handbook of Organizations. Chicago: Rand McNally, 1965,
pp. 910-971.

 

Quay, J. G. Efficiency vs. individual needs: dialectic of organization
change. Advanced Manage. J. 32 73-76, Apr. 1967.

Regan, W. A. Corporate responsibility vs. institutional autonomy.

Hosp. Progr. 53:621, Dec. 1972.

Rogers, E. M. Diffusion of Innovation. East Lansing, MI: Michigan State
University Press, 1962.

 

Roos, N. P., and others. Hospital performance: analyzing power and goals.
J. Health and Soc. Behav. 15:78-92, June 1974.

 

Three types of hospitals that deliver short-term health care are discussed
in terms of several difference models of hospital behavior. The structure—
specialization model emphasized hospital control structure as a determinant
of goal emphasis, while the exchange model stressed the interdependencies
between the organization and essential resource suppliers in its environ-
ment. In so far as the models differed, the exchange model was supported
by aggregate data (obtained from the American Hospital Association).
Additionally, a competence model emphasizing the possibility that certain
hospital types may perform relatively well on several dimensions was
partially confirmed. Suggestions are forwarded for future research along
these lines. (Journal summary)

58

463.

n 464.
465.

466.

467.

468.

l 469.
470.

471.

472.

p 473.

474.

475.

Rosner, M. M. Economic determinants of organizational innovation. Admin.
Sci. Quart. 12:614-625, Mar. 1968. '

Rothman, R. A., and others. Physicians and a hospital merger: patterns
of resistance to organizational change. J. Health and Soc. Behav. 12:
46-55, Mar. 1971.

Schein, E. H. The merger as an organizational process. J. of Applied
Behav. Sci. 7:110-111, Jan.-Feb. 1971.

Schermerhorn Jr., J. R. Determinants of interorganizational cooperation:
theoretical synthesis and an empirical study of hospital administrators'
felt needs to cooperate. Ph.D. dissertation, Northwestern University,
Evanston, IL, 1974.

Schnepple, G. R. Rural-urban hospital partnerships--a study of voluntary
hospital regionalization. Master's thesis, University of California,
Berkeley, 1973.

Study investigates the shared-service model as a method for coordinating
medical care throughout sparsely populated rural areas. Examines both
environmental and institutional factors which lead either to interdependence
or to autonomy. Discusses the organizational costs and benefits of region-
alized hospital networks and examines the technical, managerial, and
institutional ramifications of such arrangements. A number of evolutionary
organizational patterns are proposed and alternative models for develop-
ment of a shared service network are considered.

Shimp, I. G. A pilot study to determine consensus among and between in-
fluential groups for sharing and implementing certain hospital services
by members of Associated Capital Hospitals, Inc. Master's thesis,
University of Minnesota, Minneapolis, 1971. v

Simon, H. A. Administrative Behavior. 2nd edition. New York: Free
Press, 1965.

Soltis, R. J. Systematic approach to managing change. «Manage. Rev. 59:
2-11, Sept. 1970.

Starkweather, D. B. Health facility mergers: some conceptualizations.
Med. Care. 9:468-478, Nov.-Dec. 1971.
(Annotation, ll)

Strathy, R. D. The "people" aspect of a merger. Hospitals, J.A.H.A.
45:39-41, Nov° 1, 1971.

Terenzio, J. V. Sharing professional services. Hosp. Forum (New York).
41:5-6,15, Mar. 1973.

(Annotation, 144)

Thompson, J. Organizations in Action. New York: McGraw-Hill, 1967.
Veney, J. E., and Khan, J. Causal paths in elaboration of organizational

structure: a case of hospital services. Health Serv. Res. 8:139-150,
Summer 1973.

59

476.

Elaboration or change in hospital services is examined as a function

of three classes of variables: contextual (characteristics of the
environment), structural (characteristics of the hospital itself),

and characteristics of the administrator. Possible causal paths in

the flow of change forces are posited and examined by a recursive tech-
nique to determine the model that most nearly approximates reality. It
is concluded that elaboration of structure within a hospital is primarily
a function of the context and structure, but a smaller independent force
is a function of the context and the administrator himself. (Journal
summary)

White, P. E., and Vlasak, G. L., editors. Inter-Organizational Research
in Health; conference proceedings, January 1970, New York City. Washington,

DC: National Center for Health Services Research and Development.
(Annotation, 85)

ECONOMICS

This brief section on hospital and health services economics is included

in the bibliography in the hope that those readers with some training in
economics can see the problems of applying this discipline to shared services.
The less-trained reader could well benefit from a study of some of these
'source documents.

477.

478.

479.

480.

481.

482.

ARA Hospital Food Management. Conversations: Hospital Efficiency Through
Economies of Scale. Philadelphia: ARA Hospital Food Management, 1971.

Baligh, H. H., and Laughhunn, D. J. An economic and linear model of the
hospital. Health Serv. Res. 4:293-303, Winter 1969.

Berki, S. E. Hospital Economics. Lexington, MA: D.C. Heath and Co.,
1972.

Berry Jr., R. E. Product heterogeneity and hospital cost analysis.
Inguiry. 7:67-75, Mar. 1970.

.' Returns to scale in the production of hospital services.
Health Serv. Res. 2:123-139, Summer 1967.

The primary purpose of this article is to investigate whether or not
economies of scale exist in the production of hospital services. In
previous studies the results have implied the existence of economies

of scale, but the question has not been satisfactorily resolved. The
factor most responsible for clouding the issue is the overwhelming pre-
valence of product differences in the outputs of hospitals. In this
study a method which avoids the problem of product differentiation is
developed. The analysis strongly supports the conclusion that hospital
services are produced subject to economies of scale. (Journal summary)

Brown, R. E., editor. Economies of Scale in the Health Services Industry;
proceedings of an invitational seminar, May 10-12, 1971, Chicago. Rock-

ville, MD, National Center for Health Services Research and Development.

60

483.

484.

485.

486.

487.

488.

489.

490.

491.

492.

DHEW Pub. No. (HSM) 73-3009. /Reproduced and distributed by National
Technical Information Service, Springfield, VA, 1972/
(Annotation, 82)

Brown Jr., M. An economic analysis of hospital operations. Hosp. Admin.
15:60-73, Spring 1970.

Carr, W. M., and Feldstein, P. J. The relationship of cost to hospital
size. Inguiry. 4:45-65, June 1967.

Feldstein, M. 3. Economic Analysis for Health Service Efficiency.
Amsterdam: North-Holland Publishing Co., 1967.

. The Rising Cost of Hospital Care. Washington, DC: National
Center for Health Services Research and Development, 1971.

Feldstein, P. Applying economic concepts to hospital care. Hosp. Admin.
33:68-89, Winter 1968.

Griffith, J. R., and others. Practical ways to contain hospital costs.
Harvard Bus. Rev. 51:131-139, Nov.-Dec. 1973.

Harris, S. The Economics of American Medicine. New York: Macmillan
Co., 1964.

Hefty, T. R. Returns to scale in hospitals: a critical review of recent
research. Health Serv. Res. 4:267-280, Winter 1969.

Because the marketplace that ensures efficiency in a competitive industry
is inoperative in the provision of hospital services, planning of the

size and distribution of facilities by an external authority is developing
as a substitute for competitive pressures. Planners must consider the
potential effective demand for facilities and the costs of providing the
services. Many of the costs are external to the hospital, but of major _
importance is the relation between hospital costs and the scale of output,
called "returns to scale” or "economies of scale." This article reviews
the progress that has been made in the study of economies of scale in
hospitals, finding that historically the long-run average cost curve
appears to be U-shaped, with minimum average costs at the level of 200-300
beds. Empirical studies however, do not exclude the possibility of an‘
L-shaped curve, as in other industries. (Journal summary)

Klarman, H. E., editor. Empirical Studies in Health Economics: Proceedings
of the Second Conference on the Economics of Health. Baltimore: Johns
Hopkins University Press, 1970.

Lave, J. R. A review of the methods uSed to study hospital costs. Inguiry.
3:57-81, May 1966..

This paper is a survey of the ways that hospital costs have been measured
and analyzed. Section one mentions two problems which face researchers:
the inability to measure the hospital's product and data limitations.

A classification of costs is introduced for use in later analysis. Section
two enumerates the factors most often cited as important in causing the
increase in hospital costs over time. Some of the methods that have been

61

493.

494.

495.

496.

497.

498.

499.

500.

used to determine the relative importance of each factor in contributing

to the increase in costs are examined. Section three focuses on studies
that have analyzed the variation in costs among hospitals. Particular
attention is given to two studies in which a new measure of output is
constructed. Section four summarizes the results and enumerates suggestions
for further research. (Journal summary)

, and others. Hospital cost estimation controlling for case-mix.
Applied Econ. 4:165-180, Sept. 1972.

, and Lave, L. B. Hospital cost functions. Amer. Econ. Rev.
60:379-395, June 1970. '

Lee, M. L. A conspicuous production theory of hospital behavior.
Southern Econ. J. 38:48-58, July 1971.

5 and Wallace, R. L. Problems in estimating multi-product cost
functions: an application to hospitals. Western Econ. J. 11:350-363,
Sept. 1973.

Mann, J. K., and Yett, D. E. The analysis of hospital costs: a review
article. J. Bus. 41:191-202. Apr. 1968.

Newhouse, J. P. Toward a theory of nonprofit institutions: an economic
model of a hospital. Amer. Econ. Rev. 60:64-74, Mar. 1970.

Pauly, M. V., and Redisch, M. The not-for-profit hospital as a physician's
cooperative. Amer. Econ. Rev. 63:87-100, Mar. 1973.

Rice, R. Analysis of the hospital as an economic organism. Mod. Hosp.
106287-91, Apr. 1966.

62

FROCESS-ORIENTED STUDIES-

  

Most case studies cited in this bibliography include some discussion of at; g
planning, implementation, or evaluation of a particular shared service. In maly'f
cases the information is anecdotal and little detail is given; in others, the '
specifics may have little applicability to other situations. This section of
the bibliography is primarily a convenience; it attempts to bring together
selected articles which emphasize one or more of these administrative processes
and which are felt to be a useful starting point for those considering the
initiation or evaluation of a shared service. The boundaries of these processes {
are not distinct in practice and the lite1ature reflects this situation. For '
the purposes of this bibliography, articles which focus on analyzing needs or V
determining the potential for sharing are listed under planning. Articles which 3
focus on a detailed analysis of alternative modes of sharing or which contain
guidelines for analyzing sharing alternatives are listed under feasibility. $5
Articles in the implementation section were chosen for their emphasis on pro-
cedures or problems involved in establishing a shared service or for their
general applicability. The evaluation section consists of articles which are
more rigorous than the usual case study in documentation of evaluation results
or which emphasize the procedure of evaluation. The reader is urged to consult
other sections of this bibliography--particu1arly the section on specific ser-
vices or facilities--for information which may be relevant to a particular
sharing situation.

PLANNING

P01. American Hospital Association. Guidelines for Hospital Involvement in
‘ Comprehensive Health Delivery Systems. Chicago: AHA, 1973.
(Annotation, 14)

502. Andrew, W. F. Advantages of a shared computer. Hospitals, J.A.H.A. 45:
‘ 59-62, Nov. 16, 1971.
(Annotation, 531)

i503. Ardell, D. B., and Holohean, M. The effective use of consultant services
‘ in comprehensive health planning. Health Serv. Rep. 882902-907,

504. Bash, R. R. Feasibility of consolidating Durham County (NC) hospital
laundries. Master's thesis, Duke University, Durham, NC, 1973.
(Duke Medical Center and Durham County Hospital Corporation)

505. Bloom, B. S., and others. Radiation therapy in New Hampshire, Massachusetts,

and Rhode Island. New England J. Med. 286:189-194, Jan. 27, 1972.

1506. Blum, H. L. Priority setting for problems, solutions, and projects by means
of selected criteria. Int. J. Health Sci. 2:85-99, Feb. 1972.

1507. Broomall, C. L. Why hospital changed from in-house to shared computer sys-
tem. Hosp. Top. 50:20—22, Nov. 1972.
(Atlantic City (NJ) Hospital)

63

t

508.

509.

510.

511.

512.

513.

514.

515.

516.

 

Catania, J. J., and Loucks, J. H. A hospital-based regional laundry.

Hospitalsz J.A.H.A. 44:62-65, Sept. 16, 1970.

(Annotation, 271) '

Church, S. T. The cooperative laundry concept: it s not as costly as
you think. Executive Housekeeper. 20:46,48,50,52, Apr. 1973.
(Annotation, 276)

Cutting laundry costs--the central laundry concept. Executive
Housekeeper. 21:36,48,50, Mar. 1974.
(Annotation, 277)

Franklin II, C. L. The urban multi-hospital system: necessary conditions.
Hosp. Admin. 16:25-35, Winter 1971.

Freeman, J. R., and Zaldivar, M. F. A Generalized Model for Planning
Shared Health Services (Technical Report no. 4). Gainesville: University
of Florida, Health Systems Research Division, 1969.

(Annotation, 39)

Gal, K., and Hanok, A. Saving through centralization. Hospitals, J.A.H.A.
44:60-62,64-65, Dec. 1, 1970.

In order to determine the cost and potential savings of a central laboratory,
a study was undertaken in 1969 to review the operation of an on-site labor-
atory at the hospital of the Albert Einstein College of Medicine in New York.
The study was concerned mainly with direct laboratory costs, such as labor,
salaries, reagents and supplies, equipment repair, and educational expenses.
Study results are described and presented in three tables which show the
distribution of components of direct labor costs as a percentage of the

total cost for each section of the laboratory, and the relation between

direct cost components and some typical hematology and chemistry tests.
Technician labor was found to account for almost 40 percent of the total
direct cost of operating the laboratory. The utilization of this labor is less
than optimal because of unpredictable work flow,,small batch processing, and
other similar reasons. Furthermore, much technician time is spent on clerical
duties which could be performed by computers if large volumes of tests were
available for processing. The authors diSCUSS'in detail the potential savings
and other benefits of central laboratory facilities and conclude that even
when the central laboratory does not produce any actual savings compared with
present laboratory systems, it would substantially improve several aspects

of laboratory work without additional investment.

Health Services Research Center. Guidelines for Health Services Research &
Development: Shared Services. Washington, DC: National Center for Health
Services Research and Development. DHEW Pub. No. (HRA) 74-3023, 1972.
(Annotation, 44)

. Guidelines for shared laboratories. Part 2 of: Health Services
Research Center, Consolidation of Clinical Laboratory Facilities: An Eval-
uation. Chicago: Health Services Research Center, 1974.

(Annotation, 571)

Howell, D. L. The cooperative approach in supervisory training. Personnel.
47:57-62, Jan.-Feb. 1970.
(Annotation, 560)

64

5117.

5H8.

519.

520.

521.

512.

523.

524.

Hutton, D. H. A feasibility study of the southern tier of New York to
determine the advantages of group purchasing. Master's thesis, Xavier
University, Cincinnati, 1971.

(Annotation, 360)

Jappy, W. C. Discussion of factors involved when considering participa—
tion in a central laundry. Master's thesis, University of Toronto,
Toronto, 1969.

(Centennial Hospital Linen Services, Inc., Toronto)

Katz, S. H., and others. Regionalization of laboratory services. Health
Laboratory Sci. 10:287-293, Oct. 1973.

This paper reports the results of a task force study of clinical labora-
tory testing in various Pennsylvania Department of Public Welfare insti-
tutions. "The task force found that currently most laboratories are

small and lack sufficient equipment and overall standards of methodology,
quality control, personnel training and cost analysis.../and/ recommended
that a regionalized laboratory system be established to service the insti-
tutional needs of four major geographic regions of Pennsylvania. Several
organizational and implementation plans are discussed and projections are
made on possible cost savings. Such a system would help solve the problems
of quality, staffing, and equipment now apparent in many of the existing
laboratories. In addition, a regionalized laboratory system could branch
into other areas of delivery of health services while still reducing costs
further and continuing to enhance the quality of services." (Journal summary)

Keyes, F. Pooling health training facilities in Newark, New Jersey. Amer.
J. Public Health. 642144—147, Feb. 1974.
(Annotation, 405)

Kretschmar, C. G., and Furst, R. W. Should your hospital join a shared
laundry? Hospitals, J.A.H.A. 47:l74,176,l78,l80,182,184, July 16, 1973.

Laverty, R. E., and Peterson, M. J. Development and application of a method
for determining cost savings of sharing hospital services. Unpublished
report, University of Michigan, Ann Arbor, MI, 1972.

The authors develop a model for use in determining potential cost savings

of proposed hospital shared services or mergers. The model, which esti-
mates only direct operating costs, is based on a five-step process Which
involves specifying the function or department to be merged or shared, iden-
tifying inputs, determining input capacity in terms of units of output, con-
sidering potential economies of scale, and determining estimated savings by
pricing the inputs. The model is applied to pediatrics departments of two
Jackson, MI hospitals.

Manson, J. J. One hospital undertakes study and two hospitals benefit.
Mod. Hosp. 118:98—100, Feb. 1972. '

Norgren, W. High—pressure technique pays off. Hospitals, J.A.H.A. 48:75-76,
Aug. 16, 1974.
(Annotation, 129)

65

525.

526.

527.

528.

529.

530.

531.

532.

Oehnel, E. Central hospital laundries. Executive Housekeeper. 18:30,32,
34,36-38, Mar. 1971.

Picha, N. A study to determine the effectiveness of a shared (off—line)
computer service in the management of accounts receivable in small Texas
hospitals. Master's thesis, Baylor University, Waco, TX, 1972.

(Texas Hospital Association, Shared Hospital Accounts Receivable System)

 

Project RAISE. Regional Cooperation: A Design for Sharing among Health
Care Institutions. 1971. '
(Annotation, 61)

Rosenbaum, J. E. Hospital-based verSus shared computer services for a
126-bed hospital in a rural setting. Thesis, American College of Hospital
Administrators, Chicago, 1973.

(Idaho)

Smejda, H. A. Shared services. Hosp. Financ. Manage. 5:10-11,14-15,63,
Mar. 1975.
(Annotation, 68)

 

Thorpe, L. R. Questions about time sharing. Hosp. Progr. 51:80,82,86-87,
Feb. 1970.

FEASIBILITY

Andrew, W. F. Advantages of a shared computer. Hospitals, J.A.H.A. 45:
59-62, Nov. 16, 1971.

Description of the decision-making process which led the Lakeland General
Hospital in Lakeland FL to choose a shared computer system over available
alternatives. The hospital compared the advantages and disadvantages of
its own data processing system with six alternatives: selecting a total

» hospital information system, sharing a large computer system with the City

installing an in-house computer system, sharing a computer system with other
hospitals, designing a computer system with consultant assistance, and
sharing a computer system using a shared computer utility (time sharing).
Lack of confidence in an in—house system, cost factors, time pressures, and
interface requirements for the hospital's in-house laboratory information
system were considerations which led to the decision to pursue investigation
of time-shared computer systems. The evaluation of shared time computer
systems involved further decisions centering around mode of data gathering,
financial base of companies being considered, and comparison among available
systems. The author describes the development and use of a comparison form
which accommodated a detailed analysisof vendors by application.

. Guidelines for evaluation and selection of a shared hospital data
processing system. Osteopathic Hosp. 16:5-12, Oct. 1972.

The author identifies many of the areas which should be considered in eval-
uating a data processing system. A checklist for analysis and comparison
of data processing applications offered by various vendors is outlined and
a method of analyzing this information is described. A sample "shared

66

533.

534.

535.

1536.

537.

‘ 538.

3 539.

540.

computer system evaluation sheet" and a list of ”possible hospital data
processing objectives" are provided.

How to tell the correct time-saving. Mod. Hosp. 117:113-114,
Nov. 1971.

The author offers checklists for use by hospitals which are considering
the purchase of time on a vendor's centralized computer system. One
checklist discriminates among vendors in the following areas: application
costs; equipment; operating and miscellaneous costs; applications offered;
equipment configuration; general considerations concerning the effects of
a program on in-house needs of the hospital; and the content, frequency,
and format of reports offered. The second checklist includes 10 general
and more than 50 specific applications which should be available through

a good shared hospital computer system. A spread sheet checklist is pro-
vided and alternative rating systems are described. Finally, the author
furnishes a number of final checks on the preliminary analysis and ratings.

'Biggs, E. L., and Farnham, J. B. Evaluating laundry alternatives. Hospitals,

J.A.H.A. 44:130-131, Feb. 1, 1970.

Hammon, G. L., and Jacobs, S. E. Shared computer systems. Part 1. Hospi-
talsz J.A.H.A. 44:50-53, May 1, 1970. Part 2. Hospitals, J.A.H.A. 44:
72-76, May 16, 1970.

This detailed analysis of shared computer systems provides an examination

of the characteristics of and differences among various kinds of hospital
computer systems with special attention to system ownership, methods of
communication with the data center, and advantages and disadvantages of
shared computer syStems. The authors provide a detailed methodology for
evaluating shared computer systems based on applications offered, importance
of applications support to hospital needs, overall marginal costs and
savings, and qualitative factors concerning the shared computer system and
its relationship with participating hospitals.

Harter, T. R. Can the joint venture save you money? Hosp. Financ. Manage.
25:34-35, Jan. 1971.

Health Services Research Center. Guidelines for Health Services Research &
Development: Shared Services. Washington, DC: National Center for Health
Services Research and Development. DHEW Pub. No. (HRA) 74-3023, 1972.
(Annotation, 44)

 

Guidelines for shared laboratories. Part 2 of: Health Services
Research Center. Consolidation of Clinical Laboratory Facilities: An
Evaluation. Chicago: Health Services Research Center, 1974.
(Annotation, 571)

Hospital Association of New York State. Shared Services Program. Present
vs. Proposed vs. Benchmark Laundry and Linen Service: Cost Comparison
Procedure. Albany: Hospital Association of New York State, Feb. 1972.

 

. Shared Microfilming Cost Feasibility Analysis. Albany: Hospital
Association of New York State, Nov. 1971.

67

541.

542.

543.

544.

545.

546.

547.

548.

549.

. Shared Services: Analysis of Functional Alternatives. Albany:
Hospital Association of New York State, Mar. 10, 1972.

Hutton, D. H. A feasibility study of the southern tier of New York to
determine the advantages of group purchasing. Master's thesis, Xavier
University, Cincinnati, 1971.

(Annotation, 360)

Lehman, A., and Weinstein, A. D. Shared services in collection led to
savings, efficiency. Hosp. Financ. Managg, 27:22,24-28, Aug. 1973.
(Annotation, 226)

Massachusetts Hospital Association. Feasibilitygof Shared Drug-Related
Functions. Burlington, MA: Massachusetts Hospital Association, Management
Systems Planning, 1971.

Perla, G. G. Purchasing shared computer services. Hospitals, J.A.H.A.
47:70-71, Aug. 16, 1973.

Before purchasing a shared computer service, a hospital should develop a
clear idea of what type of computer service is desired by specifying its
needs in terms of output and by specifying its limitations in terms of
cost. Specifications should be sent next to a broad distribution of ven-
dors who may be able to meet the requirements. After the bidding is
closed, a final task is to compare bids and vendors. The author advises
comparison of the total cost of the various systems rather than charges
quoted in the bids, close attention to the details of the system being
offered, and close attention to the characteristics of the specific vendor.

Reising, J. H. A unitary medical record data base in Forsyth County,
North Carolina. Master's thesis, Duke University, Durham, NC, 1972.
(Annotation, 330)

Rosenbaum, J. E. Hospital-based versus shared computer services for a
126-bed general hospital in a rural setting. Thesis, American College of
Hospital Administrators, Chicago, 1973.

(Idaho)

Smejda, H. A. Shared services. Hosp. Financ. Manage. 5:10-11,l4-15,63,
Mar. 1975.
(Annotation, 68)

 

Soder, E. Service bureau vs. in-house computer. Hosp. Financ. Manage.
26:22,27, Jan. 1972.

 

Using an accounts receivable operation as an example, the author illustrates
the steps involved in making a comparison between in-house and service

bureau computer systems. First, the current operation must be analyzed and
broken into component tasks. For each task, the hospital must then determine:
staffing requirements; work load peak, work flow, and volume statistics;
facility and space requirements; files, reports, and forms used and prepared
and the frequency of their use. From this assessment the hospital can

define the proposed computer procedure in terms of input documents, output
reports, computer master files, and work flow for each of the areas reviewed.
If there is a service bureau package which meets the specifications of the

68

550.

551.

552.

553.

554.

555.

556.

557.

system, a further comparison must be made based on personnel and equip-
ment requirements and other projected costs of in-house and service
bureau systems such as space, supplies, utilities, and so forth. A
preliminary decision can then be made based on the cost comparison but
may be revised after consideration of external factors including the
following: possible support from a service bureau in systems development
and conversion, flexibility of either system for program modification
and future growth, availability of skilled manpower, required speed of
installation, possible loss of autonomy in establishing priorities if

a shared system is selected, and the experience of other users with
packages of service bureau systems.

Which type of laundry service is best for you? Hospitalsz J.A.H.A. 47:
64-65, Aug. 16, 1973.

Outlines a methodology for use in evaluating various options for a hos-
pital laundry service. The methodo‘ogy enables each hospital to use its
own particular requirements as criteria for comparing and evaluating
advantages and disadvantages of inplant laundries, cooperative central
laundries, and commercial laundry services.

IMPLEMENTATION

Barn raising comes to health education. In-Serv. Training and Educ. 3:
13-14,21-22,26, Aug. 1974.

(Regional Approach to Improved Service Through Education, west central
Minnesota)

Bickers, C. R. Implementation of a shared computer accounting system
for hospitals. Osteopathic Hosp. 18 7-11, Mar. 1974.
(Bay View Hospital, Bay Village, OH)

Doody, M. F. Guidelines for implementing cooperative programs. Hospitals,
J.A.H.A. 48:55-58, June 1, 1974.
(Annotation, 34)

Evaluation report shows that shared training can benefit hospitals and
employees. Bull. Hosp. Educ. and Training. Feb. 1972, pp. 1-4.
(Annotation, 387)

 

Fifer, W. R., and Ellsworth, S. J. A shared medical audit program for
small hospitals-~meeting the demands for accountability. Hosp. Med. Staff.
3:1-10, Oct. 1974. ‘

(Annotation, 329)

Goudreau, W. J., and Lowery, G. E. Shared services--a new involvement for
hospital administration. Mich. Hosp. 10:4—7,26, Feb. 1974.
(Annotation, 41)

Health Services Research Center. Guidelines for Health Services Research &
Development: Shared Services. Washington, DC: National Center for Health
Services Research and Development. DHEW Pub. No. (HRA) 74-3023, 1972.
(Annotation, 44)

 

69

.558.

559.

560.

-

,561.
562.
563.
564.
565.

566.

567.
568.

569.

Guidelines for shared laboratories. Part 2 of: Health Services
Research Center. Consolidation of Clinical Laboratory Facilities: An
Evaluation. Chicago: Health Services Research Center, 1974.
(Annotation, 571)

Hospital Association of New York State. Shared Services Program. Increas-
ing Shared Services Effectiveness by Setting Up a Joint Ventures Corporation.
Albany: Hospital Association of New York State, 1971.

Howell, D. L. The cooperative approach to supervisory training. Personnel.
47:57-62, Jan.-Feb. 1970.

The author outlines basic steps in setting up a cooperative supervisory
training program including initiating the concept; exploring the concept,
formation of an advisory group; establishing the program content;.arranging
for facilities, financial support, and instructional staff; and performing
continuing evaluation. Each step is illustrated by an example.

Killenberg, G. A. Hospital financial problems. Hosp. Top. 49:56, Oct. 1971.

The author describes accounting records which should be established to
divide shared laundry coSts equitably.

Pertl, D., and Giancola, D. Shared laundry service: development, problems,
and needed directions. Trustee. 27:25-31, May 1974.

Project RAISE. Regional Cooperation: A Design for Sharigg Among Health
Care Institutions. 1971.
(Annotation, 61)

Ross Jr., A., and Zoellick, R. F. A shared central service department.

Hospitals, J.A.H.A. 44:64,66,68,106, Sept. 1, 1970.
(Virginia Mason Hospital and Doctors Hospital, Seattle)

Schilling, G. w. Cost containment through sharing. Hospitals, J.A.H.A.
49:48-51, Jan. 16, 1975.
(Affiliated Hospital Services, Inc., Minneapolis-St. Paul)

Schweid, P. Co-ops: they're catching on. Hospitals, J.A.H.A. 46:106-108,
111-112, Mar. 16, 1972.

Skarupa, J. A. Financing shared services programs in a multihospital
system. In: American Hospital Association. Shared Services in Health Care
Institutions. Chicago: AHA, 1975, pp. 17-24.

Smejda, H. A. Shared services. Hosp. Financ. Manage. 5:10-11,14-15,63,
Mar. 1975.
(Annotation, 68)

 

Taylor, R. A. Financing a cooperative hospital laundry. Hospitals, J.A.H.A.
46:108,110-1ll, Aug. 16, 1972.

The author outlines the problems involved in financing a cooperative under-
taking under the traditional approach embodied in the "service-at-cost"

70

570.

$571.

572.

573.

574.

575.

‘576.

principle. He proposes an alternative method of finance which is based
on the revolving capital plan adopted by agricultural cooperatives.

The proposed revolving capital method of finance is described in detail.
Advantages of this method are that it keeps capital contributions in pro-
portion to each member‘s use of the facilities, it makes provisions for
additions and withdrawals of capital by individual hsopitals, and it pro-
vides the incentives necessary to maintain the cooperative nature of the
venture.

\
/

EVALUATION
Campbell, D. T., and Stanley, J. C. Experimental and Quasi-Experimental
Designs for Research. Chicago: Rand McNally, 1966.

Health Services Research Center. Consolidation of Clinical Laboratory
Facilities: An Evaluation. Chicago: Health Services-Research Center, 1974.

 

This evaluation of the consolidation of clinical laboratories within the
Northwestern Memorial Hospital is in two parts. Part 1 includes an organi-
zational evaluation, a cost evaluation, and a quality evaluation, each
with detailed explanations of evaluation research methodologies. Part 2,
"Guidelines for Shared Laboratories," is intended to assist others who

are considering some form of centralized laboratory service. It includes
an examination of definitions of laboratory sharing, an enumeration of
factors contributing to increased laboratory sharing, and a discussion of
the advantage and disadvantages of laboratory sharing. The guidelines

also include: a detailed outline of primary areas of deliberation which
should precede an agreement to share; an examination of the elements of
analysis in evaluating shared laboratory services in terms of cost, admin-
istrative effectiveness, and quality; and an outline of a plan of action
for laboratory sharing which details the activities pertinent to the
planning, feasibility, implementation, and evaluation phases of the program.

Guidelines for Health Services Research & Development: Shared
Services. Washington, DC: National Center for Health Services Research
and Development. DHEW Pub. No. (HRA) 74-3023, 1972.

(Annotation, 44)

Hospital Research and Educational Trust. Evaluating results. In: Hos-
pital Research and Educational Trust. Training and Continuing Education:
A Handbook for Health Care Institutions. Chicago: HRET, 1970, pp. 221-252.

 

Hospital Research and Educational Trust to develop methods to evaluate
shared services. Hospitals, J.A.H.A. 49:96, Jan. 1, 1975.

Huey, J. P. System cost--old vs. Medical Information System. Tex. Hosp.
26:20-11, Sept. 1970.

Lehman, A., and Weinstein, A. D. Shared services in collection led to
savings, efficiency. Hosp. Financ. Manage. 27:22,24-28, Aug. 1973.
(Annotation, 226)

 

7l

577.

578.

579.

580.

581.

582.

583.

Litman, T. J., and others. A Demonstration of Reducing Hospital Costs
by Sharing Services. Minneapolis: Health Manpower Management, Inc., 1969.

Ludwig, P. E. Cost saving and other measures of shared service effective-
ness. In: American Hospital Association. Shared Services in Health Care
Institutions. Chicago: AHA, 1975, pp. 25-32.

Five approaches to evaluation of shared services are presented: the
feasibility study, use of standards of performance, use of objective cri-
teria, use of a generalized model, and use of a revenue impact analysis.

Martin, J. C., editor. Evaluation Methodologies for Shared Services in the
Health Care Field; proceedings of a seminar, Dec. 2-4, 1974, Montreal.
Montreal: Montreal Joint Hospital Institute, 1975.

(Annotation, 83) ,

Scardino, V., and Deppisch, L. M. Laboratory centralization answer to
volume explosion. Hospitalsz J.A.H.A. 47:50-53, July 1, 1973.
(Annotation, 139)

Schulberg, H. C., and others. Program Evaluation in the Health Fields.
New York: Behavioral Publications, 1969.

Contains 35 articles in five sections: (1) Concepts and general issues
(2) Research designs (3) Evaluation techniques and indexes (4) Examples
of program evaluation and (5) Implementing research findings.

Suchman, E. A. Evaluative Research: Principles and Practice in Public
Service and Social Action Programs. New York: Russell Sage Foundation, 1967.

 

Weimer, W. C. Group activity among hospitals, an analysis of the paramedical
service center. Master's thesis, Xavier University, Cincinnati, 1970.

(Ohio Department of Medical Hygiene and Correction, Paramedical Service
Center)

72

RURAL AND SMALL HOSPITALS

In recent years, the problems of rural and small hospitals have under-

gone national scrutiny. At the same time, the mechanism of shared services
has been employed by enough of these hospitals to indicate that such link-

ages may offer real solutions to some of the problems of the small or rural
institution.

584.

585.
$86.
587.

588.

589.

590.

592.
593.

594.

595.

Administrator loaned to rural hospital. Hospitals2 J.A.H.A. 46:59,
July 16, 1972. ’

(University of Wisconsin Hospitals and Community Memorial Hospital, Wis-
consin)

An alliance for sharing. Hospitals, J.A.H.A. 47:51-53, Dec. 16, 1973.
(Rural Health Care Alliance, southeastern Oklahoma and north central Texas)

Barn raising comes to health education. In-Serv. Training and Educ. 3:13-
l4,21-22,26, Aug. 1974.
(Regional Approach to Improved Service Through Education, west central
Minnesota)

Blaine, R. A dream grows in Kansas. In-Serv. Training and Educ. 2:14-16,
18, June 1973.
(Annotation, 381)

Butler, G. D. HAS: a management tool for the small hospital. Hosp. Financ.
Manage. 25:4-8, May 1971.

Communication lines tie nine rural hospitals into network. Mod. Hosp.
118293-95, Apr. 1972.
(Annotation, 28)

Dunn, D. W., and Willitts, H. M. Through the strength of many. Hospitals,
J.A.H.A. 48:99-100,104, Oct. 1, 1974.
(Annotation, 36)

Falck, V. T. GRO with continuing education. Tex. Med. 70:84-86, Sept. 1974.
(Texas Regional Medical Program, Project Grass Roots OrganizatiOn)

Fifer, W. R., and Ellsworth, S. J. A shared medical audit program for small
hospitals. Hosp. Med. Staff. 3:1-10, Oct. 1974.
(Annotation, 329) *

Food handlers use phone for continuing education. Cross-Ref. 4:4-5, July
1974. '
Ofledical Products Systems, Inc., Bartlesville, OK)

Four small hospitals take a giant step. Chicago Med. 76:980, Nov. 17, 1973.
(Annotation, 108)

Fritz, J. T. Group purchasing: does it work in small'hoSpitals? Hosp.
Manage. 110:60-61, Nov. 1970.

73

596.

597.

598.

599.

600.

601.

602.

603.

604.

605.

606.

607.

608.

Gelsinger, J. L. Dial L for lecture. In—Serv. Training and Educ.
3:8—10,12, Aug. 1974.

(Lakes Area Regional Medical Program, Inc., Telephone Lecture Network,
Buffalo)

 

Grosjean, D. B. Data processing for smaller hospitals. Tex. Hosp. 26:
40,43, Sept. 1970.
(Texas Hospital AssociatiOn. Shared Hospital Accounts Receivable System)

Healey, L. A., and Friedrich, P. Health Services Consortium: good neigh-
bor policy. Group Pract. 24:19-21,28, Mar.-Apr. 1975.
(Health Services Consortium, Seattle area)

Health care institutions share educational services: rural hospitals join
in Project "RAISE." Bull. Hosp. Educ. and Training. No. 1421-4, Nov. 1970.
(Annotation, 395)

 

Hinson, J. W. Continuing education in a rural area. Supervisor Nurse.
4:29,32-33,36-37, Aug. 1973.
(Annotation, 397)

Jones, K. B. Shared social services in the Northwest. Hosp. Soc. Work
Directors Bull. No. 37:3, Nov.-Dec. 1973.
(Annotation, 166)

Koontz, J. S., and Zylstra, R. L. Rural shared services--an experiment in
cooperation for small hospitals. Hosp. Forum (Western). 15:11-12,24, Aug.
1972.

(Annotation, 168)

 

Laird, S. W. A shared dietitian consulting program. Hospitals, J.A.H.A.
47:75,78, Nov. 1, 1973.
(Annotation, 169)

LeBoutillier, P. SHIP: shared hospital in-service program. J. Continuing
Educ. in Nurs. 3:31-33, July—Aug. 1972.
(southwest Minnesota)

Long, S. D. Two hospitals share administrative services. Hospitals, J.A.H.A.
48:121-122,175, Oct. 1, 1974.
(Shared Services System, Omaha, NE)

Matti, L. B. Rural hospitals in a multihospital system. In: Health Services
Research Center. Multihospital Systems: An Evaluation, Pt. 4, Related Studies.
Chicago: Health Services Research Center, 1975, pp. 69-98. Bibliography pp. 95
98. -

Michael Jr., M. Networking for community hospital libraries. Biomedical Com-
munications. l:19,41-42, July 1973.
(Annotation, 324)

Phillips, D. F. Small urban hospita1--a question of survival. Hospitals,
J.A.H.A. 48:71-75, Oct. 1, 1974.

74

609.

(.10.
611.
612.

613.

614.

615.

616.

617.

618.

Picha, N. A study to determine the effectiveness of a shared (off-line)
computer service in the management of accounts receivable in small Texas
hospitals. Master's thesis, Baylor University, Waco, Texas, 1972.

(Texas Hospital Association, Shared Hospital Accounts Receivable System)

Rosenbaum, J. E. Hospital-based versus shared computer services for a
126-bed hospital in a rural setting. Thesis, American College of Hospital
Administrators, Chicago, 1973.

(Idaho)

Rosenberg, C. L. This 20-bed hospital has 500 specialists. Med. Econ.
47:160, June 8, 1970.

Roes Jr., A, and Boyle Jr., R. L. Urban-rural exchange programs. Hospitals,
J.A.H.A. 46:55-59, July 16, 1972.
(Virginia Mason Hospital, Seattle)

Schnepple, G. R. Rural-urban hospital partnerships--a study of voluntary
hospital regionalization. Master's thesis, University of California,
Berkeley, 1973.

(Annotation, 467)

Seattle‘s consortium for education. Mod. Healthcare. 1:120-121, Apr. 1974.
(Health Services Consortium, western Washington)

Simmons, J. C. Social work program meets hospitals' unique needs. Hospitals,
J.A.H.A. 49:64-66, Feb. 16, 1975.
(Hahnemann Medical College and Hospital, Philadelphia)

Small hospitals get help in a big state. Mod. Hosp. 115:110-112, Sept. 1970.
(Texas Hospital Association, Shared Management Systems Program and Medical
Information, Inc.)

Spitzer, W. The small general hospital: problems and solutions. Milbank

Memorial Fund 9. 48:413-447, Oct. 1970.

TWelve institutions form educational corporation. Cross-Ref. 2:1-4, Dec. 1972.
(Association for Continuing Education, Great Bend, KS area)

75

RELATED PERTINENT BASICS

Most U.S. hospitals are members of the American Hospital Association.

Among other things, the Association provides its membership with various
guidelines and technical manuals. These documents are well accepted and in
general use. The small listing here is intended to draw the reader's atten-
tion to some manuals that are basic to hospital operations and that give the
hospitals' perspective on certain issues.

619.

620.

621.

American Hospital Association. Budgeting Procedures for Hospitals. Chicago:
AHA, 1971.

This manual presents the necessary procedures for developing a sound annual
operating budget and supporting plans for cash management and capital asset
acquisition. It includes detailed information on: the functions, objectives,
and prerequisites of budgeting; the budgeting process, including work organi-
zation, budget coordination, and the selection of a budget period; statisti-
cal budget preparation, including the collection and reporting of data con-
cerning the expected volume and scope of activities; expense budget prepara-
tion, including the conversion of work units into expected dollars of expense;
revenue budget preparation, with revenue detailed according to the time period
in which it will be earned; capital budget preparation, including the pro-
vision of formal criteria to be used for project evaluation; cash budget
preparation, including estimation of cash receipts and disbursements and pro-
jections of estimated cash balances for the selected time interval; and
budget-related reporting mechanisms, including financial statements prepared
for submission as part of master budget documents, and periodic reports,
including cost reporting to department management and financial reporting to
top management.

Capital Financing for Hospitals. Chicago: AHA, 1974.

This reference manual is intended for use by administrators of hospitals of
any size or ownership base. It includes chapters on: capital management,
including the nature of capital need, the functions of capital management,

and the management of special purpose and endowment funds; sources and
characteristics of permanent capital, including contributed capital, federal
assistance programs, and internally generated capital; characteristics of
debt financing, including construction financing, debt capacity, restrictions,
and costs of borrowing; and methods of debt financing, including FHA-insured
mortgages, taxable bonds, tax—exempt bonds, private placement, the borrowing
process, and determination of requirements.

/ . Chart of Accounts for Hospitals. Rev. ed. Chicago: AHA, 1973.

This manual, which is the basis for other manuals in the Financial Management
Series, is a guide for establishing a uniform system for classification of
accounts in the hospital field. A discussion of the prerequisites for
effective management and an introduction to basic fund accounting concepts

and conventions precede a detailed outline for a recommended chart of accounts.
The chart is designed to permit expansion or contraction to meet specific
requirements while maintaining a basic uniformity for recording and reporting

76

p 622.

623.

‘624.

financial information. Separate chapters include detailed discussions of
the nature and content of each kind of account described-~balance sheet
accounts, revenue accounts, and expense accounts. The final chapter con-
siders the determination of the estimated useful lives of depreciable
assets used in the operation of a hospital. A number of checklists in-
tended for use as guides to such estimates are provided.

. Cost Finding and Rate Setting for Hospitals. Chicago: AHA, 1968.

This manual presents basic concepts and procedures of cost finding and rate
setting which can be adjusted to fit specific situations in hospitals of
any size or service mix. Cost finding is defined and its objectives and
prerequisites are noted. Factors influencing costs and interpretation of
these factors are discussed, bases for allocating costs are elaborated, and
three methods of cost finding are outlined. An in-depth, step-by-step
illustration of cost finding procedures and samples of statistical and
accounting data are provided. Comparison of cost finding methods, statis-
tical allocation bases for various functions and operations, and the use

of special cost studies and other statistical studies are discussed. Rate
setting usually follows policy decisions which may revolve around inflation
and technological improvements, educational costs, research programs, free
services, or retirement of loans or reserve funds. Policy decisions which
may be involved in developing a rate structure are listed and the computa-
tion of specific rates for operating rooms, laboratories, pharmacy surcharges,
and patient rooms is illustrated.

. Internal Control and Internal Auditing for Hospitals. Chicago:
AHA, 1969.

This reference manual covers virtually every area of hospital operation in
which internal audit should be applied. It discusses the need for internal
control and auditing, as well as the basic elements involved in internal'
control: a plan or organization establishing clear lines of authority and
responsibility; adequate authorization and record procedures; sound practices
to be followed in each of the organizational departments; and adequate per-
sonnel. Separate chapters are devoted to the applicability and implementa-
tion of internal audit in the areas of purchasing and inventories, payrolls,
cash disbursements, revenues and receivables, plant and equipment, invest-
ments, and cash receipts. Checklists for reviewing internal control in
each of these areas are provided. -

. Quality Assurance Program for Medical Care in the Hospital. Chicago:
AHA, 1972.

 

This guide is intended to assist.boardstof trustees, administrators, and
medical staff in developing a quality assurance program for medical services.
The proposed five-step methodology is based on development of criteria,
description of actual practice, judgment or evaluation, corrective action,
and reassessment. The manual also suggests linkages of a hospital quality
assurance program with external parallel programs, examines the legal aspects
of a hospital quality assurance program, and deals with patient education.

77

AUTHOR INDEX

References in this bibliography are indexed by main (first) author only.
Anonymous works are listed by title in a separate section following the
main author index. Underlined citation numbers indicate that the entry
is annotated.

Section title Entry numbers

General and Overview Topics

Semantics: definitions and classifications l-ll
Guidelines and General 12-74
Surveys 75—81
Conference Proceedings 82-85
Bibliographies 86-89
Specific Services and Facilities
Medical/Clinical 90-149
Manpower 150-194
Administrative/Supportive
Accounting and Information Systems 195-245
Central Service 246-249
Dietary 250-262
Equipment 263-264
Laundry 265-323
Library 324-327
Medical Audit and Medical Records 328—330
Purchasing 331-377
Education and Training 378-422
Disciplinary Studies
Tax and Legal 423-438
Organization Behavior 439-476
Economics 477-500
Process-Oriented Studies
Planning 501-530
Feasibility 531-550
Implementation 551-569
Evaluation 570-583
Rural and Small Hospitals 584-618
Related Pertinent Basics 619-624

78

 

Aiken, M. 439

American College of Hospital
Administrators 19

American Hospital Association* 19;
12; 1;; 501; 6_1_9_; E; 6_21_3 912;
6A; 9%

Ammer, D. S. 991

Anderson, H. L. 199

Andrew, W. F. 197; 198; 199; 502;
$1.; 2.3.2.; 5.32

ARA Hospital Food Management

Ardell, D. B. 503

Aronson, S. M. 90

Astolfi, A. A. 19

477

Bailey, D. R. l, 11
Bailey, D. T. 199

Baligh, H. H. 478
Balsley, M. B. 251; 334
Banner, M. T. 151; 191; 336
Bartfield, I. A. 199
Barton, J. 337

Bash, R. R. 267; 504
Bastnagel, Sister G. 91
Bauer, K. G. 19
Baumgartner Jr., R. P. 91
Bennis, W. 440

Berki, S. E. 479
Bernstein, A. H. 419
Berry Jr., R. E. 480; 991
Bickers, C. R. 200; 552
Bickley, H. C. 380
Bieter, J. T. 19; 441
Biggs, E. L. 268, 534
Bilinsky, R. T. 99
Blaine, R. 991; 587

Blau, P. M. 442

Bloom, B. S. 94; 505
Blum, H. L. 506

Blumberg, M. S. 19; 77; 86
Boone, C. C. 11

Boston, J. R. 23

Box, R. H. 99

Brawley, Sister A. 338
Brewer, G. M. 201
Brissendon, A. 99
Broomall, C. L. 202; 507
Brousseau, T. G. 270
Brown, B. D. 253

Brown, M. H. 24

Brown, R. E. 91; 482
Brown Jr., M. 483

Bunker, E. 328

79

Burkhalter, B. R. 121
Burkholder, D. F. 91
Butler, G. D. 203; 588
Cabot, E. E. 339
Caldwell, A. B. 153
Campbell, D. T. 570
Cardwell, H. M. 204

Carlquist, J. H. 98

Carr, W. M. 484

Carter, B. J. 205
Catania, J. J. 111; 508
Cathey, J. 272

Chowins Jr., R. D. 443
Church, S. T. 275; 276; 111; 509;

510
Cihlar, C. 444
Clark, W. E. 2; 9
Clay, C. C. 199
Coldewey, G. T. 278; 919
Colling, R. L. 129
Conway, B. 999
Cook, H. F. _; 29
Cooperider, N. L. 283
Cotner, W. 209
Crevasse, L. E. 103
Crews, J. C. 445
Danco, W. 119; 211
Danks, R. T. 286
Davis, R. N. 9; 30
Davis, R. R. 342; 343
Dean, E. J. 199

Deane Jr., A. S. 91
DeHoff, J. B. 32

DeView, L. 104

DeVries, R. A. 6; 99‘
Dildy, D. B. 1_9

Dobson, R. J. 191
Donaher Jr., J. C. 105
Doody, M. F. 99; 99; 553
Downey, G. W. 157

Dunn, D. W. 99; 590
Eberhard, M. J. 199
Edwards, S. A. 11
Epperson, R. L. 159
Evan, W. M. 446

Evans, V. R. 388

Falck, V. T. 389; 591
Farevaag, L. H. 344; 345
Feldstein, M. S. 485; 486

487
2;;

Feldstein, P.
Fergus, R. M.
Field, F. 288

Fifer, W. R. 529; 555; 592
Fischer Jr., E. F. 107
Foster, C. L. 213
Franklin, C. L. 447; 511
Freedman, T. J. 109

Freeman, J. R. 59; 512
Friedland, M. 40

Fritz, J. T. 347; 595
Gal, K. 110; 525

Garry, R. 299

Gatzke, H. K. _92
Gelsinger, J. L. 392; 596

Georgopoulos, B. S. 445; 449
Gerber, N. M. 59

Giunta, A. A. 348

Gnau, T. R. 111

Goudreau, W. J. 42; 556

Gouveia, W. A. 214

Gregorio, Sister M. P. 112
Griffith, J. R. 488

Grom, H. S. 225

Grosjean, D. B. 216, 597
Hahn, C. K. 353; 450
Haidinger, T. P. 217

Hain, R. F. 113

Hammon, G. L. 218; 535

Hanlon, J. J. 114
Harris, S. 489
Harter, T. R. 264; 536

Hartman Jr., J. D. 219

Hartshorn, T. 42

Hassan Jr., W. E. 115

Healey, L. A. 161; 394; 598

Health Services Research Center 7;
44; 87; 116; 222; 514; 515; 537;
538; 557; 558; 522; 572

Hefty, T. R. 490
Hendee, W. R. 396
Herring, Sister C. 162

Hess, A. E. 292

Heydebrand, W. V. 451

Hinson, J. W. 163; 592; 600

Hogan, H. H. 354

Holland, D. C. 8; 429

Holland, S. E. 355

Holmgren, J. H. 356; 357; 358

Horn, J. R. 292

Horty, J. F. 430

Hospital Association of New York
State 539; 540; 541; 559

Hospital Financial Management
Association 222

80

Hospital Research and Educational
Trust 399; 499; 573

Howell, D. L. 402; 516; 559

Huey, J. P. 223; 575

Husted, F. L. 403

Hutchings, B. B. 256
Hutton, D. H. 559; 517; 542
Jappy. W. C. 293; 518
Johnson, C. S. 257
Johnson, R. L. 452
Jonassen, J. 0. 241

Jones, K. B. 255; 404; 601
Jones, L. S. 251

Judge, D. 119

Katz, S. H. 120; 529
Kelly, J. C. 294

Kenley, G. 225

Keyes, F. 495; 520
Killenberg, G. A. 295; 552
King, P. J. 406; 407
Klarman, H. E. 491

Koontz, J. S. 259; 602

Kratz, R. L. 121

Kretschmar, C. G. 296; 521
Laird, S. W. 169; 258; 603
Lane, M. M. 362

Latimer, B. W. 170

Lauzen, E. 47; 248; 295
Lave, J. R. 492; 493; 494
Laverty, R. E. 522
LeBoutillier, P. 171; 408; 604
Lee, M. L. 495; 496
Lehman, A. 225; 543; 576
Leighton, E. 227
Levinson, P. 363

Lewis, H. L. 49; 409
Lewis, P. M. 228

Litman, T. J. 577

Lombardi Jr., T. 49

Long, S. D. 50; 172; 299; 364;
605

Ludwig, P. E. 173; 519

Lusk, E. J. 51

McCracken, R. C. 122

McGrath, J. H. 453; 454

McSwain, B. G. 52
Malm, H. 175; 229
Manke, T. 431
Mann, J. K. 497
Manson, J. J. 523
March, J. 455

Maroudas, C. D. 365

Martin, J. C. 33; 579
Massachusetts Hospital Associa-
tion 33; 125; 544
Matti, L. B. 606
Melick, B. 412
Melton, H. W. 432
Menzel, R. 300
Michael Jr., M. 324; 607
Midtown Hospital Association 34
Mills, J. 367
Moore, D. L. 231
Morse, E. E. 126
Mundt, E. L. 411; 412
Mungerson, G. W. 127
Munshaw, P. K. 413
Musser, M. J. 34
Nelson, P. E. 368
Neuhauser, D. 456; 457
Newhouse, J. P. 498
Norgren, W. 122; 524
O'Donovan, T. R. 130
Oehnel, E. 303; 525
O'Neil, D. E. 179
Owen, J. W.‘ 31; 371
Parker, B. 180
Pauly, M. V. 499
Payne, T. T. 58
Pearson, R. E. 132; 181
Perla, G. G. 232; 343
Perrine, G. 415
Perrow, C. 458
Pertl, D. 394; 305; 562
Peters, D. S. 133
Phillips, D. F. 608
Picha, N. 233; 526; 609
Pick, 0. M. 393
Pierce, P. M. 307
Platou, C. N. 32
Project RAISE 31; 527; 563
Provost, G. P. 134
Quay, J. G. 459
Rankin, J. W. 234
Regan, W. A. 460
Reising, J. H. 339; 546
Rice, R. 500
Ritter, C. A. 133
Robinson, W. M. M. 133
Rode III, E. A. 413
Rogers, E. M. 461
Roos, N. P. 462

Rosenbaum, J. E. 528; 547; 610

81

Rosenberg, C. L. 137; 138; 182;
183; 611

Rosner, M. M. 463

Ross Jr., A. 62; 184; 249; 417;
433; 564; 612

Rothman, R. A. 464

Ryan, J. P. 309

Sabichi, F. D. 2; 63

scardino, V. 132; 580

Schein, E. H. 465

Schermerhorn Jr., J. R. 466

Schilling, G. W. 64; 565
Sdmddt,A. 235
Schnepple, G. R. 467; 613

Schreck, I. E. 372

Schulberg, H. C. 331

Schwartz, M. D. 236

Schweid, P. 310; 311; 566

Shimp, I. G. 468

Shorr, A. S. 314

Simmons, B. A. 313

Simmons, J. C. 187; 419; 615

Simon, H. A. 469

Simon, S. R. 315

Singleton, R. 238

Sisters of the Third Order of St.
Francis 239

Skarupa, J. A. 567

Smejda, H. A. 33; 529; 548; 568

Smith, S. D. 240

Snider, A. J. 143

Soder, E. 241; 342

Soltis, R. J. 470

Spitzer, W. 617

Starkweather, D. B. 10;
88; 471

Stolfi, J. E. 69

Strathy, R. D. 472

Suchman, E. A. 582

Tarver, B. M. 89

Taylor, R. A. 318; 332

Tennessee Hospital Association 11

Terenzio, J. V. 144; 473

Thompson, J. 474

Thorpe, L. R. 243; 530

Tibbitts, S. J. . Z2

Tinnermon, E. 376

Tolbert, J. H. 190

Tripp, L. 121; 261

Turner, W. W. 122

Tuthill, J. P. 434

Ulrich, W. 244 West, J. W. 146; 147; 194

Vaillancourt, P. M. 226 West Suburban Hospital Association
Vaun, W. S. 422 327
Veney, J. E. 415 White, P. E. 85; 476
Wagner, C. J. 14 Widman, P. E. 377
Warm, B. 322 Williams, L. 148
Weimer, W. C. 145; 583 Winfield, D. 245
TITLE INDEX

ANONYMOUS WORKS

Administrator loaned to rural hospital 150; 584

Advice on computer networks: go ahead, but find out where to 195

An alliance for sharing 12; 378; 585

American Hospital Association group to recommend voluntary chains 16

Answers to questions involving tax exempt status 265; 422

Appalachian Regional Hospitals central purchasing service 332

Arizona hospitals form group purchasing cooperative 333

Baltimore hospitals cut costs through joint purchasing 335

Barn raising comes to health education 379; 551; 586

The birth of a central 262

Borgess and Bronson hospitals make joint effort to increase health care ser-
vices 22

Brooklyn hospitals share training 382

Cardinal Industrial Laundry Corporation v. Industrial Development Authority
of the City of Richmond, Virginia, and Virginia Hospital Laundry, Inc. 438

Central laundries can save by adding volume and control 213

Central Pennsylvania consortium seeks to fill gaps, avoid duplication 25

Change of structure, philosophy doubles group purchasing volume 340

Chicago: shared laundry, purchasing gather steam 26; 274; 341

Chicago hospital cuts EDP costs 50-66 percent through time-sharing 296

Citizens League urges hospitals to share services--and they do 21; 99

College of radiology offers consultation service 101

Commercial/in—plant battle brewing in Milwaukee 279; 426

Commercial laundries block construction of central 280; 427

Communication lines tie nine rural hospitals into network 28; 383; 589

Community kitchen 254

Computer helps hospitals maintain records on dangerous drugs 291

Computer system will store psychiatric patient data 208

Computerized radiation ;ystem links hospitals 102

Co-op laundry set to produce 14,000,000 pounds per year 281

Cooperative central laundries form their own association 286

A cooperative social work services for health care facilities in Hawaii 15_

Court denies revenue bonds for shared laundry service 284; 428

Crosswise workflow speeds linens through central facility 285

Delaware Valley hospitals interested in shared services 18

Denver meeting told: hospitals sharing everything--including the doctors 12

Eight Michigan hospitals fonniaudio-visual cooperative 385

Eleven hospital cooperative pools training 386

82

 

Emergency medical services 106

Evaluation report shows that shared training can benefit hospitals and
employees 381; 554

First quarter 1972 purchasing volume reaches record peak 346

Food handlers use phone for continuing education 390; 593

Four Minneapolis hospitals to operate common laundry 289

Four New York hospital presidents form consortium 38

Four small hospitals take a giant step 198; 594

Good neighbors work together 32;

Group buying--bonanza or disaster for medical products distributors 349

Group purchasing 350

Group purchasing is big and getting bigger, but slowly 351

Group purchasing units hit new peaks in volume, savings 352

Gustafson heads two hospitals 160

Health care data service keeps records of clients' patients 220

Health care institutions share educational services 325; 599

Health resources association seeks synergy in services >43

Hospital Association of New York State program for shared services 45

Hospital electrical safety 164

Hospital group makes effective use'of TV educational system 398

Hospital Purchasing Service of Michigan v. City of Hastings 437

Hospital Research and Educational Trust to develop methods to evaluate shared
services 574

Hospitals buy downtown buildings to house central services 246

Hospitals form purchasing co-op 359

The hot line to dietary 401

Houston hospitals plan superkitchen 255

Hurst-Euless-Bedford Hospital associates with Harris Hospital 165

Information systems threatened 224

Institutions in the Detroit Medical Center agree to shared medical services
plan 111

Joint laboratory makes specialized service possible 118

Kansas City area hospitals form group purchasing service to combat costs
46; 361

Largest non-profit hospital laundry will service 12 Newark area institutions
297

Lutheran Hospital Society to manage Saddleback Hospital 174

Management may be the best place to begin saving 116

Medical Group Management Association group purchasing plan 366

Medical Information: Texas Hospital Association shared computer prcgram 230

Member hospitals surveyed regarding shared services 81

Metamorphosis of a satellite health center 123

Missouri establishes bone tumor center 124

The multiple hospital is the only way to go 177

New corporation to provide shared hospital services 301

New federation of hospitals created for Cleveland area 55

New Jersey county hospital joins group purchasing program 369

New Jersey establishes statewide blood exchange 128

New role for hospital libraries: community health learning centers 325; 414

Nine-year progress 302

Northwest hospitals cooperate in innovative cost-savings plan 118

Oakland hospitals save with shared services 56

83

Osteopathic Group Purchasing Program expands services 370

Passavant, Wesley sharing medical staffs 131

Performing major surgery on hospital costs 59

Pounds per operator hour up, workforce down 308

Seattle‘s consortium for education 185; 418; 614

Shared computer system introduced 237

Shared food services (Hospitals, J.A.H.A.) 259

Shared food services (Southern Hosp.) 260

Shared laundries form association 3;;

Shared medical service: saving or suicide? 140

Shared services program approved 65

Shared system starts in Oregon 313

Sharing electron volts in Chicago 141

Sharing enters field of biomedical engineering 1§6

Sharing services on the obstetrics ward 142

Six hospitals to share their resources, but not medical staffs 66; 374

Sixteen Chicago hospitals form shared service laundry 316

Small hospitals get help in a big state 188; 616

Standardization, contract buying cut costs $250,000 375

Successful multi-unit systems show how shared services can help raise
productivity, lower costs 70

Survey shows a mixed pattern of computer problems and use 242

Take a tour of a central 317

Tennessee agencies develop hospital cost control program 182

Training goes underground 420

Tri-level production aids efficiency 319

Twelve institutions form educational corporation 421; 618

Twenty hospitals form group to establish shared services 73; 320

Two New Jersey hospitals share food service director 193; 262

United Hospital Services, Inc. v. United States of America 436

Virginia shared laundry service target of antitrust suits 321; 435

Which type of laundry service is best for you? 323; 550

Wyoming hospital linked to Colorado computer 149

84

ADDENDUM

Brown, M. H., and others. Shared laboratory services. What to consider.

‘ Hospitals, J.A.H.A. 49:48-51, May 1, 1975.

Brown, M. H. and Money, W. H. Promise of multihospital management. Hosp.
Progr. 56:36-42, Aug. 1975; Implications for Catholic hospitals. 56:89-
1 92, Sept. 1975.

Central management group formed by four Portland, Ore., hospitals. Mod.
Healthcare. 3:16n, Mar. 1975.

‘ Clout counts: co-op buying can cut costs 20%. Inst/Vol. Feed. 76:29-30,
June 15, 1975.

‘ Fraser, C., and Polacsek, B. K. Nursing school cooperative in the Chicago
‘ area. Nurs. Outlook. 23:504-507, Aug. 1975.

Group purchasing: more advantages than disadvantages. Investor-Owned
% Hosp. Rev. 8:32-33, Apr.—May 1975.

Guide to shared educational services. Hospitals, J.A.H.A. 49:73-75, Aug. 1,
1975; 49:95+, Aug. 16, 1975.

1 Henry Ford Hospital announces cooperative effort to coordinate, share ser-
vices. Mich. Hosp. ll:l9+, Apr. 1975.

‘ Hospital association sponsors closed-circuit television programs. Hospi-
‘ tals, J.A.H.A. 49:12, Apr. 1, 1975.

Hospitalwide education program takes to the road in northern Georgia.
‘ Cross—Ref. 5:5—7, Feb. 1975.

Johnson, R. L. Hospital mergers and shared services. Med. Rec. News.
46:29—33, Aug. 1975.

j McClelland, K. J. New shared power plant. Hosp. Eng. 20:8-9, May-
June 1975.

Marquis, J. A. Two-way closed-circuit television offers educational
‘ programs. Hospitals, J.A.H.A. 49:85+, May 16, 1975.

Montana hospitals are linked by seven learning centers. Mod. Healthcare.
3:84, June 1975.

Rumford, D. M. An analysis of the financial ramifications of exchanging
inpatient services. Master's thesis, Xavier University, Cincinnati, Ohio,
1974.

Schoenhard Jr., W. C. Growth potential of hospital management corporations.
Hosp. Progr. 56:72-75, July 1975.

Shared laundry service held tax—exempt. Hosp. Law. 8:3, Feb. 1975.

Shared services and contracted services programs for the hospital. Hosp.
Admin. Currents. 19:1—4, June 1975; 19;l—4, July-Aug. 1975.

Small hospitals take on trustee education through shared program. Cross-
Ref. 5:12, June 1975.

Support Center offers technical aid to Orange County hospitals. Mod.Health-
care. 3:16e-f, June 1975.

Turner, W. W. Tri—unit complex effects economy. Hospitals, J.A.H.A.
49:49-52, Sept. 1, 1975.

Wuest, J. R., and Schaengold, S. Pharmacy use of the shared hospital
accounting system. Amer. J. Hosp. Pharm. 32:846-849, Aug. 1975.

 

Zechman Jr., E. K. An economic analysis of shared services and the Frank—
lin County Hospitals solid waste problem. Master's thesis. Ohio State
University, Columbus, Ohio, 1974.

QU.S. GOVERNMENT PRINTING OFFICE: 1977—240'848/1‘11

 

 

 

 

 

 

 

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