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A study of former state hospital employees at a community-based outpatient clinic.

The current trend toward providing community-based services for the mentally ill has had substantial impact on state hospital employees who transfer to community mental health centers. A study, through interviews and questionnaires, of 30 Grafton State Hospital employees who transferred to a community outpatient clinic indicated initial anxiety about the hospital's closing, the relocation process, and the lack of structure in the new community setting. Many employees stated that those initial reactions were gradually replaced by satisfaction and personal growth stemming from successful adaptation to the community-based placement.

Adaptation, Psychological

It's a question of ethics.

Ethical considerations must be taken into account whenever a merger of the closing of a facility or service is contemplated/Some guiding principles that can help in making decisions.

Administrative Personnel

Reducing excess hospital capacity is a tough but necessary job.

Developing and implementing an effective program to reduce excess hospital capacity is an extremely difficult and complex task. But it is clearly a logical means to contain health care costs and to develope a cost-effective health system.

Facility Regulation and Control

Planning with the community in mind can prevent hospital closings.

A study of 46 closings and mergers in New York City over a 15-year period shows the importance of public funding for the viability of hospitals and the need for sound institutional planning for hospital survival. Regulatory agencies may deny hospitals public funds if they do not respond to their communities.

Community-Institutional Relations

The closure of maternity services in Massachusetts. The impact on the obstetricians.

A survey is presented of Massachusetts physicians who were staff members at hospitals which closed their obstetric services. Both personal and practice impacts are presented as well as the physicians' evaluation of their present maternity units in comparison to the closed units. The personal impact on responding physicians was small. Few reported significant financial or patient loss. While significant practice changes were reported, adverse comments were few, and the present obstetric unit was viewed as an improvement over the closed unit in ever one-half the cases. These findings support the concept of consolidation as a component of programs for regional planning of maternity care.

Attitude of Health Personnel

Hospital buildings have few alternative uses.

A year ago HEW published guidelines regulating hospital beds and occupancy rates. Reluctant to close their doors, administrators have sought conversion alternatives, most of them impractical and economically impossible. A go-slow attitude is recommended, as population increases will dictate hospitals' proper response.

Bed Occupancy

Creative responses needed in controlled environment.

Faced with an increasingly regulatory environment, hospitals must find innovative ways by which, first, to survive and, then, to respond constructively to externally applied constraints. Decertification of beds and a move to ambulatory care programs are only two of many possible responses. The key to success will be the measure of cooperation between health care providers, insurers, and government.

Ambulatory Care

Impact of hospital closures on nearby hospitals studied.

An AHA study showed that hospital closures during 1975 significantly affected utilization of other hospitals in the vicinity of the closures. The degree of impact on the affected hospitals varied widely according to certain factors, such as urban or rural setting, bed size, and number of other nearby hospitals.

Bed Occupancy