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A computerized scheduling system with centralized staffing.

Personnel costs make up approximately 70 percent of the operating expense of a hospital, and nursing service accounts for a large percentage of those personnel costs. It is imperative that nursing personnel be appropriately scheduled so that patient care units are properly staffed while personnel budgets are maintained. This hospital's centralized staffing function, supported by a computerized scheduling system, successfully handles all staffing situations with minimal involvement of professional nurses.

Computers

The Wyatt standards: an administrative viewpoint.

The author, the fifth superintendent of Alabama's Bryce Hospital since the Wyatt v. Stickney order was issued in 1972, discusses the major problems faced by an administrator in complying with the court-set standards. They relate to qualified mental health professionals, staffing ratios, staff attitudes, individualized treatment plans, and the hospital's negative image. He also discusses the role of the human rights committee and the hospital's goal of providing treatment of sufficient quality that the court order will be lifted.

Alabama

Nursing care in a combined adolescent medical-psychiatric unit.

In spite of the problems we have encountered in combining adolescent medical and psychiatric patients, we have found this to be a workable model. In summary, several areas are important in making this model functional: staff interest in both medical and psychiatric patients, in-service programs particularly in psychiatry, and open communication between health care givers. Certainly one of the most positive aspects of this unit is that it provides an environment which allows for easier adjustment to the community after hospitalization. Avoidance of such terms as "mental hospital," "crazy person" is less traumatic to the adolescent patient and his family.

Adolescent

Allocation of resources for ambulatory care -a staffing model for outpatient clinics.

The enormous commitment of resources to ambulatory health care services requires that flexible and easily implementable management techniques be developed to improve the allocation of health manpower and funds. This article develops a feasible model for staffing outpatient clinics and thereby potentially provides an important analytical tool for allocating and monitoring the utilization of the most critical and expensive of ambulatory care resources-professional and nonprofessional clinic personnel. The model is simplistic, extremely flexible, and can be applied to many modes of delivering ambulatory care-from HMOs to traditional hospital outpatient clinics. To employ the model, certain decision variables must be specified so that the model can produce a least-cost staffing configuration to meet the demand for service in accordance with the desired mode and intensity of care. The key decision varables that require input from administrators and medical personnel include standards for physician-patient contact time, a desired ratio of staff time actually spent treating patients to total paid staff time, and the desired mix of various staff categories to achieve program objectives. Specific benefits of using the model include determining staffing for new, expanded, or existing outpatient clinics, determining budget requirements for such staffing needs, and providing quantitative productivity and utilization objectives and measurements.

Ambulatory Care