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Columbus-Cuneo-Cabrini Medical Center prepared extensively for the Medicare prospective payment system (PPS), which went into effect there Jan. 1, 1984. Administrators believe the planning effected a smooth transition from the retrospective reimbursement system. Preparation took two froms: educational sessions for all staff and trustees and establishment of a Prospective Payment System Implementation Task Force to develop ways to deal with new problems. All staff and trustees attended educational sessions, which were tailored to address each group's specific concerns. The sessions compared the old and new systems and emphasized PPS's effects on the institution over three years. The financial staff also provided weekly written updates to administrators and physicians on financial issues, including PPS, regulations, and reimbursement. The medical center's task force consisted of eight "in-house experts" on PPS. Because they had to act quickly, they operated under unique ground rules: Communicate with each other. Ignore the chain of command. Believe any problem can be resolved. Believe conflict is good. As chairman, the vice-president of finance had the task of estimating PPS's impact on the institution. The medical records director was responsible for the case-mix management system. The utilization review director ranked physicians and DRGs according to their profitability. The data processing director was responsible for installation of the DRG information system. The controller, reimbursement director, and cost accounting manager developed ways to maintain accurate financial records. The director of patient care services developed and scheduled PPS education programs. As a result of the preparation, the medical center staff realizes the importance of cost control if the institution is to remain viable.

Human resource planning, which allows health care facilities to identify future staffing needs and to project staffing availability, will increase as institutions seek to balance quality, costs, employees' needs.

The WEVAS procedure, through use of consultative decision making, facilitates the selection of CEOs who will be accepted by associates and subordinates and thus will be able to function with maximum effectiveness.

Health professionals' lack of communication contributes to poor patient care planning. At one hospital a social worker, a clinical specialist, a nursing supervisor, a pharmacist, a nutritionist, and a physical and an occupational therapist developed criteria to identify and to handle patient problems at admission.

While statistics indicate the nation is producing more physicians than it needs, administrators of rural or inner city hospitals still may have difficulty recruiting the physicians they need. Suggestions are given for assessing a hospital's medical staff needs, organizing a search committee, locating physician resources, evaluating candidates, and conducting recruitment visits.