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Hospitals that have successfully integrated the risk-management function with other hospital departments say that the process requires both education and teamwork. Among the major challenges: overcoming physician reluctance to participate in risk-management activities, and linking risk management to quality assurance.

In an effort to improve hospital-medical staff relations, a number of hospitals are making changes in their medical staff meetings structures--putting time limits on meetings, modifying attendance requirements, even timing comments. One California hospital even uses an egg timer to facilitate the monthly meetings of its medical staff executive committee.

Technology assessment is undergoing a profound transformation in some hospitals. Driven by diverse (and sometimes contradictory) pressures from consumers and payers for cutting-edge yet cost-effective care, hospitals are finding that the evaluation process is growing more complex. Experts say that a formalized assessment process can balance organizational goals and community needs.

The nursing profession is changing, the medical profession is changing, the professional job market is changing, and hospitals are changing. So it should come as no surprise to anyone that nurse-physician relations are also undergoing considerable changes these days. And although the relationship between hospital nurses and physicians has been a topic of ongoing concern for hospital executives for years, only recently has its improvement become an action item. Experts say a number of factors have brought new opportunity to the quest: the push for cost containment, the rising acuity of patients, continuing nursing shortages, societal and workplace changes, and, most of all, the drive toward systemwide quality in hospitals.

Hospital personnel discover that duplication of patient education efforts was occurring because of the absence of coordination. A Patient Education Committee was established to consolidate all the individual efforts that were going on in the hospital.

To ensure a successful psychiatric unit in a general hospital, the hospital must determine needs, plan with all involved parties, and follow up with sensible control measures.

A Chicago-based medical center abandons the classical approach to preconstruction planning to save both time and money.

An energy committee made up of nine staff members manage a hospital's award-winning energy conservation program.

A key element in the strategic planning process is active involvement of the hospital's key personnel so that each has a commitment to the ultimate plan.

Risk management programs in hospitals are necessary not only because of some state laws that require them, but also because they can help to cut malpractice costs. In a systems approach to risk management, an effective incident reporting system should be developed, a medical incident review committee should be established, and attempts to involve attending physicians should be made. This approach can encourage a higher level of patient care and can cut costs.

Through participation on a medical equipment priority committee, medical staff members have become more aware of the problems that their hospital's board and administration face in containing costs. In reviewing individual requests for equipment purchases, they not only apply their own expertise but also consider maintenance, personnel, planning, financing, and other implications of the proposed purchases.

For successful planning, an organization and its planners must recognize and accept inevitable changes; eliminate unnecessary self-imposed restrictions that limit options in seeking solutions to problems; and take risks to promote future development.

Control of tuberculosis infection within the hospital is of major importance to general hospitals that assume the responsibility for providing tuberculous patients with primary care services. Because patients vary in their potential infectiousness, each patient's disease should be assessed individually. Patients who have completed a prescribed course of treatment are not infectious, and no precautionary measures are indicated. Patients with positive sputum who are receiving chemotherapy are rarely infectious, but they should be lodged in a room with air control. Effective antituberculous chemotherapy and adequate ventilation of the environment are the most important means of achieving infection control. Each hospital should have an infection control committee that is responsible for implementing infection control policies and for ensuring that patients with tuberculosis receive high-quality medical care. Educating personnel about tuberculosis, providing necessary consultation services, and making sure that patients are referred properly at discharge are important functions of the committee. Only those hospitals that are willing to meet these minimum standards should assume this responsibility.

A dietary department's safety program is conducted and controlled by all of the department's employees on a rotating basis through service on a safety committee and as safety inspectors.

Strategic corporate planning offers hospitals a tool for dealing with an uncertain future, an increasingly complex environment, and an accelerated rate of change. Through corporate planning, the institution can capture opportunities, maximize its potential, and control its destiny.

Parenteral feeding has saved lives and enhanced therapy of patients who cannot eat. Future trends of this technique for patients, physicians, hospitals are discussed.

A long-term care facility developed, tested, and implemented criteria for documenting care, a procedure for regular review of charts, and quantitative methods of evaluating reviews.

Hospitals can show response to community needs through planning. However, the planning process can only effect change if given appropriate and regular evaluation.

Risk management program uses an investigation report as the primary tool for collecting data about an incident, analyzing that data, and translating the information into strategies for change.