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The authors discuss the objectives of compensation programs--including direct and indirect forms of reward--and employee motivation. Job descriptions and job evaluations are also explored.

People in organizational settings exhibit predictable patterns of behavior. Effective managers understand the psychological underpinnings of group functions. Formal organizational rules and job expectations influence employees. Informal or group dynamics also exert powerful influences. Effective managers try to reduce conflict between organizational and group norms. Informal group cohesion can be harnessed and channeled towards achieving organizational goals and objectives, and informal leaders can be assets to organizational managers. While formal organizational structures can be changed, supervisors should try to accommodate informal group structures when possible. Understanding subordinates is an important skill of successful managers.

Comprehending the principles of finance is paramount to understanding the way an organization chooses to generate and use its financial resources. Financial principles may be employed in the same way a physician reviews fundamental systems to gauge a person s health. Just as basic anatomical and physiological components are used to assess the health of an individual, basic financial elements exist to ascertain the health of an organization. This chapter explains risk assessment, accounts receivable management, inventory, depreciation, capital formation, ratio analysis, and more.

About one person in eight remains employed past 65, the average age for retirement in the U.S. These persons tend to be highly reliable. They can adapt and learn new technology, but may require extra time to do so. Older workers have particular needs in the workplace due to physiological changes that accompany aging. They may require more lighting, and they may have decreased mobility, physical strength, and dexterity. These factors often have no impact on their ability to accomplish job duties. This chapter underscores the significant contributions that older workers often provide, and also addresses retirement planning.

Management is critical as an organization pursues its mission. There are many theories of management, but all agree that an effective organizational structure can facilitate the operation of a company. The author describes the typical functional areas found in most organizations (finance, operations, marketing, information systems, legal, and human resources); examines how the organization of tasks and people are inter-linked; and shows that administrators who have a working knowledge of management theory tend to be effective in the performance of their jobs.

Information is critical for the successful operation of healthcare facilities. Data must be accurate, available on a timely basis, and accessible. An information system should connect all potential suppliers and users of data; be accessible to users, but secure from unauthorized persons; have equipment that can interface with sources and users throughout an organization; archive data in a logical and accessible manner; and support users throughout the organization it serves. Dr. Fallon discusses operator training, strategic planning, and upgrading of equipment.

Ethical considerations are often important when managers make organizational decisions. There are two ethical approaches commonly employed when making decisions. The first is deontology or the existence of an absolute standard that does not change over time. Decisions made by reference to a creed or professional code are uniformly consistent. The second ethical system is teleology or optimization. Decisions are made to optimize the outcome, and they can be inconsistent over time. Health professionals must often choose their allegiance from several alternatives. These conflicts must be recognized and reconciled. Students can benefit from the inclusion of ethical training during their professional preparation.

Drug abuse is an important problem in the workplace. Seventy percent of current illegal drug users are employed, and approximately 7% of Americans employed in full-time work report heavy drinking. Drug-using employees are twice as likely to request time off, and 3.6 times more likely to be involved in a workplace accident. Individuals who use alcohol or other drugs in the workplace annually cost American business 81 billion dollars in lost productivity; 86% of these costs are attributed to drinking. Although alcohol is the primary source of problems for the workplace, other drugs such as amphetamines, cocaine, marijuana, and tobacco are also troublesome. Employee assistance programs and drug treatment hold great promise for coping with these problematic substances.

Members newly enrolled in an HMO and covered under a Medicare risk contract were screened over the telephone by a registered nurse within their first month of membership to assess whether screening could lead to early intervention and later reduce utilization of health care services. This pilot study screened 36 patients (mean age = 71 years) constituting 25.2% of the new Medicare members during the period of study. Health care encounters were tracked for the first 6 months of membership. A historical comparison group included 32 patients (mean age = 72.6 years) who had enrolled 1 year earlier. A retrospective chart review determined the number of health care encounters during the comparison group's first 6 months of membership. Episodes of health care service utilization were fewer among the screening group than among the comparison group in all areas studied. This pilot study suggests the potential benefit of screening and early intervention by health care providers.

Effectively evaluating preparation programs for health services administrators is important for program providers, trainers, future employers, the health care system, and the American public. Because the methods employed for evaluation do not exist in a vacuum, policy formation with respect to learner outcomes assessment is a critical concern for all those interested in health care management issues. During the 1990s, the prevalent trend in evaluation is "assessment," which emphasizes performance-oriented outcomes rather than traditional testing approaches. This article examines the evolving role of assessment from a higher education policy perspective. Current trends and issues in general education, teacher testing, and nursing home administrator preparation are brought to bear on the problem of how to implement the goals of assessment. Realistic expectations of assessment are subsequently offered.

Workers' compensation laws impose a no-fault status on injuries and illness sustained in the workplace. Under the statutes, victims of industrial injuries or their survivors are assured prompt, equitable payment for medical expenses, lost wages and other expenses associated with their injuries. Each state, territory or province has developed its own laws governing workers' compensation. As a result, the type, amount and duration of benefits vary. The cost of workers' compensation benefits is paid by the employer. The National Safety Council estimates that these benefits cost employers almost $35 billion in 1986. Employers pay for these benefits through the purchase of insurance, by becoming self-insured, or by participating in a state-run fund. Each state has an agency, commission or board to oversee compliance with the law.

Management is the art of utilizing all available resources to accomplish a given set of tasks in a timely and economical manner. A complete job description for a manager would include diplomacy, coercion, politics, psychology, budgeting, evaluation and a host of other attributes. Each individual manager evolves a personal style within an organizational culture. No two positions or individuals are ever exactly alike. The successful manager must be able to allocate resources and motivate subordinates to accomplish goals often imposed from external sources (i.e., upper management). The successful manager may retain previously acquired technical skills; frequently these are lost, being replaced by new knowledge. The successful manager is one who understands the local organizational milieu. The theories discussed above are only guidelines. Just as each patient is approached differently, so too are different managerial positions.

Work flow and the administrative processes by which it is controlled are fundamental in shaping the realities of the organization as a system of relationships. Organization is technology in the broadest sense: processes, procedures, policies, controls, formal authority structures, and techniques. Among groups or organizations, it is unusual for changes in sentiment to precede action or organizational rearrangements. Technology and structure must be changed first. This chapter has outlined organizational theory and structures. The components of each have been examined and potential causes of problems identified. Much space has been devoted to understanding group dynamics and behavior. In addition to understanding one's subordinates and peers, the effective manager understands the organizational forces that exist in the workplace. A willingness to listen, communicate, innovate and lead should result in both effectiveness and rewarding experiences for a manager.

As part of an environmental monitoring and medical surveillance programme to evaluate potential health hazards from firefighting, complete baseline medical examinations were performed on a cohort of 77 firefighters. During a ten day study period, 37 follow up medical examinations were performed after exposure to fire to monitor any significant differences in pre-fire and post-fire physiological indices, including pulmonary function and blood counts and chemistries. For the group as a whole, no significant differences were found. For individuals not wearing respiratory protective equipment, however, statistically significant post-fire decrements in FEV1 and FVC were noted. These decrements were consistent with previously shown levels of exposure to pulmonary toxicants in this cohort. These results support the need for more extensive use of respiratory protective equipment by firefighters.

Although a relatively uncommon neoplasm, cancer of the ampulla of Vater does account for over 300 deaths a year in the United States.1 Among biliary tract tumours, ampullary cancer is regarded as having a favourable prognosis because the early onset of symp toms, low grade histopathology, and late and infre quent m?tastases allow the possibility of surgical cure; nevertheless, high operative mortality and overall five year survival figures of between 4% and 40%, depending on type of tumour and disease spread at diagnosis, show that these cancers cannot be consid ered as having a good prognosis.J These figures also serve to underline the importance of the identification of underlying aetiological factors for these tumours. In previous research we had identified the possible importance of chemical exposures in the development of these tumours; however, statistical significance was limited by the small numbers involved.1 2 Expansion of these studies has now confirmed our previous pre dictions.