Dimensions of experiential learning at group relations conferences.

Four hundred and seventy-seven professionals attended thirteen group relations conferences. Conferences varied across three dimensions: context, including sponsorship and history: design, involving duration, intensity (residential setting) and complexity; and linkages, the social and authority ties between members and staff. Three month follow-up questionnaires were collected from sixty percent of participants. Significantly more self-assessed learning was reported by those who attended the residential than the non-residential conferences. The results, from a large diversified sample, suggest that a combination of training in a residential setting, strong institutional sponsorship and pre-existing authority and social linkages between members and staff resulted in the most reported learning. Group relations conferences provide unique learning opportunities for mental health professionals, (Correa et al. 1981) and have been increasingly used in the United States and Europe during the last twenty years. Despite this, there is little research evaluating the outcomes of such training in terms of member learning or the differential effectiveness of the alternative forms of conferences currently available. Conferences vary along three major dimensions: a) context, including the institutional sponsorship as well as the history of previous conferences held at the same site, b) design, including the duration, intensity and number of events which make up the conference, and c) linkages, the social and authority relations among members and staff. A review of the first decade of group relations work in the United States concluded that the characteristics of a conference, including the setting have an important impact on member learning, (Klein 1978).(ABSTRACT TRUNCATED AT 250 WORDS)

Economics of practice and inpatient care.

The nature and structure of inpatient psychiatric services are rapidly evolving. This article identifies and explores how these changes are being influenced by four interrelated areas: rapid growth in general and private hospital psychiatric practice; increased connections of public, private, and voluntary sectors of care; the emergence and quick acceptance of capitated and managed care programs; and dramatic change and growth in the insurance industry. These four interrelated areas further the development of a two-tier system in psychiatry: one for those with insurance, and one of the poor and the severely disabled. The changes in these four areas have also led to greater demand for increased economic competition among services, and new alliances and innovations in the delivery of treatment. This article discusses how the four areas have combined to support a two-tier system and how they are likely to affect the future evolution of general and private hospital inpatient psychiatric practice.

Medical practice in organized settings. Redefining medical autonomy.

Physicians are perplexed by the ongoing erosion of their individual professional autonomy. While the economic forces underlying such change have received much attention, the evolution of new organizational forms that modify and often diminish medical autonomy is less well understood. The practice of medicine is becoming more organized and more hierarchical. We emphasize the importance of organized medical groups, including the medical staff organization, as structures for appropriate peer monitoring, and for counterbalancing the burgeoning influence of governance and administrative constraints on practice. There is an ongoing tension within organizations between management, governance, and physicians. Over time one or another of these groups achieves some measure of dominance, but good management requires a balance of power. The role of the medical staff, which is poorly represented in some health care institutions and under threat in others, is considered. In general, we find that medical work is becoming more hierarchical, and that physician "leaders" do not substitute for collegial processes.