A model for primary care delivery to a widely dispersed medically indigent population.

Access to Care is a unique program uniting private and public resources to provide primary care to the uninsured poor. The model was designed to serve a medically indigent population that is dispersed over a large geographic area, where clinics are not a practical option. Care for illness is provided in the offices of private physicians throughout the area and supported by laboratory, radiology, and pharmacy services. The program is designed for the estimated 88,000 persons in suburban Cook County, Illinois, with family incomes of less than twice the federal poverty level, who are uninsured and ineligible for Medicaid and Medicare. Supported by grants from foundations and local governments, the program, which has been in operation for 2 years in two demonstration areas, is administered by a private not-for-profit confederation of four health and social service organizations.

Hospital benefits when managers put their heads together.

To improve its efficiency and effectiveness, Alexandria Hospital, Alexandria, VA, has developed a strategy of participatory management: the management advisory board. The board, made up of 16 middle managers elected for six-month terms, is a problem-solving, idea-generating forum that may get involved in almost any aspect of hospital operations. Project ideas, which must be aimed at increasing the morale, efficiency, and effectiveness of the hospital and employees, can come from any employee at any level. Once a project has been accepted, it is assigned to a project committee, made up of at least three members who are given much latitude and are encouraged to use their individual and group talents and creativity. After the project has been completed and approved by the full board, it is submitted to the administration for approval and implementation. The board's results have led to a number of new policies and programs at the hospital, including "employee-of-the-year" recognition, standardized uniforms, disaster plans, quality circles, and management orientation. The board is now developing a physician orientation program, identifying outpatient service opportunities, investigating ways to control the use of copying machines, and studying the feasibility of using one particular travel agency for hospital travel.