Large-scale dairy operations: assessing concerns of neighbors about quality-of-life issues.

An increasing number of large-scale dairy operations are being built across the United States. Many of the neighbors of proposed large-scale dairy operations are upset at how dairies will affect their quality of life. We assessed the intensity of these concerns at least 1 yr after 2 new dairies began operation. Surveys (n = 275) were mailed to collect data. The opinions (n = 64) of those living close to large-scale dairy operations were compared with those of individuals in control groups (n = 38) living at least 8 km away. There were no significant differences between groups and no complaints had been received, suggesting that quality-of-life issues are specious with regard to properly managed large-scale dairy operations with 700 or fewer cows. We recommend the following for future policy decisions: Large-scale dairy operations should be located in areas where there are few, if any, current neighbors and where future residential development is least likely to occur. Conducting longitudinal studies at intervals of 3 and 5 yr of operation involving these same issues could determine whether any changes in reaction have occurred since this study.

Management theory and applications.

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.

Essentials of finance for occupational physicians.

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.

Information systems.

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.

Human resource management.

The occupational health physician can take advantage of the broad functions of human resource management to offer care and treatment in a very practical way in the day-to-day workplace. Understanding the capabilities and services of the human resource department can aid the occupational health practitioner in maintaining employee health and productivity. Thus, the individual is helped as well as the organization. This article describes the functions of the human resource department and delineates the close connection between it and the occupational health physician.

Fundamentals of compensation and benefits.

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.

Concepts of organizational behavior applied to occupational medicine.

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.

The older worker.

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.

Administrative issues related to addiction in the workplace.

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.

Ethics in the practice of occupational medicine.

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.

Nurse telephone screening of new Medicare HMO members: a pilot program.

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.

The policy context of health services administration education through outcomes assessment.

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.

Health hazards of firefighters: acute pulmonary effects after toxic exposures.

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.

Occupational medicine. Workers' compensation, impairment and disability.

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.

Occupational medicine. An overview of management.

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.

Occupational medicine. Organizational behavior.

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.