Quality assurance and hospital structure: how the physician-hospital relationship affects quality measures

Mr. Spaeth writes about the relationship between hospital administration and the physician, and how that relationship affects the quality of medical care delivered to the patient. The article focuses on the differences between the employment structure in an academic teaching hospital, and the open, independent contractor medical staff typical of a traditionally smaller community hospitals. The individual traits and nuances of these structures and how they can be distinguished from one another create dynamic differences in the approach for quality care. Peer review, credentialing, and management of adverse outcomes are just a few of the ways in which hospitals continue to strive to provide higher quality care, but the way these methods are implemented and performed in different hospital structures are dramatically different, yielding distinct results. Mr. Spaeth argues that the challenges faced by community hospitals in their effort to provide higher quality care and eliminate medical error are exacerbated because of their unique structure and the particular relationship physicians share with the hospital and its administration.     

COMMUNICATION IN PUBLIC ADMINISTRATION: THE NEED FOR SKILL-BASED EDUCATION

This article notes the tremendous significance of communication skills for public administrators with the authors examining the attention that has been given to teaching these skills in MPA programs. The authors hold that basic communication skills are the essential building blocks on which more advanced skills (i.e., qualitative skills and computer skills) are constructed. This article considers the various skills of communication that are most essential to public administrators and the manner in which courses addressing these skills are handled in MPA curriculum. In concluding the article, the authors offer several options for teaching communication skills to students of the discipline.     

Predicting Conduct Problems from Community and Family Violence: The Moderating Effects of Hurricane Katrina

Although the devastation was immediately apparent, the effects of Hurricane Katrina on the behavior of youth are just now being revealed. Much post-disaster research targets adjustment of adults, but ample evidence indicates that youth experience a variety of psychological symptoms following a disaster, including depressive symptoms, aggression, and symptoms of posttraumatic stress. The aim of the current study was to determine whether hurricane exposure serves as a risk factor for developing conduct problems among violence-exposed youth. Results indicate that hurricane exposure had differential effects on the relations between conduct problems and community violence versus corporal punishment in the home. Though not statistically significant, there was an unexpected trend for youth with high hurricane exposure to show decreased conduct problems and those with low hurricane exposure to show increased conduct problems as violence exposure increased. Hurricane exposure played the predicted role in the relation between corporal punishment and conduct problems, such that high levels of hurricane exposure predicted increased conduct problems among youth experiencing high levels of corporal punishment, but not among those experiencing low levels of corporal punishment. Implications for future research and practice are discussed.     

The development and initial validation of the dating attitudes inventory: a measure of the gender context of dating violence in men

The development and initial psychometric investigation of the Dating Attitudes Inventory (DAI) is reported. The DAI was created, to fill a gap in the literature and to measure specific masculine ideology and traditional gender attitudes that rationalize the abuse of women. Using a sample (n = 164) of male college students, a 20-item measure was developed consisting of two subscales (Rationalization of Abuse and Dominance and Control) and a total score. The 20-item DAI and other measures used for validation were completed by 216 male college students. The DAI correlated in theoretically expected ways with measures of propensity for abusiveness, relational dominance, and masculine gender role stress. A confirmatory factor analysis supported the two theorized factors of the DAI. Results of the present study offer initial support for the validity and reliability of the DAI. The authors discuss the importance of measuring masculine gender role attitudes and beliefs that support and rationalize dating violence.     

TENNESSEE'S ADOPTION LAW AND THE LIMITATIONS OF THE CONSTITUTIONAL ARGUMENTS REGARDING OPEN RECORDS

In 1995, Tennessee enacted a statute allowing adult adoptees access to information contained in their adoption records. Since then, debate has arisen concerning the constitutional rights of both the adoptive parents and the adoptees. A further dichotomy arose concerning the newly-created variation between adult and minor adoptees. While the debate continues, certain cases have begun to outline a judicial position on these matters, establishing predictors for the future application of the Tennessee law.     

The framework convention on tobacco control: The politics of global health governance

This paper analyses the particular challenges that tobacco control poses for health governance in an era of accelerating globalisation. Traditionally, health systems have been structured at the national level, and health regulation has focused on the needs of populations within individual countries. However, the increasingly global nature of the tobacco industry, and the risks it poses to public health, require a transnational approach to regulation. This has been the rationale behind negotiations for a Framework Convention on Tobacco Control (FCTC) by the Tobacco Free Initiative of the World Health Organisation (TFI/WHO). In recognition of the need to go beyond national governments, and to create a governance mechanism that can effectively address the transnational nature of the tobacco epidemic, WHO has sought to involve a broad range of interests in negotiations. The contributions of civil society groups in particular in the negotiation process have been unusual. This paper explores the nature and effectiveness of these contributions. It concludes with an assessment of whether the FCTC constitutes a significant shift towards a new form of global health governance, exploring the institutional tensions inherent in attempting to extend participation within a state-centric organisation.