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PubMedDate not supplied

A professional imperative.

Nurses at the University of Michigan Hospitals (UMH) have been organized since 1974 into a bargaining unit of the Michigan Nurses' Association (MNA), known as the Professional Nurse Council. There have been several bargaining periods and contracts. The most recent contract prior to the strike terminated in September, 1980. Following this contract expiration, negotiations occurred, month after month, between the union and the hospital's bargaining team. At times, it appeared as though settlement was imminent, but negotiations continued on through the fall of 1980 and into the winter of 1981. A state-appointed mediator failed to solve the problem. The authors contend that the principal issues were not those being negotiated at the bargaining table.

Hospital Bed Capacity, 500 and over↗
PubMed1980

Hospital collective bargaining: structure and process.

The increasing influence of third parties on collective bargaining has continued to interest labor relations practitioners. The authors discusses the role of third-party payers and state regulatory agencies in labor-management negotiations at voluntary hospitals. Highlighted is the bargaining strategy adopted by negotiators when collective bargaining operates under a prospective rate-setting system. Also presented are the economic variables by which the payers influence hospital-union relationships and their effect on the outcomes of bargaining. The author describes the political context of health-care bargaining and the growing significance of cost control on hospital negotiations. He concludes that third-party payers cause health-care bargaining to change from a bilateral structure to a multilateral dimension.

Collective Bargaining↗
PubMed2000

Rural economic development vs. tobacco control? Tensions underlying the use of tobacco settlement funds.

Some public health advocates in tobacco states, having reconsidered the impacts of the federal tobacco price-support program, have negotiated common tobacco regulatory policy stances with tobacco grower representatives. This paper describes the impact of this rapprochement on the state-level negotiations of Master Settlement Agreement funds. It argues that there are indeed two worthy public health goals: tobacco control and the economic viability of tobacco dependent communities (TDCs), but the immediacy of the threat to the latter, the political potency of tobacco growers, and growers' goal of maintaining tobacco as their farms' anchor bring severe risks to the tobacco control portion of Settlement funds. Among three competing philosophies of economic development for TDCs, none are well evaluated, and two potentially create endless demands on Settlement resources. Public health policy advocates are urged to participate in negotiations on TDC economic development and to forcefully advocate for adequate tobacco control resources.

Liability, Legal↗
PubMed2000

Linking Internet strategy to high-quality, cost-effective managed care.

This article describes an experimental pilot project incorporating e-commerce and the Internet into the traditional process of health benefit negotiations through the utilization of an HMO Internet auction. The timeline and process of the auction are described, with the final auction taking place during the last week of negotiations. The results reveal an efficient and effective system to augment the traditional benefit negotiation process.

Cost-Benefit Analysis↗
PubMed2000

The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study.

CONTEXT: Osteopathic manipulative treatment has been reported to relieve a variety of conditions, but no studies have examined the outcome effects of osteopathic manipulative treatment as a complementary modality for treating musculoskeletal problems during postoperative recovery. OBJECTIVE: To assess osteopathic manipulative treatment as a complementary therapy for patients undergoing elective knee or hip arthroplasty. DESIGN: Prospective, single-blinded, 2-group, match-controlled outcome study. SETTING: Osteopathic teaching hospital. PATIENTS: Of 166 eligible patients, 38 were assigned to a treatment group and matched with 38 control subjects. INTERVENTION: The treatment group received osteopathic manipulative treatment on postoperative days 2 through 5. MAIN OUTCOME MEASURES: Days to independent negotiation of stairs, distance ambulated, supplemental intramuscular analgesic use, length of hospital stay, and patients' perceptions of treatment. RESULTS: Compared to control subjects, the intervention group negotiated stairs 20% earlier (mean = 4.3 postoperative days, SD = 1.2; control subjects 5.4, SD = 1.6, P = .006) and ambulated 43% farther on the third postoperative day (mean = 24.3 m, SD = 18.3; controls = 13.9, SD = 14.4, P = .008). The intervention group also required less analgesia, had shorter hospital stays, and ambulated farther on postoperative days 1, 2, and 4. CONCLUSIONS: Patients receiving osteopathic manipulative treatment in the early postoperative period negotiated stairs earlier and ambulated greater distances than did control group patients.

Aged↗
PubMed2000

Partner type and sexual risk behavior among HIV positive gay and bisexual men: social cognitive correlates.

This study used elements of social cognitive theory to examine the relationship between partner type and sexual risk behavior in a sample of HIV positive gay and bisexual men. Self-efficacy captures one's perceived ability to perform a behavior; outcome expectancies are estimations that a behavior will result in a given outcome. An examination of sexual risk behavior revealed that men with steady partners and men with anonymous partners had the most unprotected anal intercourse (UAI), while men with casual partners had the least. Men with anonymous partners had the lowest scores on self-efficacy and outcome expectancies for condom use, negotiation, and disclosure. Outcome expectancies for negotiation of safer sex were inversely related to UAI for men with steady partners. Self-efficacy for condom use and negotiation were inversely related to UAI for men with casual partners. These findings suggest the need to consider partner type in the development of sexual risk reduction interventions.

Adult↗
PubMed2000

Women at risk for HIV from a primary partner: balancing risk and intimacy.

Women are being devastated by the HIV/AIDS epidemic in the U.S. and all over the world, most infections occurring via heterosexual activity with a primary partner. Although a number of evaluations of behavioral risk-reduction interventions for women have been reported, many suffer from methodological problems that weaken confidence in their findings. It is clear that, despite statistically significant intervention effects, many women are unable to respond to even the most effective interventions that have been tested, a fact that might be attributable to failure to change behavior with primary partners. Achieving consistent condom use with primary partners can be highly challenging for women, for a variety of reasons. In the present paper, I review the literature regarding behavioral interventions for women. I also review data supporting the feasibility of alternative strategies that may be more effective than those usually recommended for women at risk for HIV infection by their primary male partner. The literature on woman-controlled technologies, such as the female condom and vaginal microbicides, is summarized. Alternative messages for condom negotiation and "negotiated safety" are also described. Because it is relevant to negotiated safety, and at the heart of the present topic, a review of the behavioral literature regarding serodiscordant heterosexual couples is also provided.

Female↗
PubMed2002

Clinicians and product sales representatives: developing a relationship that works.

In today's healthcare climate, clinicians in any specialty may be required to make product selections for their practice. The skills necessary to negotiate the world of sales include information about how sales relationships are conducted, product evaluations, negotiation management, and time management. Because these skills are not taught in traditional healthcare training programs, clinicians often learn these skills through trial and error. Credible and resourceful clinical experts have current information and a working knowledge about products that are available for patients. An excellent resource for this information is the product sales representative. Literature providing information for clinicians on how to establish and maintain productive relationships with medical product representatives is scarce. This article will explain what issues to address in discussions and negotiations with product representatives. Common pitfalls that often result from not understanding the agenda of the sales representative are identified. By employing the suggested strategies, a mutually beneficial relationship can be fostered.

Attitude of Health Personnel↗
PubMedDate not supplied

[Therapeutic education of the diabetic patient].

Therapeutic education is a patient centred approach focused on patients' needs, values and strategies. It allows not only to increase patients' knowledge and skills on the disease, but also on their treatments. It brings a better quality of life, an increased therapeutic compliance, and decreases complications. The most difficult part of therapeutic education occurs when patients must change their behaviour. Motivational interviewing techniques are of great support and allow to prepare and support patients in "step by step" progressive changes. It is essential to work on resistance to change. The ambivalence in the choice of a new lifestyle must be measured, discussed and negotiate. Patients become partners and health care providers become coaches. To negotiate objectives must allow patients to choose their own strategies which should cost them minimum psychological efforts and bring them maximum benefits. The efficacy of therapeutic education has not to be proved any more: 80% less of amputations at 10 years in diabetic patients, 50% of stable body weight after weight loss at 5 years, etc. In conclusion, therapeutic education is part of a humanist medicine centred on patients which allow them to take care of their own treatment, in order to improve their quality of life, therapeutic compliance and potential complications. The health care providers teach, train, negotiate, motivate and accompany their patients in the long-term follow-up of their diseases.

Diabetes Complications↗
PubMed2005

Integrated management of natural resources: dealing with ambiguous issues, multiple actors and diverging frames.

Uncertainty is an increasingly important concern when trying to manage complex systems of interrelated natural resources. Scientific knowledge or necessary information may be lacking or incomplete. Additionally, the multiple and interdependent users of those resources may diverge in defining what really is at stake. When they frame issues in very different ways, ambiguity results, i.e., the existence of two or more equally plausible interpretation possibilities. Environmental management in these conditions implies a shift in attention from solving clearly delineated problems to continuous negotiating and tuning between different actors and expertise domains. This requires dealing with the frame differences in a reciprocal way by mutually acknowledging frames and connecting them. Some or all parties will have to revise, enlarge or reframe the way they relate to the issues and to each other, in order to support mutual understanding and common action. The contribution of experts does not consist then in providing total predictability nor in predefining issues and solutions, but in supporting a joint learning and negotiation process among different actors and in feeding this process with relevant information. Behavioural simulations may play an important function to stimulate multi-actor learning and negotiation processes.

Agriculture↗
PubMed1991

HCFA pilot project may bolster hospital-physician collaboration.

A new HCFA pilot project will probe the feasibility and cost-effectiveness of paying hospitals and physicians one negotiated package fee for coronary artery bypass surgery. If successful, the pilot may be expanded to other procedures, ultimately forcing hospitals and physicians to seek new avenues of negotiation to determine how to split the lump-sum payments. Find out how the hospital executives in this project negotiated with their physicians.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

Psychiatry and the irrational: does our scientific world view interfere with the adaptation of psychotics?

Perhaps even more strongly than others in our contemporary Western world, psychiatrists cling to an exceptionally rigid scientific world view. When psychotic patients speak of such matters as their experiences with spirits or of being possessed or of their preoccupations with meaningful coincidences, psychiatrists discount their views as mere psychotic delusions. We suggest that psychiatrists should deal with their patient's attempts at explaining their symptoms by negotiation and compromise, just as any other physician would do when confronted with patient explanations for symptoms which do not coincide with the tenets of scientific medicine. Rather than relegating the psychotic to a meaning-vacuum by dismissing his or her explanations as totally false and non-negotiable, the therapist should help patients find meaning by linking their views and experiences to those of important thinkers within Western cultures. Almost all elements of psychotic thought including beliefs in disembodied spirits, synchronicity (meaningful coincidences), and the possibility of non-material, actions-at-a-distance can be found among respected Western philosophers, psychiatrists, religious leaders and quantum physicists. An example of the world view of a psychotic patient is presented in which a variety of idiosyncratic beliefs are described including convictions of the reality of synchronicity. We demonstrate that highly similar synchronicity beliefs have been entertained by many major Western intellectuals. We contend that on this basis and along with negotiation and compromise, a therapeutic alliance can be established which may provide a measure of symptom relief as well as improvements in rehabilitation potential.

Cultural Characteristics↗
PubMed1980

The ins and outs of collective bargaining.

Negotiation of a collective bargaining agreement requires knowledge and preparation. This article outlines considerations and strategies for nursing administrators who are about to participate in labor negotiations. A "how-to" focus is presented by the author, an attorney who represents major hospitals in labor negotiations.

Collective Bargaining↗
PubMed1993

Legal considerations in managed care contracting.

Managed health care systems are created primarily through contracting. Although contracts with managed care organizations, such as health maintenance organizations, are often presented to providers as non-negotiable, this chapter discusses basic contract terms that are frequently negotiated by the parties, including key contract definitions, compensation, term and termination, and "boilerplate" provisions. The chapter also emphasizes the need for contracting parties to conduct precontracting due diligence and to comply with applicable antitrust laws in negotiating contracts with groups of independent providers.

Contract Services↗
PubMed1993

Sustaining safe sex: a longitudinal study of a sample of homosexual men.

OBJECTIVE: TO assess the maintenance of safe sexual practice. (We use the term 'safe' sex throughout the paper, since 'safe' is the term adopted by the Australian National Committee on AIDS). DESIGN: Maintenance was assessed by comparing sexual behaviour with both regular and casual partners reported in a 1986/1987 survey (time 1) with behaviour reported in a second survey in 1991 (time 2). METHOD: The 145 homosexually active participants were a non-clinical sample recruited in 1986/1987 by advertisement and followed-up in 1991. A structured questionnaire was administered at both times. Items included questions about the nature of the men's sexual relationships and their sexual practices. RESULTS: Our findings indicate that the majority of men had sustained safe sex practices. HIV prevention strategies adopted included condom use, avoidance of anal intercourse and negotiated safety (i.e., the negotiated practice of unprotected anal intercourse within regular partnerships of concordant serostatus). CONCLUSIONS: Negotiated safety is not the same as relapse.

AIDS Serodiagnosis↗
PubMed1997

Predicting children's friendship status from their dyadic interaction in structured situations of potential conflict.

Dyads of 8-year-old friends identified by sociometric friendship nominations were followed through the end of the school year to determine if they remained friends. These dyads as well as a control group of nonfriends were observed while participating in two structured tasks designed to stimulate real life social situations of potential conflict. When negotiating the sharing of an object, friends made more proposals than nonfriends, spent more time negotiating, and compromised more in making their counterproposals. Compared with dyads in which the friendship did not continue through the end of the school year, dyads of continuing friends exhibited greater sensitivity in their negotiations. During a fast-paced, competitive game, friends engaged in more competitive behavior and followed the rules more closely than did nonfriends. However, behavior in this game was unrelated to the continuation of friendship.

Child↗
PubMed1997

The comforting interaction: developing a model of nurse-patient relationship.

In this article we argue that the separate literatures on the nurse-patient interaction and the nurse-patient relationship artificially fragment a unified process, and a model incorporating both interaction and relationship is critically needed. The Comforting Interaction-Relationship Model, in which the nurse-patient interaction is proposed as a means for the nurse and the patient to negotiate and establish a desired therapeutic relationship is presented. Nursing actions are described as three interrelated levels: 1) comforting strategies, or separate discrete actions which together form nurses' styles of care, 2) styles of care, or sets of comforting strategies, and 3) patterns of relating, or normative, professional behaviors. These three processes are provided in response to patient signals of distress, indices of discomfort, and patterns of relating that form patient actions. It is through this interaction of nursing actions and patient actions that the nurse-patient relationship is negotiated. This model is patient-led, dynamic, interactive, and context dependent. Even though the model is driven by the patient's behavioral state, actions, and reactions, both the nurse and the patient maintain control--the nurse selects the strategy or style to be used, and the patient, in negotiating, relinquishing, and accepting care, maintains control. Suggestions for future research are presented.

Disease↗
PubMedDate not supplied

Haggling for a patent: what a government would have to pay for prescription drug patents.

In previous papers (Guell, R. and Fischbaum, M. The Milbank Quarterly 1995; 73: 2 and Applied Economics letters in press), we established that the allocative inefficiency in the prescription drug industry is so pervasive that some remedy is warranted. In the first paper, we estimated a lower bound on this inefficiency at approximately $3 billion, with an upper bound of approximately $30 billion; all on total industry sales of approximately $50 billion. In the second paper, on a narrower set of drugs for which sales were $8 billion, we more precisely estimated this dead weight loss to be $5 billion. From this we showed that a system could exist whereby a government would purchase a drug patent from a willing seller, freely distribute it and reap significant efficiency benefits. In those papers we considered the possibility that the innovating firm would not want to relinquish the patent, but we assumed that they would be indifferent between being paid the expected net present value of future monopoly profits and reaping those uncertain profits over time. While that may be the case, a more likely scenario would be that a negotiation would take place. In the current paper I show the bargaining range that would exist under different risk preference assumptions and show that this range widens as each side becomes more risk averse and narrows if the government threatens to use its power of eminent domain. Lastly, I acknowledge the risk of firms "capturing' the government agents doing the negotiation. To conclude, I present the circumstances under which the proposed agency would likely improve societal welfare and contrast that with the circumstances where the presently inefficient system would be made more so by government intervention.

Costs and Cost Analysis↗