Finishes and furnishings: considerations for critical care environments.

When selecting finishes and furnishings within a critical care unit, multiple factors can ultimately affect patient outcomes, impact costs, and contribute to operational efficiencies. First, consider the culture of the regional location, operations of the specific facility, and the recent focus on patient-centered care. The intention is to create an appropriate familiarity and comfort level with the environment for the patient and family. Second, safety and infection control are of utmost concern, particularly for the critical care patient with limited mobility. The planning and design team must be acutely aware of the regulations and guidelines of various governing agencies, local codes, and best design practices that can directly affect choices of finishes and furnishings. Flooring, wall, and window finishes, lighting, art and color, as well as furniture and fabric selection should be considered. Issues to address include maintenance, durability, sustainability, infection control, aesthetics, safety, wayfinding, and acoustics. Balancing these issues with comfort, patient and staff satisfaction, accommodations for an aging population, increasing bariatric needs, efficient operations, and avoidance of "never events" requires team collaboration and communication, knowledge of product advancements, a keen awareness of how environmental stimuli are perceived, and utilization of the best available evidence to make informed design decisions.

Health care providers and facilities issue brief: certificate of need: year end report-2004.

At one time, every state was required by the federal government to have a certificate of need (CON) program. The process was intended to keep down costs associated with the construction of new health facilities in the state, and prevent over development. When the federal requirement was lifted, however, a number of states did away with their programs. Some later restored them in some form, and many have kept their programs alive for years, requiring a governmental seal of approval for building new facilities such as hospitals and long-term care facilities or for acquiring major medical equipment.

Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations.

After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existing federal regulations focus primarily on scene response and not on issues specific to health care facility decontamination practices. Review of existing databases, relevant published literature, and individual case reports reveal some provider health risks, especially when the exposure involves organophosphate agents. However, reported risks from secondary exposure to contaminated patients at health care facilities are low. These risks should be adequately addressed with Level C personal protective equipment, including air-purifying respirator technologies, unless the facility determines that specific local threats require increased levels of protection.

Providers issue brief: certificate of need: year end report-2003.

At one time, every state was required by the federal government to have a certificate of need (CON) program. The process was intended to keep down costs associated with the construction of new health facilities in the state, and prevent over development. When the federal requirement was lifted, however, a number of states did away with their programs. Some later restored them in some form, and many have kept their programs alive for years, requiring a governmental seal of approval for building new facilities such as hospitals and long-term care facilities or for acquiring major medical equipment.

Providers issue brief: certificate of need.

At one time, every state was required by the federal government to have a certificate of need (CON) program. The process was intended to keep down costs associated with the construction of new health facilities in the state, and prevent overdevelopment. When the federal requirement was lifted, however, a number of states did away with their programs. Some later restored it in some form, and many have kept their programs alive for years, requiring a governmental seal of approval for building new facilities such as hospitals and long-term care facilities or for acquiring major medical equipment.

Public and private perspectives on hospital conversions: proposed MUSC-Columbia/HCA "partnership".

Conversion has been defined as "any type of transaction that results in the shift of all or a substantial portion of the assets of nonprofit health care organizations to for-profit use" (Claxton and Colleagues, 1997:10-11). Not surprisingly, efforts at such conversion create political conflict and opposition within communities with some groups supporting and others opposing the intended conversion. This study looks at a particular effort at conversion: the proposed "partnership" between three hospitals of the Medical University of South Carolina (MUSC) and Columbia/HCA, the largest for-profit health services network in the U.S. Beginning in 1995, the three-year effort (now at an impasse) has drawn local and state policy-markers into increasing controversy and acrimony. Beyond the details, the episode also raises fundamental issues about the nature of public health care and the extent to which we can convert public health facilities to private control while preserving their essential public missions.

Nonprofit to for-profit hospital transactions: all roads lead to the attorney general's office.

As more and more hospitals travel the route from nonprofit to for-profit status, state attorneys general are increasingly playing the role of "traffic cop" along this rough and often contentious road. A better understanding of the attorney general's office and greater rapport with its officers is the "order of the day" for officers and directors looking to orchestrate such a transition.

Crossroads in hospital conversions--a survey of nonprofit hospital conversion legislation.

Mr. Donohue discusses the history of nonprofit hospital conversions in the United States and analyzes the National Association of Attorneys General's Model Conversion Act. In addition, this article surveys conversion-related legislation of 17 states plus the District of Columbia. Finally, Mr. Donohue recommends the implementation of adequate safeguards to insure that nonprofit hospital assets are maximized and to insure that the subsequent use of conversion proceeds continues to fulfill the original charitable mission of the nonprofit hospital.

Nonprofit conversion: theory, evidence, and state policy options.

OBJECTIVE: To describe the contributions of nonprofit hospitals and health plans to healthcare markets and to analyze state policy options with regard to the conversion of nonprofits to for-profit status. DATA SOURCES/STUDY SETTING: Secondary national and state data from a variety of sources, 1980-present. STUDY DESIGN: Policy analysis. DATA COLLECTION/EXTRACTION METHODS: Development of a conceptual economic framework; analysis of empirical, legal, and theoretical literature; and review of statutes, rules, and court decisions. PRINCIPAL FINDINGS: Three main rationales support special status for nonprofits, especially hospitals: charity care, other community benefits, and consumer protection. The main social rationale for for-profits is their incentives for better efficiency. There are reasons to expect that nonprofit and for-profit goals differ; however, measured differences in community hospital cost, prices, and quality between nonprofit and for-profit hospitals are undetectable or inconclusive. Nonprofit hospitals do provide more uncompensated care than for-profit hospitals. Similarities between nonprofit and for-profit hospitals may exist because nonprofits may set norms that for-profits follow to some degree. States have substantial power and discretion in overseeing nonprofit conversions. Some have regularized oversight through new legislation that constrains, but does not eliminate, state officials' discretion. These statutes may be deferential to converting entities and their buyers or may be very restrictive of them. CONCLUSIONS: Overseeing the appropriate disposition of nonprofit assets in individual conversions is extremely important. States should also monitor local market conditions through community benefits assessments and other data collection, however, to accurately assess (and possibly redress) what is lost or gained from conversion. Local market conditions are likely more important in determining hospital behavior than ownership form. Potentially, a mix of for-profit and nonprofit hospitals in a given market may improve market performance due to constraints the two ownership types may exercise over one another. If nonprofits disappear, the states may need to maintain quality and access norms through regulation.