By Milton Greenblatt

When the thirteen founders of the yank Psychiatric organization got here jointly in 1844, hospitals have been small, and the executive points of a superinten­ dent's task have been particularly minor in comparison with their measurement and complexity at the present time. because the flip of the century, administration-the paintings and the sci­ ence-has develop into a area of expertise of serious value, fairly in substantial company and govt. company acknowledges totally that the good fortune of organizational endeavors relies to a superb volume at the skills and energies of best lead­ ers. for this reason, spends large sums of cash to coach promising younger executives and provides beneficiant salaries and merits to appeal to them. somebody who desires to put money into a enterprise first asks: "Who manages this association, and is that this administration aggressive in modern marketplace?" even supposing healthiness is at the present time an exceptional undefined, emphasis at the govt position has lagged in the back of that during the overall enterprise box. In psychological overall healthiness circles, the robust emphasis on one-to-one remedy has not on time a whole appreciation of the effect of association in line with se on sufferer care and therapy. but there 1 are actually many indicators of switch. The popularization of behavioral technological know-how and the increase of social and group psychiatry have introduced organizational con­ siderations ahead. we're more and more considering the human facet of firm, with employee pride, staff dynamics, and organizational morale. different flags were unfurled.

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The care and treatment of the mentally ill is a reflection of their economic, political, and humanitarian status in the body politic at any given time; relatively sudden, large pendulum swings can erase gains made over decades. Unlike the national economy, no regulatory agency like the Federal Reserve Board exists to iron out dangerous fluctuations. Unfortunately, the care of the 10 Chapter 1 mentally ill appears to be more susceptible to social, political, and economic shifts than other branches of medicine.

Cambridge, Published for Commonwealth Fund by Harvard University Press, 1958 19. Wells FL, Greenblatt M, Hyde RW: As the Psychiatric Aide Sees His Work and Problems. Genetic Psychology Monographs 53:3-73, 1956 20. Cumming J, Cumming E: The Locus of Power in the Large Mental Hospital. Psychiatry 19:7785, 1956 2 Toward Scientific Management The science and art of management have developed with staggering speed over the last 50 years, although leadership itself has been important ever since people have come together in groups, divided a task in achieving some objective or goal, manufactured a commodity, or lived under some system of government.

Of the 81 community hospitals that closed in 1988, 41 were not-for-profit facilities, 31 were for-profit facilities, and 9 were government owned. In addition, 21 specialty hospitals in 15 states closed in that same year. The principal reasons given were inadequate Medicare payments, loss of physicians, and assorted other economic problems. Where hospital beds became vacant, employees were laid off; perhaps a few were rehired when occupancy increased. To survive, hospitals paid more attention to marketing, public relations, and fund-raising (see "The New Trinity" later in this chapter).

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