Traces the development of the sanitary and health problems of New York City from earliest Dutch times to the culmination of a nineteenth-century reform movement that produced the Metropolitan Health Act of 1866, the forerunner of the present New York City Department of Health. Professor Duffy shows the city's transition from a clean and healthy colonial settlement to an epidemic-ridden community in the eighteenth century, as the city outgrew its health and sanitation facilities. He describes the slow growth of a demand for adequate health laws in the mid-nineteenth century, leading to the establishment of the first permanent health agency in 1866.
Lean Behavioral Health: The Kings County Hospital Story is the first lean book that focuses entirely on behavioral health. Using the principles of the Toyota Production System, or lean, the contributors in this groundbreaking volume share their experience in transforming a major safety net public hospital after a tragic and internationally publicized event. As the largest municipal hospital system in the United States, the New York City Health & Hospitals Corporation adopted lean as the transformational approach for all of its hospitals and clinics. Kings County Hospital Center, one of the largest providers of behavioral health care in the country, continues on its transformational journey utilizing lean's techniques. While not every event was fully successful, most were and every event, including failures, increased the knowledge base about how to continually improve quality and safety. Having made major changes, Kings County Hospital Center is now recognized as a center for transformation and quality receiving high marks from oversight agencies. This volume begins by describing the basic principles of the lean approach-adding value, eliminating waste, and tapping the organization's line staff to create and sustain dramatic change. An overview of the use of lean from a quality improvement perspective follows. Lean tools are applied to many services that comprise the behavioral health value stream and these stories are highlighted. The experts in identifying waste and adding value are the line staff whose voices are captured in the clinical chapters. Insights learned by event participants are emphasized as teaching points to provide context for what has worked or has not worked at Kings County Hospital Center. While the burning platform at Kings County Hospital Center was white hot and while the Department of Justice scrutinized its quality of patient care, the application of lean methods and tools has transformed the hospital into a potential model for behavioral health programs facing the challenges of the present healthcare environment. It is a must-have story for clinicians, administrators and other leaders in the mental health field devoted to improving quality and safety at their hospitals and clinics.
Europe's "Black Death" contributed to the rise of nation states, mercantile economies, and even the Reformation. Will the AIDS epidemic have similar dramatic effects on the social and political landscape of the twenty-first century? This readable volume looks at the impact of AIDS since its emergence and suggests its effects in the next decade, when a million or more Americans will likely die of the disease. The Social Impact of AIDS in the United States addresses some of the most sensitive and controversial issues in the public debate over AIDS. This landmark book explores how AIDS has affected fundamental policies and practices in our major institutions, examining: How America's major religious organizations have dealt with sometimes conflicting values: the imperative of care for the sick versus traditional views of homosexuality and drug use. Hotly debated public health measures, such as HIV antibody testing and screening, tracing of sexual contacts, and quarantine. The potential risk of HIV infection to and from health care workers. How AIDS activists have brought about major change in the way new drugs are brought to the marketplace. The impact of AIDS on community-based organizations, from volunteers caring for individuals to the highly political ACT-UP organization. Coping with HIV infection in prisons. Two case studies shed light on HIV and the family relationship. One reports on some efforts to gain legal recognition for nonmarital relationships, and the other examines foster care programs for newborns with the HIV virus. A case study of New York City details how selected institutions interact to give what may be a picture of AIDS in the future. This clear and comprehensive presentation will be of interest to anyone concerned about AIDS and its impact on the country: health professionals, sociologists, psychologists, advocates for at-risk populations, and interested individuals.
America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.
This book is the first available practical manual on the open abdomen. Practicing physicians, surgeons, anesthesiologists, nurses, and physiotherapists will find in it a ready source of information on all aspects of open abdomen management in a wide variety of settings. The coverage includes, for example, the open abdomen in trauma, intra-abdominal sepsis, and acute pancreatitis, step-by-step descriptions of different techniques with the aid of high-quality color figures, guidance on potential complications and their management, and features of management in different age groups. The book contents illustrate the most recent innovations and drawing upon a thorough and up-to-date literature review. Useful tips and tricks are highlighted, and the book is designed to support in daily decision making. The authors include worldwide opinion leaders in the field, guaranteeing the high scientific value of the content.
Introduction -- The beginnings of homelessness policy under Koch -- The development of homelessness policy under Koch -- Homelessness policy under Dinkins -- Homelessness policy under Giuliani -- Homelessness policy under Bloomberg -- Homelessness policy under De Blasio -- Conclusion.
From a Pulitzer Prize-winning historian comes a riveting history of New York's iconic public hospital that charts the turbulent rise of American medicine. Bellevue Hospital, on New York City's East Side, occupies a colorful and horrifying place in the public imagination: a den of mangled crime victims, vicious psychopaths, assorted derelicts, lunatics, and exotic-disease sufferers. In its two and a half centuries of service, there was hardly an epidemic or social catastrophe—or groundbreaking scientific advance—that did not touch Bellevue. David Oshinsky, whose last book, Polio: An American Story, was awarded a Pulitzer Prize, chronicles the history of America's oldest hospital and in so doing also charts the rise of New York to the nation's preeminent city, the path of American medicine from butchery and quackery to a professional and scientific endeavor, and the growth of a civic institution. From its origins in 1738 as an almshouse and pesthouse, Bellevue today is a revered public hospital bringing first-class care to anyone in need. With its diverse, ailing, and unprotesting patient population, the hospital was a natural laboratory for the nation's first clinical research. It treated tens of thousands of Civil War soldiers, launched the first civilian ambulance corps and the first nursing school for women, pioneered medical photography and psychiatric treatment, and spurred New York City to establish the country's first official Board of Health. As medical technology advanced, "voluntary" hospitals began to seek out patients willing to pay for their care. For charity cases, it was left to Bellevue to fill the void. The latter decades of the twentieth century brought rampant crime, drug addiction, and homelessness to the nation's struggling cities—problems that called a public hospital's very survival into question. It took the AIDS crisis to cement Bellevue's enduring place as New York's ultimate safety net, the iconic hospital of last resort. Lively, page-turning, fascinating, Bellevue is essential American history.
A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 "This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems. In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast? Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.
