The management specialist in effective pediatric ambulatory care

THE concept of comprehensive medical care can be viewed as a mandate and a goal that challenges health personnel to alter traditional ways of delivering health services, and to devise new modes of delivery so that quality care becomes a reality. There is ample evidence that health services for children are less than adequate. This can be demonstrated most dramatically among families of low socioeconomic status, but it is not limited to that group. The deficit is not in scientific knowledge, but in our capacity and willingness to translate this knowledge into effective care. Numerous studies have shown that available health care is often poorly utilized; even when it is utilized, it is rare to find the medical recommendations completed.'7 The task, then, is to identify where this failure occurs, and to intervene so that families are helped to get the maximum benefit from health services. Traditional medical care has concerned itself with reaching the proper diagnosis and prescribing the proper treatment. The task of fully implementing these prescriptions, which may be called management, is not sufficiently recognized as requiring special skill and attention. We realize that many health personnel in present ambulatory settings are already involved in management activities. The services of the physician, clinic nurse, public health nurse, and social worker do contribute to the management process. Our concern is that these services are not coordinated in planning and execution, and that the responsibility for management is so divided as to be ineffective. It is to this crucial area that we have directed our studies. Three basic assumptions underly our investigations: (1) the average patient and family have common difficulties in performing medical care, and this frequently results in a significant loss of medical effectiveness; (2) medical effectiveness can be improved by routine investigation of individual family needs before failure of management has occurred, and this knowledge can be used to plan individualized care; (3) management of care should be regarded as