Transplanting an organization: how does culture matter.

Cultural differences are often cited as a major obstacle to the successful transition/integration into new situations of organizations. In this contribution, the author details the changing cultural factors impacting the operation and move of the Menninger Clinic from autonomous status to an affiliation with and first year of operation in the Baylor College of Medicine and Methodist Hospital Health Care System. Both functional and dysfunctional consequences are outlined, and specific examples illustrate how the organization's leadership and staff struggled to adapt during this complicated process.

Psychiatric and sociotherapeutic perspectives on the difficult-to-treat patient.

IN SPITE of substantial advances in the effective treatment of psychiatric illness, there is a growing perception among clinicians that those patients who present for inpatient care are more difficult to treat. The authors review the history of contributions about the patient who is difficult to treat and propose a new typology for characterizing acute, severe and complex dimensions of this cohort. They hypothesize first that patient difficulty cannot be conceptualized independently from the treatment context; and second, that treatment complexity leads to a specific strain between the on- and off-floor treatment staff, thus enhancing the perception of difficulty.

Efforts to preserve the mind in contemporary hospital treatment.

The author proposes a restructured and refocused extended length-of-stay inpatient treatment program designed to maintain an emphasis on the whole person. He suggests that the conditions for implementing a genuine biopsychosocial approach to treatment are now more possible than ever before. Note is made of the evolution of the new structures, the change in treatment constraints, and the type of patient currently presenting for inpatient treatment.

Leadership and restructured roles: the evolving inpatient treatment team.

The author discusses the impact on unit leadership of the dramatic changes in contemporary inpatient treatment. In addition to substantial changes in the role of the unit chief, there are concomitant changes in the relationship between the organizers and the providers of care. The author proposes a model for hospital care that reshapes and empowers the multidisciplinary team to maintain the quality of care and narrow the gap between leaders and clinicians.