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.

No One Was Turned Away is a book about the importance of public hospitals to New York City. At a time when less and less value seems to be placed on public institutions, argues author Sandra Opdycke, it is both useful and prudent to consider what this particular set of public institutions has meant to this particular city over the last hundred years, and to ponder what its loss might mean as well. Opdycke suggests that if these public hospitals close or convert to private management--as is currently being discussed--then a vital element of the civic life of New York City will be irretrievably lost. The story is told primarily through the history of Bellevue Hospital, the largest public hospital in the city and the oldest in the nation. Following Bellevue through the twentieth century, Opdycke meticulously charts the fluctuating fortunes of the city's public hospital system. Readers will learn how medical technology, urban politics, changing immigration patterns, economic booms and busts, labor unions, health insurance, Medicaid, and managed care have interacted to shape both the social and professional environments of New York's public hospitals. Having entered the twentieth century with high hopes for a grand expansion, Bellevue now faces financial and political pressures so acute that its very future is in doubt. In order to give context to the Bellevue experience, Opdycke also tracks the history of a private facility over the same century: New York Hospital. By noting the points at which the paths of these two mighty institutions have overlapped--as well as the ways in which they have diverged--this book clearly and persuasively highlights the significance of public hospitals to the city. No One Was Turned Away shows that private facilities like New York Hospital have generally provided superb care for their patients, but that in every era they have also excluded certain groups. This exclusion has occurred for various reasons, such as patients' diagnoses, their social characteristics, behavior, or financial status--or simply because of a lack of unoccupied beds. Fortunately, however, year in and year out, Bellevue and its fellow public facilities have acted as the city's medical safety net. Opdycke's book maintains that public hospitals will be as essential in the future as they have been in the past. This is a thoughtful and well-written study that will appeal to anyone interested in the history of medicine, public policy, urban affairs, or the City of New York.

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.

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.

For seasoned professionals as well as students, A History of Public Health is visionary and essential reading.

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.