Chapter 6 - Program Administration

1-6.1  PURPOSE

This chapter sets forth policies and procedures related to various matters affecting program administration.

1-6.2  Monthly Narrative Report.

1. General.  Headquarters requires current information on all. Area activities which may have a significant effect on Headquarters in relations with other agencies and groups including the public. Statistical reports of activities are not sufficient, as there are many types of activities and issues which cannot be reported statistically.  Consequently, it is necessary that there be a regular medium of communication from the Area and Field Offices to Headquarters, by which each Area Director may keep Headquarters informed of significant activities, events projects, public relations problems, and other matters of interest within the Area.  The Monthly Narrative Report is the Area Director's report to the Service Director and his staff, and is the only single report from the field which is circulated to all offices and branches.  However, it is not intended to serve as a newsletter nor as an initial request for immediate action or assistance.  The report should highlight those events, activities, operations and issues occurring in the area which may be of importance and significance to the Headquarters staff.

2. Subject Matter.  Following are examples of types of information which may be of significance to Headquarters.

   1. Significant program changes and trends.

   2. Accomplishments which reflect important steps toward achieving particular program objectives.

   3. Special surveys, studies, research and other projects planned, initiated, or completed by the Indian Health Service or other agencies.

   4. Problems which have arisen involving other offices or agencies.

   5. Area problems, especially those in which Headquarters assistance is needed.  (Potential trouble spots and/or irregularities should not be delayed for inclusion in the Monthly Narrative Report but should be reported separately or called into Headquarters by telephone or wire, if urgent.)

   6. Visits, other than by Indian Health Service personnel, which may be of significance to Headquarters.  (Report expected visits only if it is essential that Headquarters be informed.)

   7. Important conferences attended, specifying program implications.  Examples:  Conferences with Indian tribal representatives or groups, state or local health officers, citizens groups.

   8. Significant public or press reactions to the program, whether favorable or unfavorable.

3. Due Date.  Fifty copies of each report shall be mailed to Headquarters no later than the 5th working day following the end of each month.

1-6.3  Reporting of Potential Trouble Spots.

1. Policy.  Reporting procedures have been published in various Indian Health Service issuances, in Personal Property Management Manual Guide No. HEW h-l, in HEW Personal Manual Chapter C-2, Guide 5, in pertinent titles of the GAO Policy and Procedures Manual, and in other sources relating to incidents involving Federal employees, beneficiaries, funds, and property.  This is to emphasize the need for reporting promptly to Headquarters those incidents which can be considered potential trouble spots and which may be brought to the attention of the public or the Congress.  It is most beneficial for Headquarters, Indian Health Service to be aware of such potential problems as soon as they are known by Indian Health Service officials. This is particularly true in areas where conditions may be sensitive due to possible adverse effect on employee morale, presence of discontented employees, situations where there has been a series of unfavorable incidents occurring, etc., as related to the urgency and importance of the incident.

2. Responsibility.  Area Directors are responsible for notifying Headquarters. Officers in Charge at all facilities are responsible for notifying promptly the Area Director.

1-6.4  Incident Report - HSA 123 (Rev. 3/74, Clinical Record.  (See Exhibit 1-6.4)

Preparation of Report Form.  Incidents involving either inpatients or outpatients in Indian Health Service medical facilities, such as: patients falling, wrong medication received, deleterious result of procedures, burns, etc., shall be investigated and recorded on the Incident Report form (HSA-123).  The form should be completed by the individuals as indicated following the normal supervisory channels.  No comments are necessary for those positions shown on the form which are not staffed.

1. The Incident Report form, when completed, shall be signed by the examining physician and filed in the Service Unit’s Director of Nurses' files.  At the same time, a note should be entered in the patient's chart summarizing the incident, particularly as it may relate to the patient’s health, treatment, or potential complications which the health care team should be aware of.  A Standard Form 92, Supervisor’s Report of Accident, shall be prepared at the same time and forwarded to the SUD’s safety representative to be used for accident reporting purposes.  Refer also to Part 1, 3-4.4C3., of the Indian Health Manual, regarding incident reports.

2. The “Report of Unit Physician" section, when such physician is also the SUD or Officer in Charge, will include findings, treatment and action taken to prevent a recurrence of the incident.

3. The Comments and Report of Head Nurse” section of the report will include the names of employees on duty responsible for the patient, where and what they were doing at the time of the incident, and the number of patients for whom the employees are responsible.

   The HSA 123, Incident Report form, bears nursing titles.  It is recognized that some incidents occur in parts of the hospital where nurses are not involved.  The observer or participant in such an incident should report in Block 1 of Page 1 and the supervisor or supervisors of the observer or participant should complete as many sections as necessary on Page 2 and should show their titles by lining out the nursing titles on the form.

   Types of incidents to be records are listed below:

   Patient falling -- out of bed; while walking; out of chair, etc.

   Wrong medication -- (whether or not medicine caused harm.)

   Children -- fighting, falling, etc., when cuts, bruises, or other injury results.

   Alteration between patients, patient and employee, or visitor and patient.

   Deleterious result of procedures -- broken needle, etc.

   Burns -- regardless of cause.

   Food poisoning -- occurring while patient is in hospital.

   Severe adverse reactions to serums, food.

1-6.6  Volunteer Services.  This section provides guidelines for establishing and conducting a volunteer program in Indian Health Service hospitals and health centers in accordance with Public Law 90-174, Section 223, PHS Act (42 U.S.C.217b).  Volunteer services are services performed by individuals (hereafter called volunteers) whose services have been offered to the Government and accepted under a formal agreement on a without compensation basis for use in the operation of a health care facility or in the provision of health care.

1. Policy.

   1. It is the Indian Health Service policy to permit and promote utilization of volunteer workers to aid Indian patients and to supplement the services of personnel already on duty.

   2. Volunteer workers may be accepted from appropriate group voluntary agencies or as one or more interested individuals.

   3. The volunteer services of medical, para-medical, and administrative, technical, skilled and semi-skilled personnel may be accepted in addition to those voluntary services which have been rendered previously.

   4. Every volunteer, individual or group, shall perform duties under the supervision of a Government employee.

   5. A formal agreement should be made with each voluntary agency or each individual stating the length of the voluntary assignment and stating the scope of responsibilities of the volunteer or volunteers.

   6. In cases where an individual offers voluntary services to Headquarters specifying the particular area where he wishes to work, the application will be forwarded to the Area Director concerned who may make final commitment or have such commitment made by the officer in charge of the service unit where services will be used.

2. Authority.

   1. Authority to establish volunteer service programs and accept volunteer services for use in the operation of a health care facility or the provision of health care has been delegated to the Director, Indian Health Service.

   2. This authority has been redelegated to the Area Directors, Deputy Directors and Service Unit Directors.  This delegated authority should be used to the utmost.

3. Purpose and Benefits of a Volunteer Program.

   1. Patients.  A volunteer program brings supportive non-professional services to patients. Such services are an integral part of a total medical care program and are over and above that which the regular staff can usually provide.  Volunteers do not take the place of paid employees but add an important function to services which otherwise might be omitted.  All services of hospitals and clinics center about the patient and his family.  An interested and qualified volunteer adds to these over-all services.

   2. Volunteers.  Since Indians would make up the large portion of volunteers in Indian Health Service hospitals and health centers, the objective of IHS to raise the level of Indian health would be advanced through opportunity for the volunteer to: Learn and promote general health practice and teaching, understand child growth and development, interpret medical service learned in the IHS program to the Indian community, advance PHS public relations, and interpret Indian cultural practices for incorporation in the total medical care plan.

   3. Services.  Services as used herein, is the performance of certain beneficial acts which add to the comfort of patients and contribute to the accomplishment of program objectives or projects.  Examples of appropriate volunteer activities in health or medical facilities include:

      1. Impersonal Services:  writing letters, reading and telephoning for patients; distributing books and magazines, cigarettes and toilet articles; teaching skills and hobby development; sewing; arranging for entertainment and recreation, decorating rooms, and similar activities.

      2. Personal Services:  assisting selected children in feeding themselves and guiding those who need physical adaptation in use of utensils; holding selected babies for bottle feeding, comfort, security, and "mothering;" assisting in changing well infants and teaching convalescent children how to dress; sitting with and assisting groups of children during table feeding; assisting older children and adults in activities such as feeding, walking, etc.

      3. Recreational Services:  story telling, reading, playing games, teaching play activities, playing records during naps or before meals to quiet children and to help them to be more receptive to the entire hospitalization process.

      4. Professional Services:  supplementing the services of the professional counterpart in appropriate professional activities such as medical, nursing, social service and other allied health services.

4. Services and Benefits Available to Volunteers.

   1. All volunteers, depending, on need, are eligible for the following services:  (DHEW Personnel Manual Instr. 930-2.)

      1. Volunteers are considered employees of the Federal Government for the purposes of the benefits provided by 5 U.S.C. 8101 for work related injuries or diseases.  In case of injury sustained by a volunteer while in the performance of duty, the procedures applicable to regular Government employees should be followed. (B.E.C. cases)

      2. Volunteers are covered by the tort claims provisions of Title 28, U. S. Code.

      3. Volunteers may be provided protective clothing and equipment under 5 U.S.C. 7903.

      4. Meals may be provided to volunteers without charge when scheduled assignment extends over an established meal period.

      5. In case of emergency, or when necessitated by the special nature of volunteer assignment, quarters may be furnished temporarily, if available, at no charge to the volunteer.

      6. Physical examination must be undertaken by all volunteers, for, the protection of volunteers, patients, and other employees.  These examinations may be administered within IHS facilities without charge to the individual.

      7. Emergency outpatient treatment for injuries sustained while performing assigned volunteer services will be provided volunteers.  Volunteers may also be provided temporary care and treatment in IHS facilities under the same circumstances and to the same extent such care and treatment may be provided to paid employees.

      8. A volunteer who renders service for the Federal Government at an IHS facility away from his home or regular place of business may be allowed transportation expenses and per diem under 5 U.S. C.5703 as "an individual serving without pay," in accordance with Department policy.  (See Travel Manual Chapter 6-10)

      9. Volunteers may be authorized to use Government' vehicles for official purposes in accordance with established policy.  They may also be authorized to use a private conveyance for official purposes, as provided in 5 U.S.C.5704, the Standardized Government Travel Regulations, and Department policy.  (See Travel Manual Chapter 5-20.)

5. Teen-Aged Volunteers.

   1. A teen-age volunteer service program should be considered primarily as an educational procedure and part of the hospital's total community education program.

   2. Guidelines for Teen-Age Volunteers.  The following guidelines are applicable to all volunteer workers below the age of 18 years:

      1. Health - They are required to have a physical examination and certified to be in good physical health by a physician.  The physical examination may be performed by the staff at the hospital where the teen-ager plans to participate in the volunteer workers program.

      2. Organization - They must be a member of an organization or a group recognized by the Service Unit Director.

      3. Parental Consent - They will be required to present a HOSPITAL VOLUNTEER CONSENT SLIP, signed by either parent or by a legal guardian.  The following format should be used:

      HOSPITAL VOLUNTEER CONSENT SLIP
      United States Public Health Service
      Indian Hospital
      

      ---

      Date___________

      I, (Father's printed name)_____________________ , and I (Mother's printed name)_________________, being the parents and/or legal guardians of (Volunteer's printed name) ________________Age, do hereby give permission for her or him to participate in the Hospital Volunteer Program at the USPHS Indian Hospital at _____________________. .

      Signed:  (Father's signature)___________________ Signed:  (Mother's signature) __________________

      ***********

      (A copy should be kept on permanent file by the Service Unit Director)

   3. General Standards.  A teen-age volunteer service program will fulfill its purpose only if it adheres to certain high standards which must be met both by the young volunteers and the hospital.  The following recognized standards are suggested:

      1. Each teen-age volunteer should have a regular assignment, for which the volunteer is specifically oriented and trained.

      2. The volunteer should be expected to be punctual, loyal and regular.  A trial period before final acceptance is recommended to be sure that both the hospital and the volunteer are satisfied.

      3. The amount of time which the teen-ager should be allowed to give in service to the hospital should have a minimum and a maximum limit.  The maximum should be set so as to assure that the volunteer does not become bored with the job nor too attached to it and that the volunteer service does not interfere with a balanced extra curricular activity.

      4. All teen-age volunteers should wear an identifying uniform if these are available through their organization.  Name tags might be used if they are available as they serve to give the young volunteers a sense of identity in the hospital.

      5. The Area Office should establish standards for recognition of service. Recognition is essential to the success of any volunteer service program and is especially important to the young volunteer.

      6. Assignments of teen-age volunteers should be scheduled at a time when there are sufficient professional nursing staff on duty to provide close supervision.

   4. The following standards are mandatory for the program in the Indian Health Service facilities:

      1. Teen-age volunteers will not be assigned duties which require the exercise of mature judgment or place too great a responsibility on young shoulders.

      2. Teen-age volunteers will not participate in medication and treatment of patients nor handle drugs of any kind.

      3. Teen-age volunteers will not be assigned activities in which they have direct contact with patients other than for recreational or feeding purposes and always under supervision.

      4. Teen-age volunteers will not be permitted in isolation units, dietary or food service department, maternity unit or operating and emergency rooms.

   5. Suggested Activities for Teen-Age Volunteers.  Activities should be mainly of the recreational type, such as:

      1. Interest children in games and help on play activities.

      2. Provide paper and crayolas and help children, particularly bed patients, with a drawing period.

      3. Provide children with scissors, magazines and pastes and help them make scrap books.

      4. Provide a music period, playing records, singing, etc. for children and adults.

      5. Reading, telling stories, playing cards, writing letters.

      6. Securing craft materials and teaching the children simple crafts.

      7. Feeding selected children and older persons.

   6. Supervision and Assignment. Each teen-age volunteer service worker will be assigned to a hospital staff member for supervision.  A staff member of the hospital will not have more than three teen-age volunteer workers assigned to her during any one period.  The teen-age volunteer will report to the designated staff member in accordance with the written schedule established by the Service Unit Director.

   7. Prior approval of the Area Office will be obtained by the local facility before establishing a teen-age volunteer worker program.  Each Area Office may supplement this chapter with appropriate area requirements.

   8. The booklet issued by the American Hospital Association on "Teen-age Volunteer Worker" provides helpful information on the teen-age volunteer service worker program.  Copies (60¢ per copy) can be secured from the American Hospital Association, 840 North Lake Shore Drive, Chicago, Illinois 60611.

6. Records to be Maintained.

   1. Records of actual service performed by each volunteer should be maintained by the accepting official.

   2. The maintenance of Official Personnel Folder (SF-66) or Service Record Card (SF-7) is not required.

      However, officials authorized to accept volunteer services will arrange for a copy of the offering letter, (see Exhibit Xl-6.6F) a statement of acceptance and a copy of any letter of recognition to be filed.  The acceptance statement bearing the volunteers signature is to be kept on file for the period of the volunteer's service and one year thereafter.

7. Awards and Recognition.  Officials authorized to establish volunteer service programs are responsible for developing any appropriate plans for recognizing the contributions made by volunteers.  Cash awards may not be given but certificates of service or similar forms of recognition are very desirable.