Create a report that includes the following items:
Question 1. Review the IoM’s 1999 and 2001 reports (ATTACHED).
- Compare and contrast the recommendations in these reports.
- Evaluate the outcomes of their implementation and assess their impact on healthcare quality improvement (familiarize yourself with Quality Improvement points – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-).
- Ascertain the consequences of not using HIT and frame your recommendations for improvement of healthcare quality using HIT?
Question 2. HIPAA (1996) and HITECH (2009) Acts contain provisions for the protection of health information both by Covered Entities (CEs) and Business Associates (BAs).
- Compare Security Rule provisions for CEs and BAs in both Acts?
- Identify the organization responsible for monitoring its compliance by providers and explain its mode of operation. Ascertain the value of the Security Rule provisions for electronic health records.
- Finally, assess implications for noncompliance of the Security Rule provisions by healthcare organizations?
Question 3. Develop an example case that can be used in the presentations where a Chief Information Security Officer (CISO) at a local healthcare facility has not adopted any Password use policy yet.
- Delineate the role of CISO in the implementation of the password use policy.
- Offer approaches to developing a Password use policy for this organization.
Tips: Identify and discuss at least three (3) essential components of the password use policy that must be followed to securely log into the facility’s healthcare information systems. Explain which of these components is most critical and why. Ascertain implications for the organization if the policy is not followed strictly.
Question 1 & 2 should be in tabular/narrative format. Question 3 should be presented in narrative format. Please include introduction and conclusion. Title and Reference Page. All supportive evidence should be formatted in APA 7th Edition.
Question 4. You have been asked to address the following items:
Narrative Brief: To propose training methods that can work for three categories of employees: clinicians, administrators, and staff at a local healthcare facility that has just transitioned from paper-based medical record to Electronic Health Record (EHR).
- Evaluate the appropriateness of three training methods (one-to-one, workshops, computerized or web-based self-paced) for these three categories of staff (clinicians, administrators, staff).
- Assess the need for contents to be covered for training of each category of employee (keep in mind their duties and functionalities of EHR to be used).
Also propose a suitable training time of the day (morning before duty, mid-day during break, after duty hours) for training of each category of the staff.
Question 5.
PowerPoint Presentation (with presenter notes): Develop a framework for training materials development.
- Discuss your philosophy of training comprising areas of the training to be addressed for the general staff and describe a method to assess the training effectiveness (whether the learners have learned what was intended)
- Include a 5-point question-based assessment tool (e.g., Likert scale Likert Scale: What Is It and How to Use It? (thoughtco.com) for assessing the training effectiveness; and the satisfaction level (%) based on responses to be considered satisfactory.
POLICYMEDICAL™ ARTICLE
Crossing the Quality Chasm
Based on the 2001 IOM Report
PolicyMedical™ Copyrighted. All trademarks belong to their respective holders. All Rights Reserved.
An electronic version of this white paper can be found on www.policymedical.com or
www.patientsafetypeople.com
POLICYMEDICAL™ ARTICLE
[CROSSING THE QUALITY CHASM]
Automated policies are safer than manual policies.
Instinctively, many healthcare professionals would not debate this fact, but how many of them really
understand the foundations that make this a true statement?
In 2001, the Institute of Medicine (IOM) report “Crossing the Quality Chasm- A New Health System for
the 21st Century”, recommended six “aims for improvement” as part of the redesign of the American
health care system. The intent being to set forth a specific direction for policymakers, healthcare
leaders, clinicians, regulators, purchasers and others to improve healthcare.. These six aims are safety,
effectiveness, patient-centeredness, timeliness, efficiency and equity.
Is your organization seriously evaluating its current process and practices as it relates to policy and
procedure management to ensure it aligns with these aims? To figure out if your system meets or
beats the standards for the American health care system, let’s consider the IOM’s six aims as it pertains
to policy management.
PolicyMedical™ Copyrighted. All Rights Reserved.
Page 1 of 6
POLICYMEDICAL™ ARTICLE
[CROSSING THE QUALITY CHASM]
Aim #1: Healthcare must be safe.
Healthcare professionals understand the concept “first do no harm” and that it is their responsibility to
be more careful and aware of those human factors that can contribute to making errors. Performing
risk assessments, talking about failure points (FMECA), piloting changes before spreading initiatives
house-wide are all actions that healthcare professionals – most of all quality assurance professionals –
need to make a priority. As leaders in healthcare, we need to be proactive, constantly checking
progress and evaluating outcomes: what is commonly known as the cycle for improvement, or the
plan-do-check-act (PDCA) problem solving process.
How do you know if your policy management process is safe? Simple: perform a tracer activity, one of
the activities the Joint Commission performs during survey spot checks. This consists of following a
process or a patient encounter from beginning to end, observing, asking questions of staff and looking
in the charts as needed to determine compliance with standards. You may be taken by surprise that
there are blatant unsafe practices taking place in your healthcare facility.
Aim #2: Healthcare needs to focus on being effective.
It explains that healthcare should match science and not overuse or underuse available best
techniques. Look at policy management as the service being delivered. What we put in a policy affects
the outcome. We can analyze the process for effectiveness. For example, if an employee follows an
outdated clinical pathway, the old procedure will not be as effective as the one that reflects current
practice.
PolicyMedical™ Copyrighted. All Rights Reserved.
Page 2 of 6
POLICYMEDICAL™ ARTICLE
[CROSSING THE QUALITY CHASM]
Aim #3: We need to look at policy management as being “patient
centered”.
This aim is particularly relevant since policies guide how the care is delivered to the patient. Our
system needs to fix the gaps that are roadblocks to patient centricity. Having access to the most
current policy is imperative to ensuring that staff follow an informed consent process, and
simultaneously ensures that the patient is adequately involved in making decisions about their own
treatment plan. This is not only patient centric, but also a CMS and Joint Commission requirement.
During a survey, I witnessed a healthcare facility that was in an absolute mess regarding informed
consent. Surveyors requested a copy of the informed consent policy from three different managers
and they received three different copies. This incident was an eye-opener that forced management to
look into updating their policy management structure. They asked for the policy on policies, which they
did not have. Thus, they had to develop an immediate action plan to innovate their policy
management. One of their most successful implementations was to have their policies online, and
have only the most current version posted for the staff to see and comply to.
PolicyMedical™ Copyrighted. All Rights Reserved.
Page 3 of 6
POLICYMEDICAL™ ARTICLE
[CROSSING THE QUALITY CHASM]
Aim #4: The care we provide should be timely.
How much time is wasted trying to find the manual and the policy we need? How much time is spent
routing a paper policy through the system to get approval and feedback from all those it implicates?
Then we find out that the one disseminated doesn’t include all the input and that the wrong version
was given to staff. When we have to send an alert to staff rescinding the last version, we create
feelings of mistrust toward the process and lack of confidence in the quality of information.
What if an employee needed to refer to a procedural policy immediately for the patient’s procedure?
The time spent finding it means a delay in treatment – which is unsafe for the patient. In addition,
having the nurse waste his/her time looking for a policy means taking more time away from the
bedside and adds to staff dissatisfaction.
PolicyMedical™ Copyrighted. All Rights Reserved.
Page 4 of 6
POLICYMEDICAL™ ARTICLE
[CROSSING THE QUALITY CHASM]
Aim #5: Healthcare should be efficient.
Hospitals know now, more than ever, that we need to reduce waste and cost. Manual policy
management is inefficient in the sense that it eats up a hospital’s time, financial and human resources,
all of which should be devoted to direct patient care.
Aim #6: Healthcare should be equitable.
Employees should be able to work on any unit in the hospital and have the same access to the policies
that they need to do their job. There should be consistent mechanisms to inform staff of new policies
and/or changes in current policies that are relevant to them. New employees need a channel during
orientation through which they can learn about this mechanism and it should be listed on their
competency checklist. In addition, the policy process should be standardized and hardwired so that, at
any point in time, the correct procedure is provided to a surveyor or attorney upon request. Patients
should be able to come to any hospital and receive the same evidence-based care. That is dependent
on the policies, procedures and other documents caregivers rely on to deliver their care.
In light of this, where are we headed?
Automation with medication records (EMRs) and computerized physician order entry (CPOE) are the
way of the future for healthcare organizations. Likewise, document management systems for policies
will benefit your organization in minimizing the work and effort needed to align a manual system with
the six aims, in providing automatic and electronic mechanisms in store to assist the staff.
PolicyMedical™ Copyrighted. All Rights Reserved.
Page 5 of 6
POLICYMEDICAL™ ARTICLE
[CROSSING THE QUALITY CHASM]
If you are targeting a safe, successful policy management system, it will only happen if you align your
process with the six aims of healthcare safety; by becoming automated, you are well on your way to
hitting your mark!
Nicola Heslip | Policy & Patient Safety Specialist | PolicyMedical™
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Page 6 of 6
November 1999
I N S T I T U TE OF M E D I C I N E
Shaping the Future for Health
TO ERR IS HUMAN:
BUILDING A SAFER HEALTH SYSTEM
H
ealth care in the United States is not as safe as it should be–and can
be. At least 44,000 people, and perhaps as many as 98,000 people, die
in hospitals each year as a result of medical errors that could have
been prevented, according to estimates from two major studies. Even using
the lower estimate, preventable medical errors in hospitals exceed attributable
deaths to such feared threats as motor-vehicle wrecks, breast cancer, and
AIDS.
Medical errors can be defined as the failure of a planned action to be
completed as intended or the use of a wrong plan to achieve an aim. Among
the problems that commonly occur during the course of providing health care
are adverse drug events and improper transfusions, surgical injuries and
wrong-site surgery, suicides, restraint-related injuries or death, falls, burns,
pressure ulcers, and mistaken patient identities. High error rates with serious
consequences are most likely to occur in intensive care units, operating rooms,
and emergency departments.
Beyond their cost in human lives, preventable medical errors exact
other significant tolls. They have been estimated to result in total costs (in
cluding the expense of additional care necessitated by the errors, lost income
and household productivity, and disability) of between $17 billion and $29
billion per year in hospitals nationwide. Errors also are costly in terms of loss
of trust in the health care system by patients and diminished satisfaction by
both patients and health professionals. Patients who experience a long hospi
tal stay or disability as a result of errors pay with physical and psychological
discomfort. Health professionals pay with loss of morale and frustration at
not being able to provide the best care possible. Society bears the cost of er
rors as well, in terms of lost worker productivity, reduced school attendance
by children, and lower levels of population health status.
A variety of factors have contributed to the nation’s epidemic of medi
cal errors. One oft-cited problem arises from the decentralized and frag
mented nature of the health care delivery system–or “nonsystem,” to some
observers. When patients see multiple providers in different settings, none of
whom has access to complete information, it becomes easier for things to go
Errors…are costly
in terms of loss of
trust in the health
care system by pa
tients and dimin
ished satisfaction
by both patients
and health profes
sionals.
Types of Errors
Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatment or in responding to an abnormal test
Inappropriate (not indicated) care
Preventive
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up of treatment
Other
Failure of communication
Equipment failure
Other system failure
Health Care System at Odds with Itself
The Quality of Health Care in America
Committee of the Institute of Medicine
(IOM) concluded that it is not acceptable
for patients to be harmed by the health
care system that is supposed to offer healing and comfort–a system that promises,
“First, do no harm.” Helping to remedy this problem is the goal of To Err is Hu
man: Building a Safer Health System, the IOM Committee’s first report.
In this report, issued in November 1999, the committee lays out a compre
hensive strategy by which government, health care providers, industry, and con
sumers can reduce preventable medical errors. Concluding that the know-how
already exists to prevent many of these mistakes, the report sets as a minimum
goal a 50 percent reduction in errors over the next five years. In its recommenda
tions for reaching this goal, the committee strikes a balance between regulatory
and market-based initiatives, and between the roles of professionals and organi
zations.
One of the report’s main conclusions is that the majority of medical er
rors do not result from individual recklessness or the actions of a particular
group–this is not a “bad apple” problem. More commonly, errors are caused by
faulty systems, processes, and conditions that lead people to make mistakes or
fail to prevent them. For example, stocking patient-care units in hospitals with
certain full-strength drugs, even though they are toxic unless diluted, has re
sulted in deadly mistakes.
Thus, mistakes can best be prevented by designing the health system at all
levels to make it safer–to make it harder for people to do something wrong and
easier for them to do it right. Of course, this does not mean that individuals can
be careless. People still must be vigilant and held responsible for their actions.
But when an error occurs, blaming an individual does little to make the system
safer and prevent someone else from committing the same error.
SOURCE: Leape, Lucian; Lawthers, Ann G.; Brennan, Troyen A., et al. Pr eventing Medical Injury. Qual Rev Bull. 19(5):144–149, 1993.
More commonly,
errors are caused
by faulty systems,
processes, and
conditions that
lead people to
make mistakes or
fail to prevent
them.
wrong. In addition, the processes by
which health professionals are licensed
and accredited have focused only limited
attention on the prevention of medical er
rors, and even these minimal efforts have
confronted resistance from some health
care organizations and providers. Many
providers also perceive the medical liabil
ity system as a serious impediment to sys
tematic efforts to uncover and learn from
errors. Exacerbating these problems, most
third-party purchasers of health care provide little financial incentive for health
care organizations and providers to im
prove safety and qua lity.
2
Strategy for Improvement
To achieve a better safety record, the report recommends a four-tiered approach:
• Establishing a national focus to create leadership, research, tools,
and protocols to enhance the knowledge base about safety.
Health care is a decade or more behind many other high-risk industries in
its attention to ensuring basic safety. This is due, in part, to the lack of a single
designated government agency devoted to improving and monitoring safety
throughout the health care delivery system. Therefore, Congress should create a
Center for Patient Safety that would set national safety goals and track progress in
meeting them; develop a research agenda; define prototype safety systems; de
velop, disseminate, and evaluate tools for identifying and analyzing errors; de
velop methods for educating consumers about patient safety; and recommend ad
ditional improvements as needed.
Funding for the center should be adequate and secure, starting with $30
million to $35 million per year and growing over time to at least $100 million an
nually–modest investments relative to the consequences of errors and to the resources devoted to other public safety issues. The center should be housed within
the Agency for Healthcare Research and Quality (AHRQ), which already is in
volved in a broad range of quality and safety issues, and has established the infra
structure and experience to fund research, education, and coordinating activities.
• Identifying and learning from errors by developing a nationwide
public mandatory reporting system and by encouraging health care organi
zations and practitioners to develop and participate in voluntary reporting
systems.
Under the mandatory reporting system, state governments will be required
to collect standardized information about adverse medical events that result in
death and serious harm. Hospitals should be required to begin reporting first, and
eventually reporting should be required by all health care organizations. This
system will ensure a response to specific reports of serious injury, hold health care
organizations and providers accountable for maintaining safety, provide incen
tives to organizations to implement internal safety systems that reduce the likeli
hood of errors occurring, and respond to the public’s right to know about patient
safety. Currently, about a third of the states have mandatory reporting require
ments.
Voluntary reporting systems will provide an important complement to the
mandatory system. Such systems can focus on a much broader set of errors,
mainly those that do no or minimal harm, and help detect system weaknesses that
can be fixed before the occurrence of serious harm, thereby providing rich info r
mation to health care organizations in support of their quality improvement ef
forts. To foster participation in voluntary systems, Congress should enact laws to
protect the confidentiality of certain information collected. Without such legisla
tion, health care organizations and providers may be discouraged from partic i
pating in voluntary reporting systems out of worry that the information they provide might ultimately be subpoenaed and used in lawsuits.
3
Health care is a
decade or more behind many other
high-risk industries
in its attention to
ensuring basic
safety.
Voluntary reporting
systems will provide an important
complement to the
mandatory system.
• Raising performance standards and expectations for improve
ments in safety through the actions of oversight organizations, professional
groups, and group purchasers of health care.
The process of de
Setting and enforcing explicit performance standards for patient safety
veloping and
through regulatory and related mechanisms, such as licensing, certification, and
adopting standards accreditation, can define minimum performance levels for health professionals,
also helps to form
the organizations in which they work, and the tools (drugs and devices) they use
expectations for
to care for patients. The process of developing and adopting standards also helps
safety among pro
to form expectations for safety among providers and consumers.
viders and con
Standards and expectations are not only set through regulations, however.
sumers.
The values and norms set by the health professions influence the practice, train
ing, and education for providers. Thus, professional societies should become
leaders in encouraging and demanding improvements in patient safety, by such
actions as setting their own performance standards, convening and communicat
ing with members about safety, incorporating attention to patient safety in training
programs, and collaborating across disciplines.
The actions of large purchasers of health care and health care insurance, as
well as actions by individual consumers, also can affect the behaviors of health
care organizations. Public and private purchasers, such as businesses buying in
surance for their employees, must make safety a prime concern in their contract
ing decisions. Doing so will create financial incentives for health care organiza
tions and providers to make needed changes to ensure patient safety.
Medication errors
now occur fre
quently in hospi
tals, yet many hos
pitals are not mak
ing use of known
systems for im
proving safety…
• Implementing safety systems in health care organizations to ensure safe practices at the delivery level.
Health care organizations must develop a “culture of safety” such that
their workforce and processes are focused on improving the reliability and safety
of care for patients. Safety should be an explicit organizational goal that is dem
onstrated by strong leadership on the part of clinicians, executives, and governing
bodies. This will mean incorporating a variety of well-understood safety princ i
ples, such as designing jobs and working conditions for safety; standardizing and
simplifying equipment, supplies, and processes; and enabling care providers to
avoid reliance on memory. Systems for continuously monitoring patient safety
also must be created and adequately funded.
The medication process provides an example where implementing better
systems will yield better human performance. Medication errors now occur fre
quently in hospitals, yet many hospitals are not making use of known systems for
improving safety, such as automated medication order entry systems, nor are they
actively exploring new safety systems. Patients themselves also could provide a
major safety check in most hospitals, clinics, and practice. They should know
which medications they are taking, their appearance, and their side effects, and
they should notify their doctors of medication discrepancies and the occurrence of
side effects.
4
Progress Under Way
The response to the IOM report was swift and positive, within both government
and the private sector.
Almost immediately, the Clinton administration issued an executive order
instructing government agencies that conduct or oversee health-care programs to
implement proven techniques for reducing medical errors, and creating a task
force to find new strategies for reducing errors. Congress soon launched a series
of hearings on patient safety, and in December 2000 it appropriated $50 million to
the Agency for Healthcare Research and Quality to support a variety of efforts
targeted at reducing medical errors.
The AHRQ already has made major progress in developing and imple
menting an action plan. Efforts under way include:
• Developing and testing new technologies to reduce medical errors.
• Conducting large-scale demonstration projects to test safety interve n
tions and error-reporting strategies.
• Supporting new and established multidisciplinary teams of researchers
and health-care facilities and organizations, located in geographically diverse locations, that will further determine the causes of medical errors and develop new
knowledge that will aid the work of the demonstration projects.
• Supporting projects aimed at achieving a better understanding of how
the environment in which care is provided affects the ability of providers to im
prove safety.
• Funding researchers and organizations to develop, demonstrate, and
evaluate new approaches to improving provider education in order to reduce er
rors.
Casting its net even more broadly, the AHRQ has produced a booklet of
practical tips on what individual consumers can do to improve the quality of
health-care services they receive. The booklet focuses on key choices that indi
viduals and their families face, such as choosing doctors, hospitals, and treat
ments, and it stresses the importance of individuals taking an active role in se
lecting and evaluating their care. (The booklet is available on the organization’s
Web site at www.ahrq.gov.)
In efforts focused at the state level, during the past year the National
Academy for State Health Policy (NASHP) convened leaders from both the ex
ecutive and legislative branches of the states to discuss approaches to improving
patient safety. The NASHP also helped lead an initiative to better understand
how states with mandatory hospital error-reporting requirements administer and
enforce their programs. (A report on this initiative is available on the organiza
tion’s Web site at www.nashp.org). In addition, the Agency for Healthcare Research and Quality has contracted with the National Quality Forum to produce a
list of so-called “never events” that states might use as the basis of a mandatory
reporting system.
Among activities in the private sector, the Leapfrog Group, an association
of private and public sector group purchasers, unveiled a market-based strategy to
improve safety and quality, including encouraging the use of computerized phys i5
cian-order entry, evidence-based hospital referrals, and the use of ICUs staffed by
physicians credentialed in critical care medicine.
Professional groups within the health-care community also have been ac
tive. As but one example, the Council on Graduate Medical Education (COGME)
and the National Advisory Council on Nurse Education and Practice (NACNEP)
held a joint meeting on “Collaborative Education Models to Ensure Patient
Safety.” Participants addressed such issues as the effect of the relationships between physicians and nurses on patient safety, the impact of physician-nurse col
laboration on systems designed to protect patient safety, and educational programs to ensure interdisciplinary collaboration to further patient safety. (A report
on the meeting is available on the COGME’s Web site at www.cogme.org.)
Pulling Together
Although no single activity can offer a total solution for dealing with medical er
With adequate
rors, the combination of activities proposed in To Err is Human offers a roadmap
leadership, atten
tion, and resources, toward a safer health system. With adequate leadership, attention, and resources,
improvements can improvements can be made. It may be part of human nature to err, but it is also
part of human nature to create solutions, find better alternatives, and meet the
be made.
challenges ahead.
For More Information…
Copies of To Err is Human: Building a Safer Health System are available for
sale from the National Academy Press; call (800) 624-6242 or (202) 334-3313 (in
the Washington metropolitan area), or visit the NAP home page at www.nap.edu.
The full text of this report is available at
http://www.nap.edu/books/0309068371/html/
Support for this project was provided by The National Research Council and The
Commonwealth Fund. The views presented in this report are those of the Institute
of Medicine Committee on the Quality of Health Care in America and are not
necessarily those of the funding agencies.
The Institute of Medicine is a private, nonprofit organization that provides health
policy advice under a congressional charter granted to the National Academy of
Sciences. For more information about the Institute of Medicine, visit the IOM
home page at www.iom.edu.
Copyright ©2000 by the National Academy of Sciences. All rights reserved.
Permission is granted to reproduce this document in its entirety, with no additions
or alterations
� � �
6
COMMITTEE ON QUALITY OF HEALTH CARE IN AMERICA
WILLIAM C. RICHARDSON (Chair), President and CEO, W.K. Kellogg
Foundation, Battle Creek, MI
DONALD M. BERWICK, President and CEO, Institute for Healthcare
Improvement, Boston
J. CRIS BISGARD, Director, Health Services, Delta Air Lines, Inc., Atlanta
LONNIE R. BRISTOW, Past President, American Medical Association, Walnut
Creek, CA
CHARLES R. BUCK, Program Leader, Health Care Quality and Strategy
Initiatives, General Electric Company, Fairfield, CT
CHRISTINE K. CASSEL, Professor and Chairman, Department of Geriatrics
and Adult Development, Mount Sinai Medical Center, New York City
MARK R. CHASSIN, Professor and Chairman, Department of Health Policy,
The Mount Sinai Medical Center, New York City
MOLLY JOEL COYE, Vice President and Director, West Coast Office, The
Lewin Group, San Francisco
DON E. DETMER, Dennis Gillings Professor of Health Management,
University of Cambridge, UK
JEROME H. GROSSMAN, Chairman and CEO, Lion Gate Management, LLC,
Boston
BRENT JAMES, Executive Director, Intermountain Health Care, Institute for
Health Care Delivery Research, Salt Lake City, UT
DAVID McK. LAWRENCE, Chairman and CEO, Kaiser Foundation Health
Plan, Inc., Oakland, CA
LUCIAN LEAPE, Adjunct Professor, Harvard School of Public Health
ARTHUR LEVIN, Director, Center for Medical Consumers, New York City
RHONDA ROBINSON-BEALE, Executive Medical Director, Managed Care
Management and Clinical Programs, Blue Cross Blue Shield of Michigan,
Southfield
JOSEPH E. SCHERGER, Associate Dean for Clinical Affairs, University of
California at Irvine College of Medicine
ARTHUR SOUTHAM, Partner, 2C Solutions, Northridge, CA
MARY WAKEFIELD, Director, Center for Health Policy and Ethics, George
Mason University
GAIL L. WARDEN, President and CEO, Henry Ford Health System, Detroit
� � �
7
Study Staff
JANET M. CORRIGAN, Director, Division of Health Care Services, Director,
Quality of Health Care in America Project
MOLLA S. DONALDSON, Project Codirector
LINDA T. KOHN, Project Codirector
TRACY McKAY, Research Assistant
KELLY C. PIKE, Senior Project Assistant
Auxiliary Staff
MIKE EDINGTON, Managing Editor
KAY HARRIS, Financial Advisor
SUZANNE MILLER, Senior Project Assistant
Copy Editor
FLORENCE POILLON
� � �
8
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