Managing Health Services Organizations and Systems, Sixth Edition

Managing Health Services Organizations and Systems, Sixth Edition
Managing Health Services Organizations and Systems, Sixth Edition
Managing Health Services Organizations and Systems, Sixth Edition

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3. Case Study 4: Allocation
Notes
Part II. Managing Health Services Organizations and Systems
Chapter 5. The Practice of Management in Health Services Organizations
and Systems
The Work of Managers
Key Definitions
Management and Organizational Culture, Philosophy, and
Performance
Management Functions, Skills, Roles, and Competencies
A Management Model for HSOs/HSs
Discussion Questions
Case Study 1: The CEO’s Day
Case Study 2: Today’s Workforce
Case Study 3: Healthcare Executives’ Responsibility to Their
Communities
Case Study 4: The Business Office
Case Study 5: Very Brief History of Management Theories
Notes
Chapter 6. Managerial Problem Solving and Decision Making
Problem Analysis and Decision Making
Problem Solving
Process and Model
Influencing Problem Solving and Decision Making
Unilateral and Group Problem Solving
Problem-Solving and Decision-Making Styles
Discussion Questions
Case Study 1: The Nursing Assistant
Case Study 2: The New Charge Nurse
Case Study 3: Listening
Case Study 4: Ping-Ponging
Notes

4. Chapter 7. The Quality Imperative: The Theory
Improving Quality and Performance
Taking A CQI Approach
CQI, Productivity Improvement, and Competitive Position
Theory of CQI
Strategic Quality Planning: Hoshin Planning
Organizing for Improvement
The Next Iteration of CQI—A Community Focus
Discussion Questions
Case Study 1: Fed Up in Dallas
Case Study 2: Clinics
Case Study 3: Where and How to Start?
Case Study 4: Extent of Obligation
Case Study 5: Surgical Safety—Retained Foreign Objects
Notes
Chapter 8. The Quality Imperative: Implementation
Undertaking Process Improvement
Other Improvement Methodologies
Barriers and Facilitators to Improvement
Improvement and Problem Solving
Statistical Process Control
Tools for Improvement
Productivity and Productivity Improvement
Physicians and CQI
Patient and Worker Safety in Healthcare
Quality Improvement Structures/Processes Useful in Patient/Worker
Safety
Overlapping Safety Issues for Patients and Workers
Discussion Questions
Case Study 1: The Carbondale Clinic
Case Study 2: Noninvasive Cardiovascular Laboratory
Case Study 3: Infections—C. difficile (CDI)
Case Study 4: Infections—CLABSI
Case Study 5: Infections—Flu Vaccination
Case Study 6: Sharps Injuries

5. Case Study 7: Slips, Trips, and Falls
Case Study 8: Safe Patient Handling and Patient Movement Injuries
Case Study 9: Hazardous Materials
Case Study 10: Violence in the Workplace
Notes
Chapter 9. Strategizing
Strategizing and Systems Theory
Strategizing and Planning
The Strategizing Process
Situational Analysis
External Environmental Analysis
Internal Environmental Analysis
Strategy Formulation
Strategic Implementation
Strategic Control
Strategic Issues Management
Discussion Questions
Case Study 1: No Time for Strategizing
Case Study 2: A Response to Change
Case Study 3: HSO Strategic Assessment
Case Study 4: Closing Pediatrics
Case Study 5: Affiliation
Case Study 6: Healthcare Firms Send Jobs Overseas
Notes
Chapter 10. Marketing
Marketing Defined
Strategic Marketing Management and Analysis
The Marketing Mix: Core Concepts in Marketing Management
Challenges in Identifying the Customer and Target Markets
Examples of Marketing Strategies
Industry Structure and Competitive Position: Porter’s Model
Market Position Analysis
Strategic Marketing Postures
Market Research

6. Ethics in Marketing
Discussion Questions
Case Study 1: Lactation Services at Women’s Wellness Hospital
Case Study 2: What Is Marketing?
Case Study 3: Image Management and Branding at the Disability
Services Organization of Rivertown
Case Study 4: Hospital Marketing Effectiveness Rating Instrument
Case Study 5: Nontraditional Marketing
Notes
Chapter 11. Controlling and Allocating Resources
Monitoring (Control) and Intervention Points
Control Model
Levels of Control
Control and CQI
Control and Problem Solving
Control Considerations
Information Systems and Control
Control and Human Resources
Staffing Activities
RM and Quality Improvement
Healthcare and Public Health Emergency Preparedness
Control Methods
Use of Analytical Techniques in Resource Allocation
Project Management
Construction Application
Discussion Questions
Case Study 1: Admitting Department
Case Study 2: Centralized Photocopying
Case Study 3: Barriers to an Effective QI Effort
Case Study 4: State Allocation Decisions—Centralize or
Decentralize
Case Study 5: Financial Ratios
Case Study 6: Healthcare Emergency Preparedness
Case Study 7: Placing Imaging Services to Support ED Operations
Notes

7. Chapter 12. Designing
The Ubiquity of Designing
Formal and Informal Aspects of Organization Design
Classical Design Concepts in Building Organization Structures
Designing Interorganizational Relationships
An Integrative Perspective on Organization Design
Discussion Questions
Case Study 1: Is the Matrix the Problem or the Solution?
Case Study 2: Trouble in the Copy Center
Case Study 3: “I Cannot Do It All!”
Case Study 4: Somebody Has to Be Let Go
Case Study 5: Is Outsourcing Part of Designing?
Notes
Chapter 13. Leading
Leading Defined and Modeled
Ethical Responsibilities of Leaders
Power and Influence in Leading
Motivation Defined and Modeled
Conclusions About the Roles of Power and Influence and of
Motivation in Leading
Approaches to Understanding Leadership
Toward an Integrative Approach to Effective Leading
Discussion Questions
Case Study 1: Leadership in the West Wing
Case Study 2: Charlotte Cook’s Problem
Case Study 3: The Presidential Search
Case Study 4: The Young Associate’s Dilemma
Case Study 5: The Holdback Pool
Case Study 6: Ethical Aspects of Leadership
Notes
Chapter 14. Communicating
Communicating Is Key to Effective Stakeholder Relations
Communication Process Model
Barriers to Effective Communication

8. Flows of Intraorganizational Communication
Communicating with External Stakeholders
Special Situations of Communicating with External Stakeholders
Discussion Questions
Case Study 1: Apple Orchard Assisted Living
Case Study 2: Information Technologies in Rural Florida Hospitals
Case Study 3: “You Didn’t Tell Me!”
Case Study 4: How Much Should We Say?
Case Study 5: Getting Help When Needed
Notes
Index

9. About the Authors
Beaufort B. Longest, Jr., Ph.D., FACHE, M. Allen Pond Professor of
Health Policy & Management in the Graduate School of Public Health at
the University of Pittsburgh and Founding Director of the University’s
Health Policy Institute, an organization he led from 1980–2011.
Professor Longest is a fellow of the American College of Healthcare
Executives and a member of the Academy of Management,
AcademyHealth, and American Public Health Association. With a
doctorate from Georgia State University, he served on the faculty of
Northwestern University’s Kellogg School of Management before joining
the University of Pittsburgh’s Public Health faculty in 1980. He is an
elected member of the Beta Gamma Sigma Honor Society in Business as
well as in the Delta Omega Honor Society in Public Health.
His research on modeling managerial competence, issues of
governance in healthcare organizations, and related issues of health policy
and management has appeared in numerous peer-reviewed journals and he
is author or co-author of 11 books and 32 chapters in other books. His
book, Health Policymaking in the United States, now in its fifth edition, is
among the most widely used textbooks in graduate health policy and
management programs. His newest book is Managing Health Programs:
From Development Through Evaluation (2014).
Professor Longest has consulted with healthcare organizations and
systems, universities, associations, and government agencies on health
policy and management issues and has served on several editorial and
organizational boards.

10. Kurt Darr, J.D., Sc.D., FACHE, Professor, Department of Health Services
Management and Leadership, School of Public Health and Health
Services, The George Washington University, Washington, DC 20052
Dr. Darr is Professor of Health Services Administration in the
Department of Health Services Management and Leadership at The
George Washington University. He holds the Doctor of Science from The
Johns Hopkins University and the Master of Hospital Administration and
Juris Doctor from the University of Minnesota.
Professor Darr completed his administrative residency at Rochester
(Minnesota) Methodist Hospital and subsequently worked as an
administrative associate at the Mayo Clinic. After being commissioned in
the U.S. Navy, he served in administrative and educational assignments at
St. Albans Naval Hospital and Bethesda Naval Hospital. He completed
postdoctoral fellowships with the Department of Health and Human
Services, the World Health Organization, and the Accrediting Commission
on Education for Health Services Administration.
Professor Darr is a Fellow of the American College of Healthcare
Executives, a member of the District of Columbia and Minnesota Bars,
and served for 20 years as a mediator in the Superior Court of the District
of Columbia. He serves or has served on commissions and committees for
various professional organizations, including The Joint Commission on
Accreditation of Healthcare Organizations, the American College of
Healthcare Executives, and the Commission on Accreditation of
Healthcare Management Education. He is a voluntary consultant on
quality improvement and ethics to hospitals in the District of Columbia
metropolitan area.
Professor Darr regularly presents seminars on health services ethics,
hospital organization and management, quality improvement, and
application of the Deming method in health services delivery. He is the
author and editor of numerous books and articles in the health services
field.

11. Preface
Leading health services organizations (HSOs) and health systems (HSs)
are setting the benchmarks and establishing the best practice standards for
others to emulate. They are simultaneously satisfying their customers,
achieving quality and safety goals, and meeting cost objectives. The
benchmarks of excellence in health services delivery are being established
in HSOs and HSs that have excellent managers, as well as talented
clinicians and dedicated governing bodies.
Our purpose in this 6th edition, as in previous editions, is to present
information and insight that can set the benchmarks of excellence in the
management of health services delivery. The book will be useful to two
groups. It will assist students as they prepare for health services
management careers through programs of formal study. In addition, it has
broad use in providing knowledge of applied management theory that is
part of professional development for practicing health services executives.
We hope both groups will find the book a useful reference in their
professional libraries.
As in previous editions, the main focus is managing HSOs and HSs.
This edition gives significant attention to managing the increasingly
important system of public health organizations and services. Hospitals
and long-term care organizations continue to be prominent HSOs and are
treated as such here. Ambulatory care organizations, home health
agencies, and managed care organizations, among other HSOs, are also
covered. Whether HSOs operate as independent entities or align
themselves into various types of HSs, all face dynamic external
environments—a mosaic of external forces that includes new regulations
and technologies; changing demographic patterns; increased competition;

12. public scrutiny; heightened consumer expectations; greater demands for
accountability; and major constraints on resources. The interface between
HSOs and HSs and their external environments is given added attention in
this edition.
The 6th edition includes over 30 new case studies and updated
coverage of healthcare services issues and practices—including financial
management. In addition, there are new sections on emergency
preparedness, patient and staff safety, infection control, employee stress,
hazardous materials, workplace violence, and applying project
management in health services.
As in previous editions, we present management theory so as to
demonstrate its applicability to all types of HSOs and HSs. This objective
is accomplished by using a process orientation that focuses on how
managers manage. We examine management functions, concepts, and
principles as well as managerial roles, skills, and competencies within the
context of HSOs and HSs and their external environments. For nascent
managers, the book introduces and applies terms of art, provides an
updated list of acronyms, and explains concepts that will be a foundation
for lifelong learning and professional development.
Experienced managers will find reinforcement of existing skills and
experience, provision and application of new theory, and application of
traditional theory and concepts in new ways. Managing in the unique
environment that is health services delivery requires attention to the
managerial tools and techniques that are most useful. The fourteen
chapters in this 6th edition of Managing Health Services Organizations
and Systems are an integrated whole that covers how management is
practiced in HSOs and HSs. The discussion questions and cases will
stimulate thought and dialogue of chapter content. It is our hope that the
book will assist all who aspire to establish the benchmarks of excellence
in the extraordinarily complex and essential economic sector that is the
health services field.

13. About this Edition
Part I describes the setting in which health services (HSs) are delivered.
Chapter 1, “Healthcare in the United States,” develops a framework of the
important public and private entities that are the grounding for delivery of
health services. Discussed are regulators, educators, and accreditors, as
well as sources of financing for services.
The book’s second chapter, “Types and Structures of Health Services
Organizations and Health Systems,” provides a generic discussion of
governance, management, and professional staff organization found in
health services organizations (HSOs). This triad is applied to selected
HSOs that are archetypal of those in the health services field. Each type is
discussed briefly.
Technology has a central role in delivery of health services. Chapter 3,
“Healthcare Technology,” describes the history, effects, and diffusion of
technology and the decisions made by HSOs in acquiring and managing
technology in the workplace.
Chapter 4, “Ethical and Legal Environment,” establishes the pervasive
influence and effects of ethics and law in the health services field. Ethical
frameworks are discussed, ethical issues are identified, and HSO responses
to them are suggested. Law is the minimum level of performance in
managing health services. The relationship between the law and the work
of managers is also identified.
Part II builds on the previous chapters by focusing on the process of
managing in HSOs/ HSs. In Chapter 5, “The Practice of Management in
Health Services Organizations and Health Systems,” management is
defined and a comprehensive model of the management process in
HSOs/HSs is presented. This model provides a framework for

14. understanding what managers actually do. The management process is
considered from four perspectives: the functions managers perform, the
skills they use in carrying out these functions, the roles managers fulfill in
managing, and the set of management competencies that are needed to do
the work well. These perspectives form a mosaic—a more complete
picture than any one perspective—of management work
“Managerial Problem Solving and Decision Making,” is discussed in
Chapter 6. The pervasive decision-making function is examined,
particularly as it relates to solving problems. Application of a problem-
solving model is a major focus of the chapter.
Chapter 7, “The Quality Imperative: The Theory,” describes and
analyzes the development of the theoretical underpinnings of quality and
performance improvement.
Chapter 8, “The Quality Imperative: Implementation,” focuses on how
HSOs make continuous improvement of quality and productivity a reality.
The emphasis is process improvement, which leads to improved quality
and enhanced productivity. Organizing for quality improvement requires a
commitment from governance, management, and physicians, as well as the
involvement of staff throughout the HSO in applying the methods and
tools described.
Chapter 9, “Strategizing,” details how managers determine the
opportunities and threats emanating from the external environments of
their organizations and systems and how they respond to them effectively.
Chapter 10, “Marketing,” details how managers understand and relate
to the markets they serve.
Chapter 11, “Controlling and Allocating Resources” presents a general
model of control and focuses on controlling individual and organizational
work results through techniques such as management information systems,
management and operations auditing, human resources management, and
budgeting. Control of medical care quality through risk management and
quality assessment and improvement is discussed. The chapter concludes
with applications of quantitative techniques useful in resource allocation,
such as volume analysis, capital budgeting, cost–benefit analysis, and
simulation.
Chapter 12, “Designing,” provides conceptual background for
understanding HSO/HS organizational structures. It contains information

15. on general organization theory, including classical principles and
contemporary concepts as they relate to organizations, systems, and
alliances of organizations.
Chapter 13, “Leading,” differentiates transactional and
transformational leadership and models and defines leadership. The
extensive literature on leader behavior and situational theories of
leadership is reviewed. Motivation is defined and modeled. The concept of
motivation and its role in effectively leading people and entire HSOs/HSs
is also discussed.
Chapter 14, “Communicating,” describes a communication process
model and applies it in communicating within organizations and systems
and between them and their external stakeholders.
Instructor Resources
Downloadable Course Materials
Attention Instructors! Downloadable materials are available to help you
design your course using Managing Health Services Organizations and
Systems, Sixth Edition.
Please visit www.healthpropress.com/longest-course-materials to access
the following:
•Customizable PowerPoint presentations for every chapter, totaling more
than 350 slides
•Image bank of figures and tables
*
in PDF format for easy use in your
PowerPoint presentations, tests, handouts, and other course purposes
•Summary of chapter learning objectives for use in course syllabus and
classroom/online instruction

16. •Additional discussion questions and case studies for each chapter to
extend student learning opportunities
•List of acronyms for quick and easy reference
*
Some figures and tables are not included due to permissions constraints.

17. Acknowledgments
Professor Longest thanks Carolyn, whose presence in his life continues to
make many things possible and doing them seem worthwhile. He extends
appreciation to Mark S. Roberts, M.D., Chair of the Department of Health
Policy and Management; Donald S. Burke, M.D., Dean of the Graduate
School of Public Health; and Arthur S. Levine, M.D., Senior Vice
Chancellor for Health Sciences at the University of Pittsburgh, for
encouraging and facilitating a work environment that is conducive to the
scholarly endeavors of faculty members.
Professor Darr is grateful to Anne for her unstinting support of this
latest edition and for never becoming impatient with the sometimes snail-
like pace of the work. My department chair, Robert E. Burke, Ph.D., was
supportive of my work on this 6th edition, and I am pleased to
acknowledge him. A book of this magnitude—even a revision—cannot be
researched and written without help. Thanks are owed to my graduate
assistants during its writing. Ayla Baughman and Nora Albert worked
effectively, often under severe time constraints. Both of these young
women have the qualities to succeed in the health services field. I wish
them all good things in the future.
The authors wish to thank several people at Health Professions Press
for their assistance with this book. Mary Magnus, Director of
Publications; Kaitlin Konecke, Marketing Coordinator and Textbook
Manager; Erin Geoghegan, Graphic Design Manager; and Carol Peschke
and Diane Ersepke, copyeditors; each made important contributions. We
are grateful to Cecilia González, Production Manager, for her untiring
efforts to make the book as good as it could be. She saw us through the
project with good cheer and much assistance. We also thank the publishers

18. and authors who granted permission to reprint material to which they hold
the copyright. Finally, and last but not least, we are grateful to users of the
5th edition whose comments and critiques helped us to improve the 6th
edition.
The authors acknowledge the contributions made by our coauthor on
earlier editions, Jonathon S. Rakich, Ph.D. Professor Rakich collaborated
with us on Managing Health Services Organizations and Systems for more
than three decades. His participation and historic role in setting direction
and selecting substance to achieve a high-quality book can be found even
in the 6th edition. We thank him.

19. Acronyms Used in Text
AA associate of arts (degree)
AAAHC Accreditation Association for Ambulatory Healthcare
AAHSA American Association of Homes and Services for the
Aging, also known as LeadingAge
AAMC Association of American Medical Colleges
ABC activity-based costing
ABMS American Board of Medical Specialties
ACA Affordable Care Act of 2010
ACHE American College of Healthcare Executives
ACO accountable care organization
ACS American College of Surgeons
ADL activities of daily living
ADR alternative dispute resolution
AHA American Hospital Association
AHCA American Health Care Association
AHCPR Agency for Health Care Policy and Research
AHIP America’s Health Insurance Plans
AHRQ Agency for Healthcare Research and Quality
AI artificial intelligence
AIDS acquired immunodeficiency syndrome
ALOS average length of stay
AMA American Medical Association

20. ANA American Nurses Association
AND allow natural death
AOA American Osteopathic Association
APACHE acute physiology and chronic health evaluation
APC ambulatory payment category
APG ambulatory patient group
ASC ambulatory surgery centers
ASQ American Society for Quality
BCG Boston Consulting Group Matrix
BEAM brain electrical activity mapping
BIM building information modeling
BLS Bureau of Labor Statistics
BSC balanced scorecard
BSN bachelor of science in nursing (degree)
CABG coronary artery bypass grafting
CAD computer-aided design
CAHME Commission on Accreditation of Healthcare Management
Education
CalRHIO California Regional Health Information Organization
CAMH Comprehensive Accreditation Manual for Hospitals
CAS carotid artery stenting
CAUTI catheter-associated urinary tract infection
CBO Congressional Budget Office
CDC Centers for Disease Control and Prevention
CDI Clostridium difficile infection
CDSS clinical decision support system
CEA carotid endarterectomy
CEO chief executive officer
CEPH Council on Education for Public Health
CFO chief financial officer
CGE continuing governance education

21. CHA Catholic Health Association of the United States
CHAP Community Health Accreditation Program
CHC community health center
CHIN community health information network
CIO chief information officer
CLABSI central line–associated bloodstream infection
CMO chief medical officer
CMS Centers for Medicare and Medicaid Services
CNA certified nursing assistant
CNM certified nurse midwife
CNO chief nursing officer
CNS clinical nurse specialist
COE Center for Outcomes and Evidence
CON certificate of need
COO chief operating officer
COP conditions of participation
CPI consumer price index
CPM critical path method
CPR cardiopulmonary resuscitation
CQI continuous quality improvement
CQO chief quality officer
CRM crew resource management
CRNA certified registered nurse anesthetist
CSS clinical support system
CT computerized tomography
CTO chief technology officer
CUS “I am Concerned. I am Uncomfortable. This is a Safety
issue.”
CUSP comprehensive unit safety program
DBS deep brain stimulation
DHHS Department of Health and Human Services

22. DIC diagnostic imaging centers
DMAIC Define, measure, analyze, improve, control
DNR do not resuscitate
DNVHC Det Norske Veritas Healthcare, Inc.
DO doctor of osteopathy
DOL U.S. Department of Labor
DRG diagnosis-related group
DVA Department of Veterans Affairs
EAP employee assistance program
ECHO echocardiogram
ED emergency department
EH employee health
EHR electronic health record
EMR electronic medical record
EMS emergency medical services
EMT emergency medical technician
EOC environment of care
EPC evidence-based practice center
EOP emergency operations plan
EPM epidemiological planning model
EVM earned value management
FAH Federation of American Hospitals
FC fixed costs
FDA Food and Drug Administration
FEMA Federal Emergency Management Agency
FMEA failure mode effects analysis
fMRI functional magnetic resonance imaging
FQHC Federally Qualified Health Centers
FTC Federal Trade Commission
FTE full-time equivalent employee

23. GB governing body
GDP gross domestic product
GE General Electric
GPO group purchasing organization
HAI healthcare-associated infection
HCFA Health Care Financing Administration
HCAHPS Hospital Consumer Assessment of Healthcare Providers
and Systems
HCQIA Health Care Quality Improvement Act of 1986
HEDIS Health Plan Employer Data and Information Set
HHA home health agency
HIPDB Healthcare Integrity and Protection Data Bank
HIT health information technology
HIV human immunodeficiency virus
HME home medical equipment
HMO health maintenance organization
HQI hospital quality improvement
HR human resources
HRET Hospital Research and Educational Trust
HRM human resources management
HS health system
HSA health systems agency
HSO health services organization
HTA healthcare technology assessment
HVA hazard vulnerability analysis
ICRC infant care review committee
ICU intensive care unit
IDN integrated delivery network
IDS integrated delivery system
IEC institutional ethics committee
IHI Institute for Healthcare Improvement

24. IHIE Indiana Health Information Exchange
IOM Institute of Medicine
IOR interorganizational relationship
IPA independent practice association
IRB institutional review board
IRS Internal Revenue Service
IS information system
ISO International Organization for Standardization
IT information technology
IV intravenous
JCAHO Joint Commission on Accreditation of Healthcare
Organizations
JCC joint conference committee
KQC key quality characteristic
KPV key process variable
LAN local area network
LCL lower control limit
LIP licensed independent practitioner
LLC limited liability company
LOS length of stay
LPC least preferred co-worker
LPN licensed practical (vocational) nurse
LTC long-term care
LTCH long-term care (extended stay) hospital
M&M morbidity and mortality
MBNQA Malcolm Baldrige National Quality Award
MBO management by objectives
MBR management by results
MCO managed care organizations
MD medical doctor
MDSS management decision support system

25. MGMA Medical Group Management Association
MICU medical intensive care unit
MIS management information systems
MRI magnetic resonance imaging
MRSA Methicillin-resistant Staphylococcus aureus
MSD musculoskeletal disorder
MSDS material safety data sheets
MSI magnetic source imaging
MSO management services organization
M-TAC multidisciplinary technology assessment committee
MVS multi-vendor servicing
NCQA National Committee for Quality Assurance
NA nursing assistant
NASA National Aeronautics and Space Administation
NaSH National Surveillance System for Healthcare Workers
NCHSRHCTANational Center for Health Services Research and Health
Care Technology Assessment
NCHCT National Center for Health Care Technology
NCHL National Center for Healthcare Leadership
NCVL noninvasive cardiovascular laboratory
NF nursing facility
NGC National Guideline Clearinghouse
NHS National Health Service (U.K.)
NHSN National Healthcare Safety Network (CDC)
NICU neonatal intensive care unit
NIH National Institutes of Health
NIOSH National Institute for Occupational Safety and Health
NLM National Library of Medicine
NLN National League for Nursing
NLNAC National League for Nursing Accrediting Commission
NP nurse practitioner

26. NPSG National Patient Safety Goals
OBRA Omnibus Budget Reconciliation Act of 1987
ODS organized delivery system
OPG ocular plethysmograph
OR operating room
OSHA Occupational Safety and Health Administration
OT occupational therapy
OTA Office of Technology Assessment
PA physician assistant
PAC political action committee
PAS physician-assisted suicide
PBT proton beam therapy
PDCA plan, do, check, act
PDSA plan, do, study, act
PERT program evaluation and review technique
PET positron emission tomography
PGY postgraduate year
PHO physician-hospital organization
PI productivity improvement
PICU pediatric intensive care unit
PIT process improvement team
POS point of service
PPE personal protective equipment
PPO preferred provider organization
PRO peer review organization
PSDA Patient Self-Determination Act
PSO professional staff organization
PSRO professional standards review organization
PT physical therapy
PTCA percutaneous transluminal coronary angioplasty

27. PVR pulse volume recording plethysmograph
PVS persistent vegetative state
QA quality assurance
Q/PI quality/productivity improvement
QA/I quality assessment and improvement
QI quality improvement
QIC quality improvement council
QIO quality improvement organization
QIT quality improvement team
QMHCD quality management for health care delivery
QWL quality-of-work life
RBRVS resource-based relative value scale
RDE rule of double effect
RHIO regional health information organization
RM risk management
RN registered nurse
ROI return on investment
RT rehabilitation therapy
RUG resource utilization group
SA strategic alliance
SBAR situation, background, assessment, recommendation
SBU strategic business unit
SCAP service, consideration, access, and promotion
SD standard deviation
SEA sentinel event alert
SHRM strategic human resources management
SICU surgical intensive care unit
SNF skilled nursing facility
SPC statistical process control
SPECT single-proton emission computed tomography

28. SSU strategic service unit
STEPPS strategies to enhance performance and patient safety
SWOT strengths/weaknesses/opportunities/threats
TB tuberculosis
TC total costs
TEAM Technology Evaluation and Acquisition Methods
TEE transesophageal echocardiography
t-PA tissue plasminogen activator
TQM total quality management
UCL upper control limit
UPMC University of Pittsburgh Medical Center
UR utilization review
USPHS United States Public Health Service
VAP ventilator-associated pneumonia
VC variable costs
VNS vagus nerve stimulation
VP vice president
VPMA vice president for medical affairs
WAN wide-area network

29. To those who manage health services organizations and to those who
aspire

30. Part I
The Healthcare Setting

31. Other documents randomly have
different content

35. The Project Gutenberg eBook of Balloons,
Airships, and Flying Machines

36. This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
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ebook or online at www.gutenberg.org. If you are not located in the
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you are located before using this eBook.
Title: Balloons, Airships, and Flying Machines
Author: Gertrude Bacon
Release date: May 27, 2017 [eBook #54799]
Most recently updated: October 23, 2024
Language: English
Credits: Produced by deaurider, Charlie Howard, and the Online
Distributed Proofreading Team at http://www.pgdp.net
(This
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*** START OF THE PROJECT GUTENBERG EBOOK BALLOONS,
AIRSHIPS, AND FLYING MACHINES ***

37. THE
Practical Science Series
The following Vols. are now ready or in the Press:—
BALLOONS, AIRSHIPS, AND FLYING MACHINES.
By Gertrude Bacon.
MOTORS AND MOTORING. By Professor Harry
Spooner .
RADIUM. By Dr. Hampson .
METEOROLOGY; or, Weather Explained. By J.
Gordon M‘Pherson , M.A., LL.D.
Others in Preparation

38. The Authoress, her Father, and Mr. Spencer
making an Ascent.
Frontispiece.

39. BALLOONS
AIRSHIPS AND FLYING
MACHINES
BY
GERTRUDE BACON
NEW YORK
DODD, MEAD & COMPANY
LONDON: T. C. & E. C. JACK
1905

40. CONTENTS
CHAP.  PAGE
I.THE ORIGIN OF BALLOONING 9
II.THE COMING OF THE GAS BALLOON 23
III.FAMOUS BALLOON VOYAGES OF THE
PAST 38
IV.THE BALLOON AS A SCIENTIFIC
INSTRUMENT 57
V.THE BALLOON IN WARFARE 69
VI.THE AIRSHIP 84
VII.THE FLYING MACHINE 105
VIII.CONCLUSION 119

41. BALLOONS, AIRSHIPS, AND
FLYING MACHINES

43. CHAPTER I
THE ORIGIN OF BALLOONING
One November night in the year 1782, so the story runs, two
brothers sat over their winter fire in the little French town of
Annonay, watching the grey smoke-wreaths from the hearth curl up
the wide chimney. Their names were Stephen and Joseph
Montgolfier, they were papermakers by trade, and were noted as
possessing thoughtful minds and a deep interest in all scientific
knowledge and new discovery. Before that night—a memorable
night, as it was to prove—hundreds of millions of people had
watched the rising smoke-wreaths of their fires without drawing any
special inspiration from the fact; but on this particular occasion, as
Stephen, the younger of the brothers, sat and gazed at the familiar
sight, the question flashed across his mind, “What is the hidden
power that makes those curling smoke-wreaths rise upwards, and
could I not employ it to make other things rise also?”

44. Medallion showing Brothers Montgolfier .
Then and there the brothers resolved on an experiment. They
made themselves a small fire of some light fuel in a little tin tray or
chafing-dish, and over the smoke of it they held a large paper-bag.
And to their delight they saw the bag fill out and make a feeble
attempt to rise. They were surely on the eve of some great
invention; and yet, try as they would, their experiment would not
quite succeed, because the smoke in the bag always became too
cool before there was enough in it to raise it from the table. But
presently, while they were thus engaged, a neighbour of theirs, a
widow lady, alarmed by seeing smoke issuing from their window,
entered the room, and after watching their fruitless efforts for some
while, suggested that they should fasten the tray on to the bottom
of the bag. This was done, with the happy result that the bag
immediately rose up to the ceiling; and in this humble fashion the
first of all balloons sailed aloft.
That night of 1782, therefore, marks the first great step ever
made towards the conquest of the sky. But to better understand the

45. history of “Aeronautics”—a word that means “the sailing of the air”—
we must go back far beyond the days of the Montgolfier brothers.
For in all times and in all ages men have wanted to fly. David wished
for the wings of a dove to fly away and be at rest, and since his
time, and before it, how many have not longed to take flight and sail
away in the boundless, glorious realms above, to explore the fleecy
clouds, and to float free in the blue vault of heaven.
And since birds achieve this feat by means of wings, man’s first
idea was to provide himself with wings also. But here he was at once
doomed to disappointment. It is very certain that by his own natural
strength alone a man will never propel himself through the air with
wings like a bird, because he is made quite differently. A bird’s body
is very light compared with its size. The largest birds in existence
weigh under thirty pounds. A man’s body, on the contrary, is very
heavy and solid. The muscles that work a bird’s wing are wonderfully
powerful and strong, far stronger in proportion than the muscles of a
man’s arm. To sustain his great weight in the air, a man of eleven
stone would require a pair of wings nearly twenty feet in span. But
the possession of such mighty wings alone is not enough. He must
also possess bodily strength to keep them in sufficient motion to
prevent him from falling, and for this he would require at least the
strength of a horse.
Such strength a man has never possessed, or can ever hope to;
but even as it is, by long practice and great effort, men have
succeeded at different times, not exactly in flying, but in helping
themselves along considerably by means of wings. A man is said to
have flown in this way in Rome in the days of Nero. A monk in the
Middle Ages, named Elmerus, it is stated, flew about a furlong from
the top of a tower in Spain, another from St. Mark’s steeple in
Venice, and another from Nuremburg. But the most successful
attempt ever made in this direction was accomplished about 200
years ago by a French locksmith of the name of Besnier. He had
made for himself a pair of light wooden oars, shaped like the double
paddle of a canoe, with cup-like blades at either end. These he
placed over his shoulders, and attached also to his feet, and then

46. casting himself off from some high place, and violently working his
arms and legs so as to buffet the air downwards with his paddles, he
was able to raise himself by short stages from one height to another,
or skim lightly over a field or river. It is said that subsequently
Besnier sold his oars to a mountebank, who performed most
successfully with them at fairs and festivals.
Besnier and his Oars.
But it was soon clear that the art of human flight was not to be
achieved by such means; and when men found that they were
unable to soar upwards by their own bodily strength alone, they set
about devising some apparatus or machine which should carry them
aloft. Many ancient philosophers bent their minds to the inventing of
a machine for this purpose. One suggested that strong flying birds,
such as eagles or vultures, might be harnessed to a car, and trained
to carry it into the sky. Another gravely proposed the employment of
“a little imp”—for in those days the existence of imps and demons
was most firmly believed in. A third even went so far as to give an
actual recipe for flying, declaring that “if the eggs of the larger
description of swans, or leather balls stitched with fine thongs, be
filled with nitre, the purest sulphur, quicksilver, or kindred materials
which rarefy by their caloric energy, and if they externally resemble
pigeons, they will easily be mistaken for flying animals.” (!)

47. The first man who appeared to have any inkling of the real way
of solving the problem of a “flying chariot,” and who in dim fashion
seems to have foreshadowed the invention of the balloon, was that
wonderful genius, Roger Bacon, the Learned Friar of Ilchester, the
inventor or re-inventor of gunpowder, who lived in the thirteenth
century. He had an idea—an idea which was far ahead of his times,
and only proved to be true hundreds of years after—that the earth’s
atmosphere was an actual substance or “true fluid,” and as such he
supposed it to have an upper surface as the sea has, and on this
upper surface he thought an airship might float, even as a boat
floats on the top of the water. And to make his airship rise upwards
to reach this upper sea, he said one must employ “a large hollow
globe of copper or other similar metal wrought extremely thin, to
have it as light as possible, and filled with ethereal air or liquid fire.”
It is doubtful whether Bacon had very clear ideas of what he
meant by “ethereal air.” But, whether by accident or insight, he had
in these words hit upon the true principle of the balloon—a principle
only put into practice five centuries later. He saw that a body would
rise upwards through the air if it were filled with something lighter
than air, even as a body will rise upwards through the water if it is
made of, or filled with, something lighter than water. We know that if
we throw an empty bottle tightly corked into the sea it does not
sink, but rises upwards, because it is filled with air, which is lighter
than water. In the same way exactly a light bag or balloon which is
filled with some gas which is lighter than air will not stay on the
surface of the ground, but will rise upwards into the sky to a height
which depends upon its weight and buoyancy.
Later philosophers than Bacon came to the same conclusion,
though they do not seem to have seen matters more clearly. As
recently as 1755 a certain learned French priest actually suggested
that since the air on the top of high mountains is known to be lighter
than that at an ordinary level, men might ascend to these great
heights and bring down the light air “in constructions of canvas or
cotton.” By means of this air he then proposed to fly a great
machine, which he describes, and which seems to have been as

48. large and cumbersome as Noah’s Ark. Needless to say, the worthy
Father’s proposal has never yet been put into practice.
But it is time now that we return to the two brothers Montgolfier
and their paper-bag of smoke. Their experiments proved at once
that in smoke they had found something which was lighter than air,
and which would, therefore, carry a light weight upwards. But of
what this something was they had, at the time, but a confused idea.
They imagined that the burning fuel they had used had given off
some special light gas, with the exact nature of which they were
unacquainted. The very word gas, be it here said, was in those days
almost unknown, and of different gases, their nature and properties,
most people had but the very vaguest notions.
And so for some time the Montgolfiers and their followers
supposed that the presence of this mysterious gas was necessary to
the success of their experiments, and they were very careful about
always using special kinds of fuel, which they supposed gave off this
gas, to inflate their bags. Later experiments proved, however, what
every one now knows, that the paper-bag rose, not because of the
gases given off by the fire, but by reason of the hot air with which it
became filled. Nearly all substances, no matter how solid, expand
more or less under the influence of heat, and air expands very
greatly indeed. By thus expanding heated air becomes lighter than
the surrounding air, and, because it is lighter, rises upwards in the
atmosphere, and continues to rise until it has once more regained
the average temperature.

49. Montgolfier ’s Balloon.
Encouraged by the success of their first humble experiment, the
Montgolfiers next tried their paper-bag in the open air, when to their
delight it sailed upwards to a height of 70 feet. The next step was to
make a much larger craft of 600 cubic feet capacity and spherical in
shape, which they called a “Balloon,” because it was in appearance
like a large, round, short-necked vessel used in chemistry which was
technically known by that name. This great bag, after being inflated,
became so powerful that it broke loose from its moorings, and
floated proudly upwards 600 feet and more, and came down in an
adjoining field. After a few more successful trials the brothers
thought that the time had come to make known their new invention.

50. Accordingly they constructed a great balloon of 35 feet in diameter,
and issued invitations to the public to come and see the inflation.
This was successfully made over a fire of chopped straw and wool,
and the giant rose up into the sky amid the deafening applause of a
huge multitude, and after attaining a height of 7000 feet, fell to the
ground a mile and a half away.
The news of this marvellous event spread like wild-fire
throughout the kingdom, and soon not only all France, but all
Europe also, was ringing with the tidings. The French Royal Academy
of Sciences immediately invited Stephen Montgolfier to Paris, and
provided him with money to repeat his experiment. He accordingly
constructed a yet larger machine, which stood no less than 72 feet
high, had it most magnificently painted and decorated and hung
with flags, and sent it up at Versailles in the presence of the King
and all his court.
This particular balloon is noteworthy as having been the first of
all balloons to carry living passengers into the air. They were three in
number, a sheep, a cock, and a duck. Breathlessly the assembled
multitude watched these innocent victims placed in the basket and
soar calmly and majestically above their heads; and eagerly they
followed the balloon to where it fell half a mile away to learn their
fate. Would they have been suffocated in those upper regions of the
air which no human being had yet explored, or would they be
dashed to pieces in the descent? But they found the trio quite
uninjured; the unimaginative sheep grazing quietly, and the duck
cheerfully quacking. Forthwith the cry then arose that it was time for
a man to hazard the ascent, and King Louis, who, like every one
else, was vastly excited over the wonder, suggested that two
criminals then lying under sentence of death should be sent aloft.
But now a brave French gentleman—M. Pilâtre de Rozier, a name
ever to be remembered in the history of the conquest of the air—
uprose in indignation. “Shall vile criminals have the first glory of
rising into the sky!” he cried, and then and there he proudly claimed
for himself the honour of being first among mortals in the history of

51. the world to sail the air. His courageous resolve was wildly
applauded, and forthwith preparations were commenced for the new
venture. A yet larger balloon was made, in height as tall as a church
tower, with a mouth 15 feet across. Around the mouth was fastened
a gallery of wicker-work, three feet wide, to hold the passengers,
and below all was slung with chains an iron brazier of burning fuel.
By way of precaution, when all was complete De Rozier made a
few short captive excursions, the balloon being fastened to earth by
a rope. But all proving satisfactory, he decided to hazard a “right
away” trip on the 21st of November 1783, when he was also to be
accompanied by an equally courageous fellow-countryman, the
Marquis d’Arlandes. It would be difficult to conceive a more daring
and perilous enterprise than these two brave Frenchmen set
themselves. They were to venture, by an untried way, into unknown
realms where no mortal had been before; they were to entrust their
lives to a frail craft whose capabilities had never yet been tested,
and at a giddy height they were to soar aloft with an open fire,
which at any moment might set light to the inflammable balloon and
hurl them to destruction.
Wild indeed was the applause of the crowd as the mighty craft,
after due inflation, rose majestically into the sky, carrying with it its
two brave voyagers—
the first that ever burst
Into that silent sea;
and with what anxiety was its course followed as, rising rapidly
to a height of 3000 feet, it drifted away on an upper current which
bore it right over the city of Paris. The travellers themselves
experienced various excitements during their adventurous trip. They
had constantly to stir the fire and feed it with fresh fuel; they had
also with wet sponges continually to extinguish the flames when the
light fabric from time to time ignited. At one period they feared
descending into the river or on the house-tops, at another a sharp
shock gave them the impression that their balloon had burst. But

52. they came safely in the end through all perils and alarms,
descending quietly, after a voyage of twenty-five minutes’ duration,
five miles from their starting-place.
An Early Hydrogen Balloon.
Thus was invented and perfected in the course of less than a
year the first of all craft which carried man into the sky—the Hot-Air
or Montgolfier Balloon. To this day large hot-air balloons inflated by
the same methods employed a hundred years ago occasionally take
passengers aloft. Indeed, there now seems a likelihood that the use
of the Montgolfier balloon will be largely revived for military
purposes, since, with modern improvements, it would appear to be
more quickly and easily inflated than a gas balloon in time of
warfare. With miniature hot-air balloons we are all familiar, for every
schoolboy has made them for himself of coloured papers, and
watched them float away on the breeze with as much admiration
and delight as the two brothers of Annonay watched their bag first
float upwards to the ceiling.
But almost before the invention of the hot-air balloon had been
completed, and before Pilâtre de Rozier had made his ascent, a rival

53. craft had appeared upon the scene, to which we must more specially
refer in the next chapter.

54. CHAPTER II
THE COMING OF THE GAS BALLOON
During the time of which we are speaking there was living in
London a famous chemist named Henry Cavendish. He was the son
of a nobleman, and a very rich man; but he shut himself up entirely
from the world, and devoted his whole time and energies to the
study of science. So afraid was he of being interrupted in his work
that he lived the life of a hermit, commanding his servants to keep
out of his sight on pain of dismissal, and ordering his dinner daily by
means of a note placed on the hall table. In the year 1760—twenty-
two years before the Montgolfier brothers began their experiments—
this eccentric man had discovered what was then known as
“inflammable air,” but what we now call hydrogen gas.
Cavendish’s experiments proved that hydrogen is the lightest of
all known substances, being about fourteen times lighter than
atmospheric air; and soon after he had made known his researches,
it occurred to a certain Dr. Black of Edinburgh that if a sufficiently
thin and light bladder were filled with this “inflammable air” it would
rise upwards. Dr. Black even went so far as to order a special
bladder to be prepared for the purpose; but by the time it was ready
he was busy with other work, and the experiment was never made;
otherwise it is extremely probable that the honour of inventing the
balloon would have been won for this country, and not for France.
A little later Tiberius Cavallo, an Italian chemist living in England,
came yet nearer to the great invention, for he filled a number of
soap-bubbles with the newly discovered gas, and saw them float

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