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At least 685 records · Page 38Linked to original sources
PubMed1992

Self-audits. First step in TQM.

In the fall of 1987, West Paces Medical Center (WPMC), a 294-bed hospital in Atlanta, made a commitment to a new way of management, one that would make it a learning organization. The commitment would not be just to a higher quality of service, but would be a change in the way of doing business. The three components included in the hospital's quality improvement process were customer mindedness, process mindedness and statistical mindedness. West Paces employees concentrated on understanding customers and their needs, learning how they should perform each day to satisfy those needs, and routinely measuring the improvements made in daily processes. Led by Vicki S. Davis, director of quality resources, WPMC implemented, in November 1987, a program based on W. Edwards Deming's quality management method. One year later, 54 department managers had been trained in quality improvement. Davis shares her account of the quality improvement process on the following pages.

Georgia↗
PubMed1984

Marketing audit in group practice.

The marketing audit, whether large-scale or small-scale, will soon be critical to the success of every medical group practice. This dynamic process, in which the many components of a group's marketing efforts are analyzed, is examined from the perspective of ideal circumstances and unlimited resources, and more pragmatically, from the perspective of various-sized groups, with different resources and marketing talent. The audit components are prioritized, possible adaptations and combinations are presented, and reasonable implementation mechanisms, designed to address audit outcomes, are suggested.

Group Practice↗
PubMed2000

The surgical management of cervical carcinoma within the South West of England: progress through an audit loop. Gynaecology Tumour Panel.

OBJECTIVE: To define and use a minimum clinical dataset for prospective data collection in order to audit the surgical management of cervical cancer in the South West of England. To compare this data set with a retrospective audit allowing assessment of the quality of care offered to patients. DESIGN: Prospective collection of a defined dataset on paper forms which were put into a computerised database for analysis. Registrations validated against histopathology databases and hospital coding. SETTING: All 13 hospitals in the South West of England which participated in the retrospective audit. PARTICIPANTS: One hundred and sixty-five women with cervical cancer diagnosed in 1997. MAIN OUTCOME MEASURES: Distribution of cases by hospital and surgeon; workload of individual surgeons; adequacy and accuracy of FIGO staging; adequacy of histological information; and adequacy of surgery. RESULTS: There is a trend to centralisation of cancer care and radical surgery in the region. Prospective collection of data has dramatically improved FIGO staging with 92% of all cases staged. For cases greater than Stage Ia, 98% were staged suggesting that a target of 100% staging is feasible. The histological dimensions of tumours were not measured in a high proportion of cases (20% of tumour diameters and 28% of tumour thicknesses). Apparent inadequacies in surgical management are explored. In 10/165 cases (6%) inappropriate conservative surgery may have been unavoidable, suggesting that a quality standard of 95% for appropriate radical surgical management of cervical cancer can be achieved. An anatomically complete removal of pelvic node-bearing tissue, yielding greater than 10 nodes in more than 95% cases, should be achievable with each surgeon/pathologist achieving a mean of more than 20 nodes. CONCLUSION: Regional audit of cervical cancer management is feasible. It can be used to improve the quality of information on management and guide improved service provision.

England↗
PubMed1996

Overview: performance measures--the next generation.

Can our existing quality toolkit respond adequately to the unprecedented changes in the health care system? The guest editor highlights the lessons offered by the articles in the issue and reflects on the challenges in identifying performance measures and using the data for quality improvement.

Cost Control↗
PubMed1998

Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

Benchmarking↗
PubMed1998

Measuring risk in a children's unit: developing a local strategy for health, safety and risk management at Queen's Medical Centre, Nottingham.

This article demonstrates the Queen's Medical Centre approach to assessing and addressing risk in terms of Health and Safety within a busy children's unit. This article focuses on compartmentalising a large clinical area on two floors of a busy teaching hospital which become manageable sized subunits; each has a health, safety and risk management link person who attends the regular meetings to discuss key issues. These link people, with experience and training observe clinical areas within the zone, for hazards and potential hazards (risk inspection) and then calculate the hazard on a risk score. This is then risk assessed and all risk prioritised within the Children's Services Directorate Team. The author describes how a proactive approach to health, safety and risk management has brought about significant improvements, enhanced quality of care and improved morale and motivation of the nursing team.

Adult↗
PubMed1996

Continuous quality improvement reduces length of stay for fast-track patients in an emergency department.

OBJECTIVE: To demonstrate how continuous quality improvement (CQI) can identify rational and effective means to reduce length of stay for minor illness/injury in an ED. METHODS: A CQI team documented the process of fast-track (FT) patient flow and prioritized the causes of delay. In Phase I, two solutions were implemented. In this Phase II of the study, three changes were implemented, including expansion of the FT area, realignment to provide a full-time FT nurse, and a detailed, stricter triage classification. The outcome was assessed by examining the interval from presentation to release from the ED (length of stay; LOS). Differences were ascertained by analysis variance for consecutive FT patients not requiring radiography, ECG, or blood testing. Intervals from three pre-Phase II intervention 48-hour periods and one post-Phase II intervention 48-hour period were analyzed. RESULTS: Before the Phase I changes, the mean +/- SD LOS was 92 +/- 46 min. After the Phase I changes, the LOS was 67 +/- 31 min. After the Phase II changes, this was reduced to 57 +/- 34 min (p < 0.05). CONCLUSION: The formal application of CQI techniques in the ED can change patient flow and reduce LOS for FT patients.

British Columbia↗
PubMedDate not supplied

Use and abuse of the medical loss ratio to measure health plan performance.

This paper examines the use and abuse of the medical loss ratio in the contemporary health care system and health policy debate. It begins with a survey of the ways in which the medical loss ratio has been interpreted to be something it is not, such as a measure of quality or efficiency. It then analyzes key organizational features of the emerging health care system that complicate measures of financial performance, including integration between payers and providers, diversification of payers across multiple products and distribution channels, and geographic expansion across metropolitan and state lines. These issues are illustrated using medical loss ratios from a range of nonprofit and for-profit health plans. The paper then sketches a strategy for improving the public's understanding of health plan performance as an alternative to continued reliance on the flawed medical loss ratio. This strategy incorporates data on structure and process, service quality, and financial performance.

Accounting↗
PubMed1992

Reengineering: more than meets the eye.

Changes too often leave us shaken, unsteady and unable to perform, yet hospital reengineering usually means major, lingering change. Systematic reengineering, properly implemented, can reduce the strain.

Computer Simulation↗
PubMed1995

Continually improving governance.

What can governance do to ensure the continual improvement of organizational performance? This article explores this question, with particular emphasis on two central considerations. First, what constitutes good governance? Second, what are the sources of and opportunities for leveraging performance available to governance? We argue that focusing on strategy, evaluating performance, and developing the means to learn are the key venues available to governance for leveraging its own and organizational performance.

Documentation↗
PubMed1996

Change your performance measurements of there may be no future.

Performance measurements help to define and promote desired behaviors, activities, and attitudes within an organization. The "right" behavior must be consistent with and supportive of the strategies an organization has adopted to move it toward its preferred future. There must be vertical and horizontal integration of all performance measures to support consistent activities at all levels and in all functions. In today's world of rapid change and greater reliance on teams, there must be recognition of both individual performance and a new set of measurements to promote teamwork.

Employee Performance Appraisal↗
PubMed1996

Linking quality and performance. Quality orientation can be a competitive strategy for health care providers.

Many organizations are not convinced a quality orientation pays off and are looking for ways to link quality with performance. The authors' exploratory study found that a quality orientation is a differentiating factor between low-performing and high-performing general service hospitals. They also developed a quality scale to assess the performance implications of quality-based strategies in the health care industry. Successful health care organizations (1) develop a strategic quality orientation at the management level, (2) support the pursuit of quality at the contact level, and (3) monitor external customers' perceptions of quality.

Consumer Behavior↗