Quality circles: a management strategy that works.
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Although quality circles have been successfully introduced into U.S. hospitals, they have not fared well in Japan. In light of the fact that Japanese hospitals have within their organizational structures many elements considered a precondition for the success of quality circles, their hesitance in adopting this innovation deserves attention. It is useful to examine the reasons quality circles may be more feasible in the United States than in Japan.
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Use of a survey and employee focus groups to solve problems in a hospital pharmacy department is described. All pharmacy staff members were asked to identify perceived problems; 33% completed the written questionnaire. Managers clarified the survey comments and ranked problems for priority, using nominal group technique. Focus groups were formed to address appropriate problems; for each focus group supervisors selected two pharmacists and two technicians who volunteered or were nominated by peers. A pharmacy resident was the facilitator for each group. Meeting weekly for one hour, each group defined problems, set priorities, gathered ideas, analyzed possible solutions, and proposed a solution to the pharmacy supervisors. One group proposed guidelines for staff scheduling and seven-days-on, seven-days-off rotations for night pharmacists; the other proposed a structure for technician training in the department and a required orientation and training schedule for all employees. This process required more staff time than unilateral management decisions would have, but the solutions were acceptable to all levels of staff members. The focus group process was effective in identifying and solving problems at this hospital. Routine resurveys will be conducted and new focus groups will be formed to address problems that would benefit from analysis and consensus by employees.
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