Quality Management in Health Care (QMHC) was founded more than 20 years ago with the idea of providing a forum for the systematic exploration of ways to measure the health care delivery system as a social system, viewing high-quality patient care as the product of the organization and its components. From the beginning, much of the research reported in the journal borrowed its methodology from studies of industrial productivity and efficiency, with high-quality outcomes an integral part of the productivity calculation. Over time, increasing emphasis has been placed on hospitals and other health care organizations as social systems. This emphasis is again reflected in QMHC's current issue.
The construct of organizational coherence as a state characterized by "a core set of organizational cultural attributes independent of context and setting" is presented and analyzed by Ann Scheck McAlearney, Darcey Terris, Jeanne Hardacre, Peter Spurgeon, Claire Brown, Andre Baumgart, and Monica E. Nystrom. Reporting on 5 pilot studies, they suggest that 3 components of organizational coherence-people, processes, and perspective-influence quality-directed efforts in health care organizations.
The development and pilot testing of a patient and family experience-of-care survey, designed for the use of community cystic fibrosis centers in evaluating the care provided to patients with cystic fibrosis and their family members, are reported by Karen Homa, Kathryn A. Sabadosa, Eugene C. Nelson, William H. Rogers, and Bruce C. Marshall. The authors cite an additional dimension of quality-the experience of care-to supplement the customary clinical process and outcome measures used in outcome evaluation.
In a hospital, it is expected that a clinical protocol disseminated to all units that perform the procedure addressed is to be followed as uniformly as possible by each unit that carries out the procedure in question. In the winter 2013 issue of QMHC (22:1), Pavani Rangachari explored the dynamics involved at the unit level in carrying out this expectation. In this spring 2013 issue (22:2), Pavani Rangachari, Peter Rissing, and R. Karl Rethemeyer follow up with a study of the contextual hurdles that may exist between dissemination of a protocol (such as a best practice) and its perfect implementation at the level of the individual patient. They point to the value of implementation research in preventing performance discrepancies.
Developing and implementing standardized order sets to more reliably follow clinical guidelines is the subject of a report by Kunut Kijsirichareanchai, Saowanee Ngamruengphong, Ariwan Rakvit, Kenneth Nugent, and Sreeram Parupudi. In their study of patients with liver disease, they found that adherence to the guideline's provisions appeared to be enhanced with the use of the standardized order set.
Further emphasis on health care as a social system is provided in the Ann-Charlott Norman, Lena Fritzen, and Marianne Lindblad Fridh discussion of the role of the clinical microsystem concept in learning. They point to the vital role of societal context in the learning process.
Response delay in a secure e-mail messaging system used at a large medical center by primary care patients to communicate with their physicians was analyzed by James E. Rohrer, Frederick North, Kurt B. Angstman, Sara S. Oberhelman, and Matthew R. Meunier. Among their findings was a high rate of delayed response on weekends. The authors pose several possible remedial measures for the observed patterns of delayed responses.
-Jean Gayton Carroll, PhD
Editor