Formerly Director of Ancillary Services at the Naval Medical Center in San Diego, Dr Peter A. S. Johnstone has recently retired from the Navy and assumed the position of Professor of Radiation Oncology and Hematology/Oncology at Emory University School of Medicine. Drawing on his Navy experience and his insights, Dr Johnstone discusses certain of the US Navy's organizational characteristics that he believes underlie an effective healthcare quality management system in a very large, complex organization. Pointing to the necessity in today's high-tech Navy to entrust equipment of mind-boggling complexity to young, relatively inexperienced personnel and to how the Navy overcomes the potential problems, he endorses simplifying, or "sailorproofing," all kinds of complex systems and mechanisms, including quality management. He points to the effects of the Navy culture as it influences the application of quality management philosophy and concepts.
In an article previously published in this journal (Qual Manag Health Care 2003;12(1):5-19), Marilyn Hart, James W. Robertson, Robert F. Hart, and Kwan Y. Lee addressed the use of risk-adjusted control charts. In their new article, "Application of Variables Control Charts to Risk-adjusted Time-ordered Healthcare Data," the authors now discuss a similar class of control charts applicable to types of variables data that are often skewed. The application of risk-adjusted data in addition to actual performance data characterizes the variables control charts. The authors believe that the resulting charts should decrease the occurrence of both type I and type II errors.
In their timely paper, "SARS: A Quality Management Test of Our Public Health Safety Net," Ron Zapp, Mel Krajden, and Tim Lynch evaluate the methodology and results of the response of the BC Centre for Disease Control (BCCDC) to the 2003 outbreak of severe acute respiratory syndrome (SARS). As they point out, the spread of SARS and the BCCDC's response occurred "under international scientific and media scrutiny over a 4-month period," with the need for expeditious and authoritative decision making. They emphasize the critical importance of the team collaboration between laboratory science and epidemiology in the overall success of the Centre's effective response.
At the Huddinge University Hospital in Stockholm, Sweden, teams composed of clinicians and administrative staff identified quality problems and collaborated in carrying out 24 process improvement projects. Johan Thor, Bo Herrlin, Karin Wittlov, John Skar, Mats Brommels, and Olle Svensson describe and evaluate the process and its results. In their article, "Getting Going Together: Can Clinical Teams and Managers Collaborate to Identify Problems and Initiate Improvement?" they point to the dilemma that arises from the fact that problems need to be locally identified, while the significance of the problems is assessed in terms of their impact on the larger organization.
In connection with an organizationwide effort to enhance care efficiency at Montefiore Medical Center in New York, Eran Bellin and Gary Kalkut used an extension of the Cox proportional hazard model to analyze the contribution to length of stay of only those patient-days that occurred within a specified timeframe and on a specified clinical service. They report on the test of time-slice analysis in their article "Is Time-Slice Analysis Superior to Total Hospital Length of Stay in Demonstrating the Effectiveness of a Month-long Intensive Effort on a Medicine Service?" They conclude that the "time slice" analytical model presents clear superiority over the conventional analysis of length of stay.