For several years consumers of health care services have shown an increasing interest in trying to ascertain the quality of the health care services available to them. One major deterrent in this endeavor is the confusing array of measures available for assessing the quality of care. In his challenging editorial, "The Measure of Quality," Irwin Press addresses the issues surrounding the ways in which we try to measure the quality of care and the value of the common measurements for public utilization. He discusses outcome and process measures, risk-adjustment issues, and how a satisfactory outcome is defined. Press calls for the development of more precise definitions of measures of health care quality.

Measurement is also the theme of Farrokh Alemi's presentation of Tukey's Control Chart and its uses. The author compares Tukey's Control Chart with the widely used Moving Range chart, pointing out the former's advantage in handling small data sets, a significant point in connection with hospital studies of patient management. In addition, Dr Alemi comments that a Tukey's Control Chart can be developed by an individual with no statistical background, something that just might serve to expand the pool of hospital personnel who could be deployed in the quality management program.

Leadership issues and the comprehensive scope of quality management efforts and systems are examined from various points of view in several of the articles in this issue of QMHC. Aleece Caron, Paul Jones, Duncan Neuhauser, and David C. Aron report on the effects of the 2 alternative approaches-the diagnosis-specific and the organizational-on the assessment and improvement of quality. The choice is made by the organization's leadership. They conclude that "Improvement in many areas suggests strong leadership that focuses on organizational improvement."1 The source of the data these authors used was the Greater Cleveland Health Quality Choice (GCHQC).

Faten Fahad Al-Mailam of the Hadi Clinic in Howally reports on a study conducted in Kuwait, addressing the impact of the transactional leadership style on quality as compared with that of the transformational style. He points out that the difficult choices that must be made by hospital leadership require proactive leadership that will facilitate the overarching organizational change that is a prerequisite for enduring quality improvement. He observes that the transformational leadership style can be successfully transferred across international borders to a Middle Eastern setting.

Factors contributing to patient satisfaction are many and varied, and various measurement approaches are discussed by authors in this issue of QMHC. Elizabeth Ablah, Ruth Wetta-Hall, and Charled A. Burdsal studied the levels of satisfaction reported by a sample of patients and their health care providers who were participating in Project Access, a program that connects low-income, uninsured adults to hospital services and specialty care. Both patients and providers reflected the importance of feeling respected as a component of satisfaction. In discussing the value of identifying what they call the "drivers of satisfaction" among low-income populations, the authors suggest the importance of these findings in shaping health care delivery policy.

Same-day scheduling, or open access, is a vital factor in patients' satisfaction with primary care. This subject is explored by Karen Homa, who presents an illustrative case study and an analysis of the Open Access model developed by Murray and Tantau.

Sabina B. Gesell and Robert J. Wolosin report on a study of patient satisfaction in a sample of 10,000 patients hospitalized for heart attack, heart failure, stroke, pneumonia, or childbirth in 210 hospitals. Among other findings, patients treated for different conditions expressed different levels of satisfaction with their care. On the basis of the findings, the authors identify 4 issues as quality improvement priorities. These are response to complaints; sensitivity to the inconvenience of hospitalization; inclusion of the patient in decision making; and addressing the patient's emotional and spiritual needs.

Bradford Kirkman-Liff reports on a project carried out by Banner Health Care called "The Care Management and Organizational Performance Initiative." The Banner system includes 19 hospitals, 6 long-term care centers, and a number of family health clinics, home care programs, and home medical equi- pment providers. The author calls attention to the importance of information sharing, collegial support, data quality, the expansion of statistical analytical capacity at care sites, distribution of knowledge products, and the strategic deployment of certain operational units referred to as Functional Teams and Work Groups in effective care management.

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