Managing the unforeseen and unknown is the theme of a timely report from British Columbia's Ministry of Health Services. The province of British Columbia confronted 2 major emergencies. One of these, the emergence of a new disease, severe acute respiratory syndrome, had to be dealt with in the presence of a worldwide knowledge vacuum. Because of the new disease's special characteristics, plans that were in place for handling traditional epidemics would not have been effective. The other emergency, forest fires at the wildlife-urban interface, is a more or less predictable phenomenon in heavily forested and urbanizing British Columbia, with tested management plans in place. Dauphinee and Lynch, in their article, "Quality Management Case Studies in Health Service Emergencies: SARS and Wildland-Urban Interface Fires," explore the organizational issues that are germane to the management of the two 2 types of emergency.
Everyone agrees that a hospital's governing body, its board, bears ultimate responsibility for the quality of care rendered in the hospital, yet recognition and implementation of this responsibility continue to be far from universal. In his challenging article, "A Call for Board Leadership on Quality in Hospitals," Kanak Gautam analyzes twelve 12 common causes of the disconnect between board commitment and patient care quality. Then he presents a practical, thoughtfully developed 13-point agenda or road map designed to guide a hospital board as it acknowledges and assumes its responsibility for the quality and safety of patient care.
"Pay for Performance," or "P 4 P," is currently a hot topic. In the course of their exhaustive study of the concept, Norbert Goldfield and his coauthors explore the attributes of a successful pay for performance program. They challenge the current physician and hospital payment systems, and they charge that improvement is needed in the care provided by specialists. The authors argue that health care providers must be at financial risk for quality improvement. In addition, they hold that a good pay for performance system will use a single cost score and a single quality score. They urge greater consumer participation in the choice of health care services, and they want the pay for performance measures made publicly available.
A review of the last 12 years of Quality Management in Health Care reveals the fact that this journal has published some pioneering articles during its history. One such article, "An Introduction to Critical Paths," by Raymond J. Coffey, Janet S. Richards, Carl S. Remmert, Sarah S. LeRoy, Rhonda R. Schoville, and Phyllis J. Baldwin, was first published in the Fall 1992 issue of QMHC. The article is reprinted at this time because the processes detailed in it are being used to an ever-increasing extent in the assessment and improvement of patient care today.
Jean Gayton Caroll, PhD
Editor