In their report on the effect of organizational and cultural changes in providing safe patient care, Odwazny, Hasler, Abrams, and McNutt display unusual candor. Referring to the organizational setting, they state that "[horizontal ellipsis] the organizational culture beyond the DOM [Department of Medicine] was not well suited to the open exchange of ideas needed to improve patient care in a complex environment." These authors then go on to describe how the department formed a Patient Safety Committee with a membership that included chief residents and representatives of medical informatics, nursing, pharmacy, utilization management, quality assurance, and risk management. The department found that the formation and activities of the multidisciplinary Patient Safety Committee had the effect of stimulating communication among disciplines. Patient safety issues and failures were analyzed in a collegial atmosphere. The authors report on the substitution of a safety-oriented approach for the previous culture of blame.
Quantifying the relationship between patient safety and residents' perceptions of the causes and impact of medical errors is the subject of the article by Nir Menachemi, Richard M. Shewchuk, Stephen J. O'Connor, Eta S. Berner, and Jeroan J. Allison. To better understand residents' perceptions of medical errors, the researchers first developed a 40-item survey questionnaire reflecting issues arrived at in earlier focus group discussions. Following factor analysis and regression analysis, the authors found that the findings loaded on 10 selected factors. In terms of methodology and relevance to current efforts to improve patient safety, this is a very important study.
As Robert J. Wolosin observes, the degree of satisfaction of a patient with his or her care depends in large part on the patient's expectations of the processes and outcomes of that care. While patient satisfaction has been used as one of the measures of hospital quality for over a decade, there have been few studies of patient satisfaction in the family practice setting. It has been difficult to identify and validate service issue variables for use in measuring patient satisfaction, resulting in heavy reliance on such factors as office waiting time and time spent with the doctor. In the study reported on here, the researchers investigated (1) patient satisfaction with care processes and providers, (2) overall satisfaction by patient age and gender, (3) gender differences in satisfaction ratings, and (4) areas that indicate relative dissatisfaction with care.
In the Fall 2004 issue of the Quality Management Health Care (QMHC) (13:4), Farrokh Alemi proposed the construction and use of Tukey's Control Chart in tracking and analyzing data in quality assessment and improvement programs. 1 Borckardt and his colleagues, in QMHC's Spring 2005 issue (14:2), presented a response to Dr Alemi's proposals, arguing that, when observations are not independent, the Tukey approach demonstrates an unacceptable type I error performance. 2 Continuing a very informative and interesting scholarly debate, Alemi and Baghi respond in this issue of QMHC.
Access to good care is one of the several components of high-quality health care, and any form of discrimination in the provision of needed health care services interferes with the quality of care. To the extent that it interferes with good care, an attitude such as ageism calls for investigation and correction. Using a survey instrument designed to measure the perceptions and attitudes of a sample of health care professionals toward 3 different cohorts of elderly people, Gunderson, Tomkowiak, Menachemi, and Brooks found that physicians in their sample who routinely provide care for the elderly demonstrated ageist perceptions. The authors state that the identified trends are important because they may directly influence the quality of care that the elderly population receives.
Stone, Schweikhart, Mantese, and Sonnad hypothesized that ineffective implementation strategies can hinder the use of clinical practice guidelines. They analyzed the effects of physicians' preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments. Working with a sample of 500 physicians, the authors used paired sample t tests and Tukey's method of comparisons to determine the relative ranking of physicians' preferences in guideline implementation. The authors conclude that guideline use by physicians can be encouraged through the application of their preferred modes of implementation.
The role of the health care consumer in promoting quality care should not be overlooked. Marilyn H. Ohrmann, Marsha L. Lesley, and Jillon S. VanderWal report on an innovative project in educating consumers about patient safety and health care quality. Their objective was to teach consumers accessing health care Web sites how to evaluate the information supplied on these sites. With the use of computers in 2 public libraries in the Detroit area, the project participants were taught critical evaluation skills and how to apply them to the health care Web sites they viewed.
The development and impact of a formal quality improvement program in a Canadian long-term care facility are described in a report by Schmidt, Comm, and Beatty. The dimensions addressed in the program include clinical outcomes, issues, and improvements; resident and family opinions and community relations; utilization management outcomes; human resource issues; program evaluation; and environmental issues.
Jean Gayton Carroll, PhD, Editor
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