Carolynn V. Nuwinski and Ross M. Mullner examine the current state of commitment of managed care organizations (MCOs) to the quality of patient care. They note that MCOs have typically focused their efforts on pay-for-performance, "largely ignoring patient safety efforts," and that their policies have been perceived as contributing to poor quality in health care.1 The authors point out that few MCOs have committed significant resources to the improvement of patient safety. Pointing to MCOs' utilization management practices, they discuss the potential role of such practices in contributing to poor care and to lapses in patient safety. In examining solutions to the problem, they point to the high degree of leverage that MCOs exercise in their relationships with providers. They strongly recommend that MCOs use this leverage to require that providers support and participate in ongoing education in patient safety concepts and practices.
A combination of ISO 9001-2000 and Six Sigma was used by the Red Cross Hospital in Beverwijk, The Netherlands, to achieve its objectives of growth, efficiency, and quality enhancement over a 5-year period. The progress of this strategy is reported by Jaap van den Heuvel, Ad J. J. C. Bogers, Ronald J. M. M. Does, Sandra L. van Dijk, and Marc Berg. They conclude that heightened productivity is not inconsistent with improvements in the quality of care.
The potential for improvements in patient safety afforded by the use of electronic ordering systems and patient records is universally acknowledged. Nir Menachemi, Stephanie Cruz Lee, Janet E. Shepherd, and Robert G. Brooks argue that obstetrician-gynecologists stand to reap significant benefits from the use of electronic health records (EHRs). They analyze the use of EHRs in Florida ambulatory care settings by obstetrician-gynecologists in comparison with their use by primary care physicians. Among their findings was that EHR use was significantly lower among obstetrician-gynecologists than among primary care physicians. Another (possibly related) finding was that obstetrician-gynecologists had significantly fewer program functions available to them than did primary care physicians. The authors discuss the implications of program design, present and future, for the quality and safety of patient care.
Jeffrey J. Borkardt and Farrokh Alemi have previously discussed the use of nonparametric control chart approaches in health care quality management in the pages of QMHC.2-4 In this issue, Jeffrey J. Borkardt, Joan Herbert, Deza Borkardt, Michael R. Nash, Harriet Cooney, and Sue Hardesty discuss the need for a distribution-free control chart technique that can handle a short stream of data characterized by the presence of autocorrelation. The authors analyze the effect of autocorrelation in such a data stream and its potentially distorting effect on estimated control limits in, and inferences drawn from, a control chart. They present a version of Tukey's nonparametric control chart technique with an adjustment for autocorrelation.
Reducing emergency department waiting time continues to be a compelling issue with implications for patient safety and patient satisfaction. While the emergency department was originally designed for the immediate care of seriously ill or injured patients, today it also serves as a primary care site for large numbers of "low acuity" patients, a situation contributing to emergency department delays. In the words of the Institute for Healthcare Improvement, "Unnecessary delays contribute to poor medical outcomes, frustrated and unhappy patients, increased cost from waste and rework, potential harm, and stress for both patients and caregivers."5 The formation of Fast Track units is suggested as a way of speeding up the needed emergency services to patients whose conditions are critical. Scott W. Rodi, Maria V. Grau, and Caroline M. Orsini report on a study involving such a unit, using triage and the development of separate streams of care. They conclude that focusing existing resources on the needs of a specific patient population can significantly improve patient satisfaction and reduce length of stay for low-acuity patients.
With the Joint Commission on Accreditation of Healthcare Organizations emphasizing the need for patient health education, it has become increasingly important for hospital staff to document the fact that such educational efforts have been made. Barbara A. Leisner and Diane E. Wonch report on a Veterans Administration program designed to create and monitor a user-friendly electronic medical record process for documenting the details of patient education.
Predictive research involves, among other things, choosing the most effective statistical model for use with the available data. Anna-Maria Mouza of the Technological Educational Institute of Serres, Greece, addresses this subject in "A Note Regarding the Projections of Some Major Health Indicators." Using survivorship data from Greece and Portugal, Ms Mouza evaluates predictive models, including the Autoregressive Integrated Moving Average (ARIMA) and plain regression models.
On the intuitive level, it would seem that high levels of employee morale and job satisfaction must be associated with positive outcomes in patient care. Presumably, job satisfaction and employee motivation are linked to fostering effective service. Using a database from 88 hospitals, Elena A. Platonova, S. Robert Hernandez, Richard M. Shawchuk, and Kelly M. Leddy study the impact of the various aspects of the employment relationship on the job satisfaction of hospital workers.
Jean Gayton Carroll, PhD, Editor
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