The ability to distinguish quality management investigation from clinical investigation is vital to hospitals as they perform quality assessment studies to comply with the policies of Centers for Medicare & Medicaid Services and Joint Commission on Accreditation of Healthcare Organizations. The regulations applied by institutional review boards do not clearly distinguish the two types of research in terms of criteria. Nate Johnson, Lee Vermeulen, and Kelly M. Smith surveyed institutional review boards throughout the country to determine whether local guidelines making the distinction existed. On the basis of their findings, they developed and present a new decision algorithm designed to provide guidance to institutional review boards and quality management committees in differentiating the two types of study.
Thomas K. Ross argues that improving patient care is a task that should not be hampered by a lack or misunderstanding of quality management techniques. He points to the lack of training in quality management techniques received by health care workers at all levels. The author sets about the job of remedying this gap in health care workers' knowledge and training. He uses the case study approach in applying the procedures of statistical process control to a problem in conforming to a schedule for medication administration. He believes that understanding statistical process control and how it works in reflecting performance can change the attitudes of employees toward their work, providing a greater sense of ownership.
Patients' waiting times for services in health care centers and clinics strongly influence patient satisfaction, and are usually viewed as one of the dimensions of quality of care. They are also very popular subjects of measurement and analysis. Shiow-Ru Chang, Yueh-Chih Chen, and Kuang-Ho Chen study waiting time and satisfaction issues in a pediatric outpatient clinic in which the sequential steps ("stops") follow a clearly identifiable pattern. They measure the relationship among actual time spent waiting for each service in the sequence, the perceived time, and the level of patient dissatisfaction. The authors found that the actual time spent at each stop could be estimated on the basis of the perceived time and dissatisfaction level expressed by the subject at all preceding stops. They conclude that an index profile of estimated actual time spent at each stop can be generated from the perceived elapsed time of, and expressed dissatisfaction with, each stop. The authors argue that having such a profile may help hospital management to evaluate the quality of outpatient department operations and could possibly play a part in calculating personnel requirements.
Using a case study approach, Beata Kollberg and Mathias Elg review and analyze the experiences of 6 different project groups within the Swedish health care system who were trying out the flow model method for measuring and evaluating performance with reference to writing times. A number of features of hospital operations were identified as challenges, or possible impediments, to the development of effective performance measurement systems in the industry. The authors conclude that there is a need for better communication and understanding between management personnel and line personnel of the objectives and processes of performance measurement and improvement.
As is true with respect to many diagnoses, patients with a particular diagnosis may be treated by members of more than one specialty. Patients with thyroid cancer usually are treated by general surgeons and otolaryngologists. Robert Takesuye, Stacy Brethauer, J. Kim Thiringer, Robert J. Riffenburgh, and Peter S. S. Johnstone analyze the respective practice patterns of members of these 2 specialties in treating patients with thyroid cancer. The authors study the care of a sample of 136 of the 178 patients who had undergone partial or total thyroidectomy for cancer during the study period at the Naval Medical Center, San Diego. They measure and compare outcome measures, including inpatient hospital days, estimated blood loss, number of patients with temporary hypoparathyroidism, and duration of hypocalemia, for the 2 groups of surgeons.
Peter A. Chyka and Stephen L. Winbery study the level of compliance with a revised set of poison control center guidelines for the use of ipecac syrup, gastric lavage, cathartics, and activated charcoal in gastric decontamination following the ingestion of poisons. They point out that the broad range of variation among poison control centers in their utilization of ipecac syrup for poison ingestion by young children has made it difficult to establish benchmarks. Nonetheless, the role of poison control centers in making treatment recommendations gives weight to any revisions they make in guidelines. The authors study the effect on patient outcomes following a change in guidelines for gastrointestinal decontamination of poison exposures at a poison control center with a continuous performance improvement process in place to monitor the effectiveness of the recommended change.
As Megan-Jane Johnstone and Olga Kanitsaki point out, the occurrence of preventable adverse events and clinical errors in patient care is universally acknowledged to be a matter of extreme importance in public health. With reference to nurses' accountability for patient safety, the authors argue that corporate failure to provide new graduate nurses with training in clinical risk management (CRM) early in their employment, and to reinforce the training, significantly hinders their ability to manage risk. In their study, Johnstone and Kanitsaki explore the acquisition and development of nurses' knowledge and understanding of the principles, processes, and application of CRM; the impact of nurses' CRM capabilities on the safety of patients during their first postgraduate year; and the effectiveness of management in providing graduate nurses with CRM education.
A case study featuring the role of a college of nursing in establishing a formal apparatus for the evaluation of patient care quality is presented in a series of articles by members of the college's faculty. These authors offer an overview of the quality-directed journey undertaken by Resurrection Health Care Systems' West Suburban College of Nursing, based at West Suburban Hospital in Oak Park, Ill.
The subject of this issue's interview is Richard G. Cowart, JD. Dr Cowart is a partner-shareholder in the firm of Baker, Donelson, Bearman, Caldwell & Berkowitz, of Nashville, Tenn, and Jackson, Miss. He serves as Chairman of the firm's Health Law Department and member of its Board of Directors.
Mark Best, MD, MBA, MPH, reviews Ethics in Health Services Management, by Kurt Darr, JD. Dr Best is an Associate Professor at the Lake Erie College of Osteopathic Medicine-Bradenton, in Bradenton, Fla.
Jean Gayton Carroll, PhD, Editor