Showing papers in "Journal for Healthcare Quality in 1993"
96 citations
79 citations
TL;DR: Individual observations where events are infrequent can be charted on an individual's chart with moving range limits or by several alternative methods discussed in this article.
Abstract: Control charts are a basic tool for understanding variation in all healthcare processes. Control chart limits are not standards; rather, they divided variation into special and common cause, each of which requires a different management response. Each type of data--variables, count defect, or defectives data--requires a different type of chart (e.g., X bar and R, X bar and S; C or U; P or NP). Individual observations where events are infrequent can be charted on an individual's chart with moving range limits or by several alternative methods discussed in this article.
44 citations
20 citations
TL;DR: A quality improvement survey that examined the role nurses, patients, and patients' families expect the hospital chaplain to play when they use the chaplain's services suggests that patients and nurses sometimes see the role of the chaplains differently.
Abstract: The following article describes a quality improvement survey that examined the role nurses, patients, and patients' families expect the hospital chaplain to play when they use the chaplain's services. The results of the questionnaire suggest that patients and nurses sometimes see the role of the chaplain differently. There are times when nurses readily call a chaplain to help with a problem on a unit. There are other times when nurses are reluctant to ask for the chaplain, but patients would be most appreciative of the chaplain's presence. This article explores these situations and gives suggestions for ways to use a chaplain's expertise more effectively.
11 citations
TL;DR: The clinical path can improve satisfaction levels for patients, nurses, rehabilitation staff, and physicians by establishing a method of reinforcement for everyone involved in efficient delivery of care.
Abstract: Collaborative care is a system of patient care delivery that focuses on the achievement of outcomes within effective and appropriate time frames and resources. It addresses the entire episode of illness, bridging all clinical settings in which the patient receives care. Through the collaborative efforts of multiple caregivers, a plan of medical care is mapped out that results in a clinical path. The clinical path can improve satisfaction levels for patients, nurses, rehabilitation staff, and physicians by establishing a method of reinforcement for everyone involved in efficient delivery of care.
10 citations
TL;DR: As healthcare industry leaders and major customer groups attempt to establish measurable performance standards, the emergence of the National Committee for Quality Assurance (NCQA) has enhanced the ability of managed care organizations (MCOs) to demonstrate excellence by way of accreditation.
Abstract: Health maintenance organizations (HMO)s are taking center stage in our nation's move toward healthcare reform. Issues such as quality, cost, and access to healthcare are critical to consumers; the managed care industry provides care at a significantly more affordable cost than does traditional fee-for-service medicine. Although national surveys show that HMO members are extremely satisfied with the level of service and care they receive, managed care organizations still strive to demonstrate their commitment to quality. As healthcare industry leaders and major customer groups attempt to establish measurable performance standards, the emergence of the National Committee for Quality Assurance (NCQA) has enhanced the ability of managed care organizations (MCOs) to demonstrate excellence by way of accreditation.
7 citations
TL;DR: An interdisciplinary automated care‐planning system that interfaces with a preexisting data base demonstrated quality improvement in the documentation of patient education and compliance in meeting JCAHO nursing process standards.
Abstract: Care planning continues to be be an integral part of nursing, yet it is often criticized by professionals as time-consuming, repetitious, and inconsistent. This problematic situation prompted the development and implementation of an interdisciplinary automated care-planning system that interfaces with a preexisting data base. The advantages of the system include standardization of care, consolidated documentation, provision of patient education tools, shared responsibility during the patient's length of stay, and minimal cost. Evaluation of the system demonstrated quality improvement in the documentation of patient education and compliance in meeting JCAHO nursing process standards.
7 citations
7 citations
6 citations
TL;DR: Two basic questions helped the staff to establish the indicators within this project: what common variables could be measured within the high‐risk patient population, and by assessing these variables within the plan of care, could a link or association be made to reduce the incidence of the ileus complication?
Abstract: As healthcare providers, nurses in an acute care setting have the opportunity to review and evaluate the impact of their care delivery. The orthopedic nursing staff at a not-for-profit tertiary care community hospital in Michigan decided to undertake this challenge when they began to pursue a quality management (QM) review of patients admitted to their unit. The QM study targeted the elective surgical candidate admitted for a lumbar decompression with spinal fusion. The quality care issue focused on the complication known as an abdominal ileus. Two basic questions helped the staff to establish the indicators within this project: (1) what common variables could be measured within the high-risk patient population, and (2) by assessing these variables within the plan of care, could a link or association be made to reduce the incidence of the ileus complication?
TL;DR: Improvement will be seen in improved patient satisfaction, increased revenue as a result of more accurate billing, clearer understanding of costs and outcomes, better clinical documentation, and enhanced staff productivity.
Abstract: Total quality management (TQM) has the potential to help medical practices in the transition to a healthcare system that is more demanding in terms of both higher quality and lower cost. Incorporation of TQM principles, however, must be based on creating skills in the areas of teamwork, communication, and problem solving. The potential gain will be seen in improved patient satisfaction, increased revenue as a result of more accurate billing, clearer understanding of costs and outcomes, better clinical documentation, and enhanced staff productivity.
TL;DR: The authors describe the educational approach taken by one institution as it implemented the QI process in a facility that recently merged three acute care hospitals and explain the necessary commitment and structure for a successful QI program.
Abstract: Quality improvement (QI) is a practice now expected of the healthcare industry. The Joint Commission on Accreditation of Healthcare Organizations has incorporated continuous QI into its standards; furthermore, the implementation of QI is a major challenge facing healthcare institutions today. The authors describe the educational approach taken by one institution as it implemented the QI process in a facility that recently merged three acute care hospitals and explain the necessary commitment and structure for a successful QI program. The importance of the educational process cannot be overemphasized.
TL;DR: The issue of motivation is presented by presenting it as a process and Abraham Maslow's hierarchy of needs functions as the foundation of the process to demonstrate that satisfaction of the higher‐level needs of esteem and self‐actualization is required to produce true motivation.
Abstract: Quality management professionals confront the challenge of motivating others to participate in the improvement of patient care. Producing this motivation frequently proves problematic. This article addresses the issue of motivation by presenting it as a process. Abraham Maslow's hierarchy of needs functions as the foundation of the process. A process model is used to demonstrate that satisfaction of the higher-level needs of esteem and self-actualization is required to produce true motivation. By understanding the process of motivation, we may become more effective in improving patient care.
TL;DR: Quality improvement monitoring of universal precautions at the author's facility appeared to indicate that although personal protective equipment is always available and staff are increasingly aware of the need to protect themselves, compliance with medical center practices remained inconsistent.
Abstract: Quality improvement (QI) monitoring of universal precautions at the author's facility appeared to indicate that although personal protective equipment is always available and staff are increasingly aware of the need to protect themselves, compliance with medical center practices remained inconsistent. The use, throughout the QI program at the medical center, of appropriate indicators to monitor for sharps incidents and body fluid splashes continues to highlight the need for innovative activities to help staff achieve more optimal compliance with medical center policies. Causes for noncompliance are examined using a problem-solving approach accompanied by various continuous quality improvement (CQI) tools. Root causes are explored with the intention of providing support rather than blame for the findings. Outcomes of activities that were implemented to improve compliance with medical center policies and practices are highlighted.
TL;DR: Healthcare managers have a responsibility to promote quality communication among healthcare workers and formal negotiations, mediation, and assertiveness techniques all are very effective in resolving conflict.
Abstract: Unresolved conflicts between healthcare associates can lead to decreased teamwork and result in mistakes. Because the goal of healthcare organizations is to provide quality care, it is in the organization's best interest to avoid these damaging results. Healthcare managers have a responsibility to promote quality communication among healthcare workers. Formal negotiations, mediation, and assertiveness techniques all are very effective in resolving conflict.
TL;DR: How the Health Care Financing Administration calculates the actual and predicted death rates is explained, details on a method by which hospitals can determine if their actual death rates are significantly better or worse than HCFA's predicteddeath rates are given, and a strategy for identifying opportunities for improvement is suggested.
Abstract: Each year, hospitals are provided data on actual and predicted mortality rates for their Medicare patients. This article explains how the Health Care Financing Administration (HCFA) calculates the actual and predicted death rates, gives details on a method by which hospitals can determine if their actual death rates are significantly better or worse than HCFA's predicted death rates, and suggests a strategy for identifying opportunities for improvement when actual mortality rates are significantly different from predicted rates.
TL;DR: A quality process in action is described and how teamwork and commitment can produce the desired outcome: customer satisfaction is demonstrated.
Abstract: In a quality environment, improvement starts with a commitment from top management and flows down to all levels in the organization. One of the many ways in which an organization can demonstrate this commitment is by first listening to customers and then taking actions to improve services based on the identified needs of those the organization serves. This article describes a quality process in action and demonstrates how teamwork and commitment can produce the desired outcome: customer satisfaction.
TL;DR: In this article, a combination of early, extensive physician involvement and subsequent multidisciplinary interaction will ensure the development of and adherence to cost-effective, high-quality patient care.
Abstract: Physicians are becoming increasingly aware of how their practice patterns affect the financial viability of their practices and of the hospitals in which they work. Programs of diagnosis-related group (DRG) analysis may be used not only to educate physicians but to provide data for physician-directed efforts to reduce variations in practice patterns and deal with physicians whose practice habits may be counter to cost-effective, high-quality care. A combination of early, extensive physician involvement and subsequent multidisciplinary interaction will ensure the development of and adherence to cost-effective, high-quality patient care.
TL;DR: A three‐phase implementation approach was identified that included conceptual planning, initial training and goal setting, and full‐scale implementation of the total quality management plan in a district hospital setting.
Abstract: A total quality management (TQM) plan has been instituted by the United States Air Force Flight Test Center at Edwards Air Force Base. To determine the feasibility of implementing the same basic TQM plan in a district hospital, a joint industry-government team was established. Five areas of concentration were selected for review: infrastructure, methodology, training, strategic plan, and a "Quality Bill of Rights." The TQM "infrastructure" is intended to match and complement the existing organizational structure and chain of command, not to supplant it. As the overall plan seemed well-adapted for implementation in a hospital setting, a three-phase implementation approach was identified that included conceptual planning, initial training and goal setting, and full-scale implementation. Each phase is described in terms of objectives, staffing, and timing requirements.
TL;DR: The dual duties of loyalty and care and the legal and regulatory pressures to contain costs and assure quality, the role of the governing board is increasing in complexity and importance.
Abstract: With the dynamic movement toward healthcare reform, increased attention is being focused on the duties and legal liabilities of hospital governing board members. Given the dual duties of loyalty and care and the legal and regulatory pressures to contain costs and assure quality, the role of the governing board is increasing in complexity and importance.
TL;DR: The typical patient representative is a female between 30 and 50 years old, with a bachelor's degree and about 6 years of experience as a patient representative, and the majority of the respondents held a positive view of their role as the liaison between the patient and the administration.
Abstract: A national survey of hospital patient representatives was conducted to identify and analyze basic demographic and occupational data for patient representatives. A total of 387 randomly selected U.S. hospitals were surveyed with a response rate of 66% (256 hospitals). Only 172 responses were completed appropriately. Of those who responded appropriately, we found the typical patient representative to be a female between 30 and 50 years old, with a bachelor's degree and about 6 years of experience as a patient representative. The majority of the respondents held a positive view of their role as the liaison between the patient and the administration as well as a facilitator for patients, families, staff, and administration problem solving. Several of the respondents stated that patient representatives strive to meet the needs and expectations of patients through their role as liaison with the administration. This role has a positive and crucial impact on improving the quality of care in healthcare organizations.
TL;DR: Through the use of continuous quality improvement (CQI) tools and the development of a CQI team, the author's facility was able to implement the important process of having patients complete advance directives.
Abstract: Recognition of patients' rights is growing in the healthcare field in this country, as is recognition of the need for advance directives. Advance directives are documents that indicate treatment choices and preferences made by an individual while he or she is still competent. Through the use of continuous quality improvement (CQI) tools and the development of a CQI team, the author's facility was able to implement the important process of having patients complete advance directives.
TL;DR: This article will describe how nursing standards of patient care and standards of nursing practice have been developed and integrated into a nursing department's documentation plan and quality improvement program.
Abstract: With the revision of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) nursing standards in 1991, a new emphasis has been placed on the nursing standards of patient care and the standards of nursing practice (Claflin, 1990). These standards provide the basis for nursing care and the foundation for nursing's contributions to an interdisciplinary quality improvement program. This article will describe how nursing standards of patient care and standards of nursing practice have been developed and integrated into a nursing department's documentation plan and quality improvement program.
TL;DR: The roots of fear are discussed, how fear impedes improvement efforts, and methods to identify and eradicate fear are described.
Abstract: Even the most well-intentioned healthcare managers will encounter roadblocks to successful implementation of continuous quality improvement as long as fear remains pervasive in the workplace. This article discusses the roots of fear, explains how fear impedes improvement efforts, and describes methods to identify and eradicate fear.
TL;DR: With the dedication of personnel who assist in the essential infection control function, the ICN can maximize protection of the clients and the staff by reducing their exposure to HIV and hepatitis B.
Abstract: Due to the potential for increased HIV and hepatitis B transmission to all healthcare workers, the regulations and guidelines set forth by federal, state, and local government agencies for the prevention of these diseases and the protection of those in the healthcare industry are constantly updated. Because of the magnitude of these demands, the role of the infection control nurse (ICN) has become vitally important. The proper utilization of valuable staff resources will be a positive force in promoting the necessary quality of care to employers, employees, and clients. With the dedication of personnel who assist in the essential infection control function, the ICN can maximize protection of the clients and the staff by reducing their exposure to HIV and hepatitis B.