Showing papers in "Quality management in health care in 1993"
752Â citations
TL;DR: Results from a study of 10 hospitals trying to develop better ways of providing patient-centered care found that academic medical centers and other teaching hospitals tended to have more problems than nonteaching hospitals, but there was great variability within hospital types.
Abstract: This article describes the early activities of the Picker/Commonwealth Program for Patient-Centered Care and reports results from a study of 10 hospitals trying to develop better ways of providing patient-centered care. Reported problems were relatively infrequent, but several problems occurred as often as in an earlier national study of acute care hospitals. Academic medical centers and other teaching hospitals tended to have more problems than nonteaching hospitals, but there was great variability within hospital types. The article discusses ways patient reports can be used to improve the quality of hospital care.
115Â citations
107Â citations
TL;DR: This article outlines the use of the integrative group process and the results and discusses how these results were used to create a computer program designed to help women with breast cancer and their families.
Abstract: Patient needs have long been elicited only through the use of customer satisfaction surveys, which unfortunately are not designed to obtain the in-depth information needed to guide the improvement of health care services. Through the use of the integrative group process and the help of many patients and hospital staffs, we developed a needs assessment survey for women with breast cancer. This article outlines this process and the results and discusses how we used these results to create a computer program designed to help women with breast cancer and their families.
70Â citations
32Â citations
TL;DR: Design principles to guide the development of patient-based measurement systems are provided; a specific, yet flexible method for designing and testing patient- based measurement systems; and real-world examples of patients-based systems that offer a glimpse of the future are provided.
Abstract: Continual improvement of health care can be accelerated and evaluated by the development of patient-based measurement systems. This article provides (1) design principles to guide the development of patient-based measurement systems; (2) a specific, yet flexible method for designing and testing patient-based measurement systems; and (3) real-world examples of patient-based systems that offer a glimpse of the future. These systems can provide direct measures of successes and failures, strengths and weaknesses, and improvements and declines in the provider's capacity to produce desired health outcomes at a cost that represents value.
30Â citations
TL;DR: This tutorial explains basic concepts of quality improvement project models and shows how to use them to examine and enhance the understanding of some widely used models.
Abstract: Quality improvement teams function best when all team members agree to a unifying model to guide their effort. Unfortunately, there are many quality improvement project models to choose from in the literature. And while it seems that they are quite different, all effective models are built on the same conceptual base. In this tutorial, we will explain these basic concepts and then show how to use them to examine and enhance our understanding of some widely used models. We will also discuss the need for these models, describe how teams can learn from projects that followed different models, and provide guidance to organizations that are choosing one.
28Â citations
TL;DR: This article discusses a four-phase TQM implementation model that includes specifications for leadership actions at each step and when leaders should take them.
Abstract: Quality experts state that ineffective leadership can hinder and even destroy efforts to implement total quality management (TQM). However, they rarely discuss the specific actions leaders should take in implementing TQM and when leaders should take them. This article discusses a four-phase TQM implementation model that includes specifications for leadership actions at each step.
21Â citations
TL;DR: This article summarizes research findings on the roles of management approach and vision, delivery system design, human assets, advanced technology, and performance assessment in generating world class health care organizations.
Abstract: This article summarizes research findings on the roles of management approach and vision, delivery system design, human assets, advanced technology, and performance assessment in generating world class health care organizations.
15Â citations
TL;DR: To have effective quality improvement teams, health care organizations must focus on six key process variables, with particular attention to group dynamics.
Abstract: Quality improvement teams are different from other work groups in their purpose, leadership, membership, training, procedures, and dynamics. To have effective quality improvement teams, health care organizations must focus on six key process variables, with particular attention to group dynamics. Quality improvement teams progress through the "traditional" stages of team development--forming, storming, norming, and performing--with a "special stage" of closing. Within each stage, there are two core dimensions--team process ("relationship" issues) and the project itself ("task" issues)--and critical tasks that need to be performed by the Quality Council, team members, team leader, and the facilitator.
12Â citations
TL;DR: The linkage between the literature of sociotechnical systems theory and current applications of self-directed work teams is described, and the organizational processes used to design and implement them are outlined.
Abstract: Increasingly, businesses are reporting successful implementation of self-directed work teams. In health care, team-based structures in both clinical and nonclinical areas are now rapidly emerging. This paper describes the linkage between the literature of sociotechnical systems theory and current applications of self-directed work teams, and outlines the organizational processes used to design and implement them. Several examples of self-directed work teams in industry and health care systems are provided. As much of the existing literature on self-directed work teams is from industry, there is a need for case reports and further research on their current applications in health care systems.
TL;DR: The seven management and planning tools are a set of easy to use, systematic methods from the quality management literature that can help planning teams in the same way that the familiar quality improvement tools aid problem-solving teams.
Abstract: While most leaders recognize the value of good planning, most lack the experience and methods to do it systematically. As a result, group planning efforts are often frustrating, generating plans that are shallow and poorly understood by those who must carry them out. The seven management and planning tools are a set of easy to use, systematic methods from the quality management literature that can help planning teams in the same way that the familiar quality improvement tools like flow charts and histograms aid problem-solving teams.
TL;DR: The need for collaboration and cooperation in health care delivery is not news, but one of the first requests often made by leaders and others promoting collaborative work in organizations is for a “facilitator course.
Abstract: The need for collaboration and cooperation in health care delivery is not news. But one of the first requests often made by leaders and others promoting collaborative work in organizations is for a "facilitator course." As the authors developed more knowledge about the real need, they understood that many of the barriers to collaborative work and learning in organizations can be reduced only by the top leaders, not by expert facilitators. The central knowledge that leaders need to support collaborative work is appreciation of work as a system.
TL;DR: The author calls for the emergence of a new breed of physician leaders who will preserve the best of traditional medical practice culture but also effectively implement a nascent form of integrated health care practice.
Abstract: This article examines how rapidly evolving health care delivery structures are radically altering the traditional clinical and organizational autonomy enjoyed by physicians. These changes may render maintenance of prior levels of physician autonomy virtually impossible. The author calls for the emergence of a new breed of physician leaders who will preserve the best of traditional medical practice culture but also effectively implement a nascent form of integrated health care practice.
TL;DR: This tutorial describes the use of hoshin planning and the seven management and planning tools to build a strategic plan for the Vermont Academic Medical Center, including lessons learned and plans for improvement.
Abstract: Hoshin planning is a systems approach to strategic planning. It is a step-by-step process for building consensus on the vital few strategic areas within which breakthroughs must occur if an organization is to meet and exceed the needs of its customers. The seven management and planning tools are the implements of the hoshin process. They provide the means for generating, deploying, and auditing the strategic work of the organization. This tutorial describes the use of hoshin planning and the seven management and planning tools to build a strategic plan for the Vermont Academic Medical Center, including lessons learned and plans for improvement.
TL;DR: The authors conclude that there are six key success factors, considers the common obstacles to achieving them, and looks at some of the future directions for TQM in health care.
Abstract: Total quality management (TQM) is gaining momentum in health care. The experiences of pioneering organizations provide insights into the hurdles that many organizations face in implementing TQM. Based on their observations of these pioneers, the authors conclude that there are six key success factors for TQM in health care. This article reviews the success factors, considers the common obstacles to achieving them, and looks at some of the future directions for TQM in health care.
TL;DR: To realize the full potential of CQI, the needs of internal customers throughout the health care organization must be met through a collaborative customer-supplier dialogue, where suppliers take the initiative to understand their internal customers' needs and make their own requirements clear.
Abstract: To realize the full potential of CQI, the needs of internal customers throughout the health care organization must be met. This is best done through a collaborative customer-supplier dialogue, where suppliers take the initiative to understand their internal customers' needs and make their own requirements clear. Unfortunately, physicians--the most critical group of internal customers--are unaccustomed to collaborative efforts and are often unwilling to participate in CQI training. The solution is to use the customer-supplier dialogue to understand physicians' unique needs so that they can be trained effectively and drawn into the CQI process.
TL;DR: Excerpts from a speech Sister Ryan delivered at the SSM Health Care System's annual leadership conference in 1990 are presented, providing insight into the kind of leadership needed to successfully implement quality management.
Abstract: The SSM Health Care System is a Catholic, not-for-profit, multihospital health care system with headquarters in St. Louis, Missouri. Sister Mary Jean Ryan, FSM, the President and Chief Executive Officer, has led the implementation of continuous quality improvement (CQI) throughout the system since 1990. This article presents excerpts from a speech Sister Ryan delivered at the system's annual leadership conference in 1990. Sister Ryan delivered this speech at the conclusion of a retreat where the principles of CQI were introduced to the SSM Health Care System leadership. The editors believe this inspiring speech provides insight into the kind of leadership needed to successfully implement quality management.
Journal Article•
TL;DR: The strategic planning process used to define the health care need of a region and to prepare Henry Ford Health System (HFHS) to meet the needs of the 21st century is described.
Abstract: This article describes the strategic planning process used to define the health care needs of a region and to prepare Henry Ford Health System (HFHS) to meet the needs of the 21st century. It presents key applications of continuous quality improvement in the development and implementation of the strategic plans for HFHS; explains how HFHS adapted the Deming/Shewhart cycle of continuous improvement for the purpose of improving its planning process; and delineates how the strategic planning, financial planning, and quality planning processes have been integrated.
TL;DR: If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.
Abstract: Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.
TL;DR: A review of typical C QI team software requirements and of available PC software suggests that Microsoft Excel 4.0 is a nearly ideal software platform to support CQI teams.
Abstract: The transition from quality assurance to continuous quality improvement (CQI) demands a basic change from centralized to decentralized information management. In CQI, front-line staff can use personal computer (PC) software skills to manage, analyze, and act on process-related information. Information services departments play a key role in this transition by, among other things, selecting software that optimally supports the PC-based work carried out by CQI teams. A review of typical CQI team software requirements and of available PC software suggests that Microsoft Excel 4.0 is a nearly ideal software platform to support CQI teams.
TL;DR: Recent advances in PC software and hardware technology that make possible revolutionary changes in health care quality data management are discussed.
Abstract: The transition from QA to CQI in health care calls for decentralized data collection and analysis in conjunction with the use of personal computers to support CQI team activities. In this article, we discuss recent advances in PC software and hardware technology that make possible revolutionary changes in health care quality data management. We also present detailed examples of how to use Microsoft Excel 4.0 as a single software platform to support commonly used CQI tools and analyses.
TL;DR: The quality improvement team reduced the time required to complete medical records following patient discharge at Christ Hospital in Cincinnati, which had a major impact on the hospital's cash flow.
Abstract: This article reviews a team-based effort to improve the performance of a key business process at Christ Hospital in Cincinnati. The quality improvement team reduced the time required to complete medical records following patient discharge. This effort had a major impact on the hospital's cash flow.
TL;DR: Implementation priorities include more formalized direction for TQM by the system board, intensive T QM educational programs, greater consistency of quality information and outcome measures, and more focused attention to patient needs.
Abstract: Integrating total quality management (TQM) into the strategic planning process of a multi-institutional health system is a high priority. Through the strategic plan, system leadership gives TQM concepts prominence and visibility and provides strategic directions for their implementation. The Sisters of Providence Health System recently developed an approach to integrating TQM into its System Strategic Plan. Implementation priorities include more formalized direction for TQM by the system board, intensive TQM educational programs, greater consistency of quality information and outcome measures, and more focused attention to patient needs.
TL;DR: It is suggested that planning methods that stress the achievement of objectively defined and measurable outcomes directly related to organizational priorities are superior to methods that emphasize as endpoints the implementation of programs (processes) without direct measurement of their effectiveness.
Abstract: This article reviews planning methods currently being used by health care organizations to meet current challenges and investigates the relationship of these planning methods to total quality management. It suggests that planning methods that stress the achievement of objectively defined and measurable outcomes directly related to organizational priorities are superior to methods that emphasize as endpoints the implementation of programs (processes) without direct measurement of their effectiveness. Finally, it provides an overview of planning practices within the ScrippsHealth system.
TL;DR: The author concludes that management behavior must shift from a control-oriented style to a mentorship style.
Abstract: This article reviews the effort to implement total quality management (TQM) at West Paces Medical Center. The author concludes that management behavior must shift from a control-oriented style to a mentorship style. A mentor is a leader capable of instilling creative inquisitiveness at all levels of the organization through the development of a shared vision and personal dedication to the widespread use of the principles and tools of TQM.