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Application of quality improvement to surgical practice

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SURGERY 2000年第5期128卷 836-844页

作者： Hamby, LS Colacchio, TA Nelson, EC Dartmouth Med Sch Hanover NH USA

Surgery 2000;128:836-44.

关键词：专业业务/标准外科学/标准全面质量管理/方法全面质量管理/标准人类

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Improving managed care through coding, monitoring, and trending quality-of-care concerns.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第1期20卷 20-23,26-28页

作者： Miller, J.A. Lowe, P.V. Physicians Health Plan of Mid-Michigan Lansing United States

With the rise of managed care, purchasers and payers are increasingly demanding value in healthcare. Traditionally, patient satisfaction surveys and focus groups have been used to elicit information regarding customers' perspectives. This article explores the use of an inexpensive alternative methodology--that of monitoring quality-of-care concerns and complaints. A nomenclature and a process for tracking, trending, and reporting quality-of-care issues are detailed;they encompass both the patient's and the provider's perception of a specific care experience. This methodology promotes the use of quantifiable data to support strategic planning and compliance with National Committee for Quality Assurance accreditation standards.

关键词：表格和记录管理管理医疗规划/标准病人满意度同行评议卫生保健过程评价(卫生保健) 危险处理/分类危险处理/方法软件设计全面质量管理/方法美国

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Quality improvement through review of inpatient deaths.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1997年第1期19卷 12-18页

作者： Olt, F. Wilson, D. Ron, A. Soffel, D. Beth Israel Medical Center New York City United States

Emphasis on hospital mortality as a monitoring tool has raised concerns about the validity of mortality rates as a measure of quality of care. An indepth review of all mortalities at Beth Israel Medical Center was conducted from 1988 through 1993. Clinical issues identified from chart review were referred for departmental physician peer review, and quarterly reports of trends and issues were disseminated to all levels of the institution. Mortality rates declined 21% over the 6 years, from 3.3% to 2.6% of all discharges. Clinical quality issues were identified in less than 3% of all mortalities. The majority of problems were related to delays and appropriateness of treatment (57% of quality issues). The review program identified specific hospital processes for improvement, and, more importantly, created a "watchful concern" about quality-of-care issues throughout the hospital.

关键词：全面质量管理/方法全面质量管理/组织和管理治疗失败美国

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Value-based cost management: the foundation of a balanced performance measurement system.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1997年第4期19卷 6-9;quiz23页

作者： Castañeda-Méndez, K. [?]Kicab Casta?eda-Méndez founded aejes Seminars & Consulting in 1991 the Ridgefield CT firm helps healthcare organizations fine-tune their continuous quality improvement efforts. He has 20 years of experience as an educator consultant and author on quality statistics and education in the United States Latin America and Europe.

Healthcare organizations need critical performance measures if they are to lead, manage, and operate effectively. Traditional financial measures or report cards on patient satisfaction and clinical outcomes are insufficient, however. Value-based cost management directly links cost accounting, processes, clinical outcomes, and patient and employee satisfaction through organizational, work environment, and financial relations measures. These measures address three levels of performance: strategic, diagnostic, and operational. Their linkages identify value in three areas: business-related financial and operational measures;employee-related measures such as those related to satisfaction and well-being;and learning and patient-related measures linked to clinical outcomes, satisfaction, and population.

关键词：费用控制教育继续效率组织管理审计/经济学管理审计/方法病人满意度过程评价(卫生保健)/经济学卫生保健质量/经济学全面质量管理/方法美国人类

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Continuous self-improvement: systems thinking in a personal context.

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The Joint Commission journal on quality improvement 2000年第2期26卷 74-86页

作者： Alemi, F. Neuhauser, D. Ardito, S. Headrick, L. Moore, S. Hekelman, F. Norman, L. George Mason University School of Nursing and Health Sciences McLean Virginia United States

BACKGROUND: Continuous quality improvement (CQI) thinking and tools have broad applicability to improving people's lives--in continuous self-improvement (CSI). Examples include weight loss, weight gain, increasing exercise time, and improving relationship with spouse. In addition, change agents, who support and facilitate organizational efforts, can use CSI to help employees understand steps in CQI. A STEP-BY-STEP APPROACH: Team members should be involved in both the definition of the problem and the search for the solution. How do everyday processes and routines affect the habit that needs to change? What are the precursors of the event? Clients list possible solutions, prioritize them, and pilot test the items selected. One needs to change the daily routines until the desired behavior is accomplished habitually and with little external decision. DISCUSSION: CSI is successful because of its emphasis on habits embedded in personal processes. CSI organizes support from process owners, buddies, and coaches, and encourages regular measurement, multiple small improvement cycles, and public reporting.

关键词：日常生活活动运动(Exercise) 疲劳/预防和控制习惯健康行为膝损伤/康复膝损伤/外科学强迫性障碍/康复自我概念自我效验全面质量管理/方法体重增长体重减轻成年人女(雌)性人类男(雄)性

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Achieving faster quality improvement through the 24-hour team.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1999年第4期21卷 4-10页

作者： Carboneau, C.E. Great Plains Regional Medical Center North Platte NE United States

This article describes how Great Plains Regional Medical Center (GPRMC) in North Platte, NE, changed its quality improvement (QI) methodology and its mind-set toward team time management to accelerate its improvement efforts. The "24-hour road map" and the improved FOCUS-PDSA methodology, coupled with strong leadership, make up the team time management element that has been missing from healthcare quality improvement but is critically needed to accelerate the process. At GPRMC, a major criterion for success is now a 6-month-or-less improvement cycle for cross-functional teams to complete their QI efforts. The lessons learned at GPRMC can help others in healthcare improve quality, lower costs, and do both more quickly.

关键词：病人预约和时间安排教育继续医院管理/标准机构管理小组领导管理质量小组模型组织管理内布拉斯加规划技术过程评价(卫生保健) 康复/组织和管理时间和运动研究全面质量管理/方法全面质量管理/组织和管理

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Teaching total quality management: developing and deploying education throughout a healthcare system.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1997年第2期19卷 17-23,26页

作者： Kleeb, T.E. Omaha Veterans Administration Medical Center NE USA.

Healthcare organizations are faced with the responsibility of teaching their entire staff the founding principles, concepts, and practices of total quality management (TQM), to improve organizational effectiveness. Purchasing training products from outside consultants can be costly, but healthcare leaders can design and develop their own TQM training products, integrating each product with their organization's mission and values. This article describes how a Catholic healthcare system successfully developed and deployed a compendium of TQM educational products throughout the health-care system.

关键词：天主教成本及成本分析卫生人员/教育医院宗教/组织和管理医院宗教/标准在职培训/组织和管理模型教育模型组织管理多机构系统/组织和管理多机构系统/标准组织文化软件设计教材全面质量管理/方法美国人类

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The role and application of the balanced scorecard in healthcare quality management.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第1期20卷 10-13页

作者： Castañeda-Méndez, K. Mangan, K. Lavery, A.M. Ridgefield CT United States

To connect practices, outcomes, quality, value, and costs, healthcare organizations must start using a balanced scorecard. A balanced scorecard is a set of measures that reveals the interdependency of the organization, its employees, and its patients. It thus serves as a balanced perspective on the organization for senior management to use in designing, developing, deploying, and directing the strategic plan, consistent with total quality management principles.

关键词：教育继续医院病床数 100至299张医院记录医院慈善/组织和管理医院慈善/标准信息服务管理质量小组纽约组织目标规划技术过程评价(卫生保健) 全面质量管理/方法

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Using a multidisciplinary CQI approach to reduce ER-to-floor admission time.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1996年第3期18卷 18-21页

作者： Jackson, G. Andrew, J. Marshall Hospital Placerville CA United States

A 110-bed community hospital used a multidisciplinary continuous quality improvement process to decrease the time needed to admit a non-critical care patient to the hospital from the emergency department (ER). The specific objective was to reduce the total amount of time needed for a patient who has entered the ER to be assigned to a bed on a designated medical/surgical unit, while at the same time maintaining quality of care and providing the patient with a pleasant atmosphere.

关键词：住院处医院/组织和管理住院处医院/标准加利福尼亚效率组织急诊室医院/组织和管理急诊室医院/标准医院病床数 100至299张医院社区/组织和管理模型组织管理卫生保健质量时间因素全面质量管理/方法

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Development of the physician satisfaction survey instrument.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第3期20卷 34-38页

作者： Soo Hoo, W.E. Ramer, L. Mercy American River/San Juan Hospital Sacramento CA United States

Continuous quality improvement (CQI) activities depend on valid and reliable instruments to generate data. An evaluation of internal and external customer satisfaction is one of the pillars of the CQI process. This article describes the development of a valid and reliable instrument for measuring physicians' satisfaction with the orthopedic nursing units at a major medical trauma center. The physician satisfaction survey instrument was found to be internally consistent (alpha = .95). Confirmatory factor analysis revealed that 68% of the variance in physician satisfaction scores (eigenvalue = 8.14) was explained by using a single-factor model.

关键词：医务工作者的态度医院专科病房/人力医院专科病房/组织和管理医院专科病房/标准职业满意医务人员医院/心理学护理部医院/标准矫形外科学/人力矫形外科学/标准医生护士关系美国西南部全面质量管理/方法创伤诊治中心/人力创伤诊治中心/组织和管理创伤诊治中心/标准人类

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