A new perspective on quality

The U.S. health care sector consumes nearly 13 percent of our nation's gross national product, $800 billion annually. Our nation allocates the highest amount per capita to health care in the world. Yet many measures of health care outcomes from these expenditures are inferior to other developed nations. The American health care system costs too much, excludes too many, fails too often, contains much excessive and inappropriate care, and knows too little about the effectiveness of the things it does. The purpose of this article is to discuss current payers' perspectives on the potential for quality improvement in the U.S. health care system.     

Medical informatics. The future is here

Informatics is an indispensable discipline for leaders and managers--of patients, facilities, and organizations--because the most important assets of those organizations are their information processing technologies, and the key skills are those that help them to manage information. Managers and executives will increasingly need to anticipate trends in information management technologies that could affect their business. In health care, computer-based patient records, integration engines, online analytical processing systems, telemedicine, expert systems, and the Internet have become vital to having the competitive advantage. Those who do not understand the promise and limitations of these technologies and the need for strong leadership to establish standards for data and transaction systems will not lead their organizations well.     

Shared planning: a new foundation for quality criteria.

The Chinese word for crisis has two characters. One for danger and one for opportunity. A crisis is a time for awakening to new perspectives and for asking different questions. The widely touted "liability crisis" in the health care field provides just such a time for new approaches. Perhaps there is a way to establish market mechanisms for decision making that gives expression to the desires and values of consumers while respecting the abilities and preferences of physicians. Quality might then be the result of natural selection or, more accurately, of market demand. Such a system would acknowledge that quality in medicine is not for defining. It's for having. Quality should be obtained in bargaining for services, not in mandates of professional regulation.     

Professionalism in medicine: the new authority

Examine some ways that the health care profession could regain lost ground and begin exerting more influence in the marketplace to help offset the pressures from insurance companies, consumers, and the government.     

The disruptive physician. A quality of professional life factor.

Medical leaders need to understand that attending to quality of professional life issues includes dealing with the insidious costs and stress associated with disruptive physician behavior. The disruptive physician or professional undermines practice morale, heightens turnover in the organization, steals from productive activities, increases the risks for ineffective or substandard practice, and causes distress among colleagues. Physician executives need to help reduce or prevent this behavior and develop accepted systems in which to manage, confront, and rehabilitate the person labeled "disruptive." Suggested strategies to consider in developing a system include: (1) Defining reasonable and competent interpersonal behavior; (2) educating in interpersonal skills; (3) evaluating interpersonal skills; (4) developing disruptive policy; and (5) assessing, confronting, and rehabilitating.     

Motion picture performance: A review and research agenda

This paper provides a comprehensive literature review of empirical studies of motion picture performance published from 1977 to 2006 inclusive in the following five disciplines of the social sciences: strategy, organization theory, marketing, cultural economics and sociology. It introduces a novel framework which organizes the various dimensions and explanatory factors of movie performance into five distinct categories and underscores their relationships. The paper, which uses this model as a roadmap for discussions of film success, serves two complementary purposes. First, it clarifies the current state of the literature, stresses core contributions and exposes limitations in existing research by emphasizing hitherto neglected independent explanatory factors, dependent dimensions and correlations between them. Second, it introduces five conceptual, methodological and empirical suggestions for further cinema performance research aimed at addressing these limitations and, accordingly, at providing better accounts of motion picture performance in view of the fast-changing conditions of cinema production, marketing and consumption.     

The application of future technologies to medical informatics

Physician: "Condyloma, Toxoplasmosis, Blepharoplasty, and Fibroadenoma." Technoguru: "Pardon?" Physician (referring to "PCDR, Physician's Computer Desk Reference): "Carrier Sense Multiple Access, Spread Spectrum, Application Programming Interface, and Clustered Indexes." Technoguru: "Oh, now you're talking! How many do you want?" Until such time as computer scientists holding degrees in medicine become de rigueur, there will inevitably be conversations such as these. A pediatrician friend once told me that he could teach me in 30 days what I would need to know to handle 95 percent of the cases he sees. To handle the other 5 percent would still require 8 years of postgraduate medical education. The corollary for the application of technology is that I can teach you how to use a personal computer, and even to do a little programming, but to build a robust, mission-critical system for a production health care environment, well, back to school you go.     

Complementary and alternative medicine. Integrative medicine: business risks and opportunities.

Much of the buzz over integrative medicine is well deserved. The opportunities seem to outweigh the risks, but superior management skills are needed to guide these programs through adolescence into clinical and business maturity. By carefully considering the staffing, team building, compensation methods, marketing, and program evaluation and development issues explored in this article, health care and physician executives should be able to steer between the rocks on their way to integrative medicine decisions that are right for their organizations. Many claim that integrative medicine has the potential to reshape health care delivery in a more patient-centered direction. While this may be true, such programs must prove themselves from financial and clinical operational perspectives in order to achieve this potential. Luminary clinical skills are not enough to guarantee the survival of such programs--a strong clinical base of expertise in alternative therapies is a key success factor. As with any health care venture, there are no substitutes for clinical excellence or sound management.     

Practice guidelines. Cookbook medicine

A large measure of the confusion and doubt currently being sowed in the ongoing debate over the advisability and effectiveness of practice guidelines is a matter of terminology. In deference to the wishes and fears of physicians, the term "requirements" is not used. But requirements they are. Their quality and the degree to which they are useful will depend on their level of detail and the degree to which they are based on positive outcomes. Regardless, attorneys and others will always view and use them as requirements.     

A case of wrongful use of quality management. Summit Health, Ltd., v. Pinhas

Summit Health, Ltd., v. Pinhas liberalized the jurisdiction of the Sherman Antitrust Act to include cases of intrastate hospital credentialing. The U.S. Supreme Court decision eased the requirements for plaintiffs to sue when they perceived that health care organizations were acting as monopolies. The court removed the defense that a plaintiff had to prove that the decision of a health care organization affected interstate commerce for the case to be heard in court. Important as the case is in antitrust law, however, greater lessons can be gained by health care organizations from analyzing the events that led to the lawsuit.     

Complementary and alternative medicine. The daunting challenge.

There is no question that the past few years have seen a tremendous surge in interest in what has come to be known as complementary and alternative medicine (CAM). Health plans contemplating adding CAM benefits face a daunting challenge. How should a plan define CAM benefits? How should a plan define appropriate CAM providers? How can these benefits be managed? Will the addition of CAM benefits undermine coverage policies for conventional biomedicine? The answer to these questions lies largely in uncharted waters, as even CAM advocates will agree that many alternative therapies (even those like Oriental medicine which has been in practice for some 5,000 years) have not yet undergone the type of rigorous, evidence-based analysis that is required to validate conventional biomedicine. This article explores options for CAM benefit design by considering two basic approaches-creating an uninsured benefit or insured benefit.     

Managing health care quality.

Using the cited principles of professional staff credentialing and quality assurance, a department chairman, medical director, or other health care executive will be in an excellent position to assess quality of care against established standards and manage problems in the routine provision of medically appropriate care. He or she will also be able to assure the hospital's board that the hospital and its medical staff are well positioned to meet future challenges to provide effective quality, utilization, and risk management.     

Aspects of quality . . . and world domination!

Training, learning and development tend to be regarded as central to the success of every organization and the nation. However, not all organizations are able or willing to invest resources in such processes. The paper presents a view that training, learning and development occur as a consequence of successful persuasive actions in a chain of talk, which draw on the discursive and rhetorical resources of an emerging learning movement. Utilizing the findings from an examination of data from the UK Department of Education and Skills-sponsored National Training Award winners, the paper provides an employment of actor-network theory and the sociology of translation to show how some organizations make the case for training, learning and development as a virtuous endeavour. It concludes by suggesting that what is needed is a more detailed understanding of how the case for the adoption of training, learning and development, or not, within organizations is made meaningful.     

A nuclear medicine patient/instrument scheduling model

The problem of scheduling patients and clinical instruments for each physician-requested Nuclear Medicine study, in a clinical environment, is resolved through the development of a computerized heuristic model. The study schedule was determined by minimizing such factors as elapsed instrument time, instrument idle time, and maximizing instrument utilization. The heuristic scheduling procedure was developed and evaluated for scheduling thirteen different Nuclear Medicine study types on a daily basis. The analysis showed that this heuristic can be utilized to provide a good basic schedule for use in Clinical Nuclear Medicine.     

无锡"530"旋风

“数量上来之后，更为重要的是，无锡未来5年能不能培育出5个或者10个像尚德这样的企业。这是评判‘530’计划成败与否的关键。”