What is quality, and how is it measured?

There is currently no universally accepted definition of "quality of care." This article describes two aspects of measurement that contribute to an assessment of quality--the perception of quality of care held by patients and comparisons of clinical care to established standards. Ongoing monitors that lead to this assessment of quality in a large HMO are described in detail. They include patient satisfaction surveys, quality of care evaluations, comparative medical expense reports, cost-effectiveness studies, and a unique physician incentive bonus plan.     

An integrated model for measuring management performance

A model of organizational performance measurement that compels attention to the proper balance among quality, cost, and access; takes into account patient perceptions; produces clear targets for continual quality improvement (CQI); yields easily understood graphical displays; and captures health care organizations in simultaneous operation across the functions of cost, quality, and access was designed for the 22 medical treatment facilities of the Strategic Air Command. Such a tool provides practitioners, payers, and patients a range of information--from systemwide, facility, clinical service, and practitioner-specific insights on current performance to resource forecasts and easily understood targets for CQI. This case study shows that integrated performance modeling may be useful in examining many health management and reform issues.     

Practice standards use with internal partners

U.S. Department of Defense experience with internal partnership programs has indicated that a lack of close supervision by medical treatment facilities can result in cost increases. The use of medical practice guidelines or standards is the subject of active investigation. The global guidelines tend to be too rigid or too vague to affect the provision of care. Their general acceptance can often be low. The use of clinical guidelines, with supervision by a clinic peer, has been determined to be a provider-friendly method of delivering cost-effective, high-quality care. Comparisons were made between the supervised partners against the total expenditures for ENT outpatient CHAMPUS care. The results indicated not only a savings but a reduction in the rate of cost increases by more than 250 percent. It is our feeling that specialty provider, peer-directed medical standards can be applied in a cost-effective manner. Their adoption as an organization-wide standard for referral can be an important tool in maintaining quality while containing costs.     

Meet the mandate to measure clinical quality

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.     

质量管理的核心活动与基础活动——重庆制造业的实证研究

质量管理活动的实证测度是国外运营管理领域的重要内容之一,但国内在此领域的研究却相对少见.本文以重庆市制造业企业为样本,通过两阶段问卷调查收集数据,采用探索性因子分析和结构方程的方法,对我国制造业企业质量管理活动的内容进行了实证研究.结果表明,我国制造业企业中的质量管理活动可以归纳为领导支持、员工参与、员工素质、统计控制、产品设计和流程管理等内容.同时,对质量管理活动的划分为基础活动与核心活动提供了实证支持.研究刻画了质量管理活动的运作机理,指出核心活动与基础活动的有机结合将有助于企业质量管理水平的提升.此外,研究还建议在我国企业质量管理实践中应加强对客户和供应商的重视与支持.     

国外物流服务质量研究述评

物流服务质量研究历时40年,在某些方面取得了一定的理论研究成果,但至今尚未形成完整的理论体系。系统地梳理和总结了国外物流服务质量研究的相关文献,认为物流服务质量研究具体可以划分为3个阶段:概念研究阶段、测量研究阶段、理论研究阶段,并着重对每一阶段的物流服务质量研究进行了分析和评论,进而提出了未来的研究展望。     

Measuring the logistics performance of internal hospital supply chains – A literature study

The patient care processes in hospitals are supported by a range of operational activities including inventory management and distribution of supplies to point-of-care locations. Hospitals carry large amounts and a great variety of items, and the issues of storing and distributing these items throughout the hospital supply chain are of great importance to providing high-quality patient service. Healthcare logistics encompasses the process of handling physical goods (e.g. pharmaceuticals, surgical medical products, medical equipment, sterile items, linen, food, etc.) and the associated information flows, from the reception of the goods within a hospital to their delivery at patient care locations. The medical supply costs constitute the second largest expenditure in hospitals, after personnel costs. A high-performing supply chain may realize improved outcomes (e.g. safe and quality patient service) and greater efficiency. Logistics managers need to identify opportunities to improve the logistics processes in order to lower costs and to improve patient care quality. However, in order to improve the logistics processes, you must understand how the healthcare supply chain is currently performing. Measuring the performance of the supply chain is fundamental to identify and address deficiencies in the logistics activities, and it serves as a good input for managerial decision-making. The purpose of this article is to present existing research on performance measurement at the internal hospital supply chain (e.g. inventory management, distribution activities), and more specifically in the operating theatre since it is among the most critical resources for a hospital. At the operating theatre, the requested items should be available at the right time at the right place, in the right condition, at the lowest cost possible. Furthermore, we will also discuss literature on multi-criteria decision-making techniques. It enables researchers to build a performance measurement framework and to prioritize between multiple performance indicators since a diverse group of stakeholders with conflicting interests is involved in the internal operating room supply chain.     

文化差异对顾客服务质量感知影响的实证研究

顾客感知服务质量的度量是服务管理理论中最具前沿性的问题,而服务质量评价方法跨文化适用性的界定,无疑对借鉴国外先进的评价方法和提高中国服务企业服务质量水平具有积极的意义。本文通过对服务质量评价最重要的评价方法SERVQUAL跨文化适用性的研究,提出了不同文化背景的顾客在服务质量感知方式等方面存在着差异等一系列结论。     

A national perspective on UR (utilization review)

Quality of care is the responsibility of each and every attending physician. There are many definitions of quality, none of which encompasses the universe of medical practice. Care that is neither medically necessary nor appropriate can never be considered good, no matter who renders it or how good the outcome. It is upon these premises that utilization review firms focus.     

Measuring the quality of ambulatory care

The challenge of the 1990s is measuring the quality of medical care. The author has developed a comprehensive matrix to measure the quality of medical care in an ambulatory setting. This matrix was designed with both patient-consumer and physician input. While the matrix has not been field-tested, it should be able to identify areas of weakness and strength and guide corrective actions. The author is now seeking funding for the testing that will be needed to make the matrix operational.     

考虑交通时间与设备转换时间的跨区域就医调度优化问题

在资源共享时代背景下,跨区域就医可以很好地解决患者日益增长的就医需求与医疗资源紧张的矛盾。本论文以医疗联盟为研究对象,在关键医疗资源共享的前提下,通过患者跨区域就医实现就医诊断延误最小化,以满足患者就医需求。本研究同时考虑了患者跨区域交通时间与基于患者诊断类型的设备转换时间,以最小化患者就医总延迟为目标,分配患者就诊医院及优化患者就诊/检查顺序。针对该问题,论文首次提出以最早交货期原则（EDD rule）为基础,以患者再分配为主导的EDD-ReAss1和EDD-ReAss2启发式算法,结合局部搜索算法以进一步提高就医调度方案的质量,缩短患者诊断/检查等待时间。实验结果表明,新启发式算法EDD-ReAss1和EDD-ReAss2算法性能显著好于EDD,SPT和LPT等调度规则;在较短运算时间内Swap局部搜索算法性能最优。     

The telephone encounter: the cast of characters encountered by the physician executive

Volumes have been written about telephone productivity, decorum, behavior, and economic impact. Although every physician is skilled in telephone communication, medical directors must approach this communications modality from a different vantage point. The attending physician uses it as an information receiver and transmittal station. The medical director uses it as a negotiation platform. It is estimated that 50 to 90 percent of the medical director's time is spent on the phone. "Working smarter" can increase productivity to save time and stress. This article identifies and categorizes many of the problems that the medical director deals with on a daily basis. It pertains to phone conversations in which there is a question about a procedure, appropriateness of care, medical necessity, or quality of care.     

Informed decision making: the new paradigm

Health care cannot survive in its present form. It is becoming unaffordable for a large share of the country's population. Its quality and effectiveness inexplicably vary between communities and across time. With all these problems, the process of health care can be understood. All that are needed are good, basic data; its access, management, and analysis; and then presentation of facts and observations. Together, these functions describe the translation of data into information--the field of medical informatics. Information about such management concerns as clinical efficiency (which largely is related to appropriateness and cost-effectiveness) and about the realities of day-to-day medical practice can be used to improve the value of health care. Informed decision making is based solely on confidence that, given the right information and understanding, we can all make the right decisions. The right decisions mean better patient acceptance and satisfaction, a sense of value enhancement by payers, and support of the Hippocratic tradition.     

Herding stats: the quality measurement dilemma

All over the country, millions of research dollars are being spent to devise an effective way of measuring quality that could be standardized in health care, and hospitals and managed care companies are experimenting with a variety of quality tools, trying to document what they now can only perceive as improvement. Experts are divided on what works best, but all applaud and embrace the efforts. In this special report, several of them discuss their views on what works, and what doesn't work, in the exploding field of health care quality measurement.     

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.     

Improving "medical necessity" acceptance by health care providers and consumers

A major problem for patients and providers has existed since establishment of peer review and authorization agency medical necessity guide lines, because physicians and patients who receive denial of proposed procedures and tests on the basis of so called "medical necessity" presume that the authorization agency considers the proposed procedure or test to be medically unnecessary, meaning of no health value to the patient. This may well not be the case. Both providers and consumers can be expected to be more accepting of negative authorization decisions if the principles of continuous quality improvement are brought to bear on the authorization process.     

TQM in health care: mistaken identity?

Total Quality Management is a powerful tool in health care today. The definition of quality improvement in the medical literature focuses on improving patient outcomes. However, most quality initiatives in the health care field focus on improving productivity, cost-effectiveness, market share, employee morale, and efficiencies of processes. This disparity between the medical definition of quality and the actual application of quality improvement may have the effect of alienating many physicians, the very people who must be involved. The semantics are important to address in a TQM initiative.     

What kind of information will be required if we are to reform health care?

The only logical way to avoid unnecessary future costs and improve quality is to analyze the past, providing input for the present. The informational management strategies are ready. There is continuous quality improvement, profiling with case-mix adjustment, and other techniques that will help us manage care and caring. But these strategies all rely on the customer being empowered to make truly informed decisions (the ethical principle of autonomy) and for us to advocate for patients (beneficence). Translating relevant data into information is the concentration of medical informatics. Virtually everyone in medical management can attest to the fact that, competitive forces notwithstanding, it is time for us to recognize not only that we are in the information business, but also that this information belongs to a larger community. Clearly, it is time to collaborate!     

Quality management in ambulatory care: the future is now

Ambulatory care has always been a stepchild. Hospitals have been and are the focal point of quality activity. Traditionally driven by Joint Commission decree and more recently inspired by market forces, hospitals find the resources to do quality. It was quality assurance in the '80s. It is quality management in the '90s. Some of this activity has oozed out into ambulatory care, but not much. We in ambulatory care have been too busy producing as many patient visits as possible in an environment of limited resources. All that is now changing. As ambulatory care becomes more and more important in the overall health care delivery scheme, medical quality management in this environment will also take on greater significance. Leading the way will be the electronic medical record.     

Formatting and presenting quality data to medical staffs and hospital boards

A host of historical and practical precedents have made hospitals responsible for the quality of care rendered within their facilities. The medical staff and the board of trustees share in this responsibility. Increasing demands for demonstrative evidence of the quality of care in an institution have made the process data-based. There is no substitute for specific data on the performance of both the hospital and its providers in the delivery of care. The trick, however, is in presenting this information to the medical staff and the board in a fashion that will be understandable and that will still maintain confidentiality of provider and patient. The authors offer a presentation system that has met with success in their community hospital.