Making quality a fundamental part of strategy

All that is known about strategy and strategic planning indicates that quality is a major factor in gaining competitive advantage. It is cost effective, profitable, promotes corporate longevity and builds an important company value system. The authors argue that is too important a factor to be left solely to quality control personnel or planners and is a fundamental part of the chief executive's responsibility for the development of strategy.     

Dependence Estimation Over a Finite Bivariate Failure Time Region

This articleconcerns nonparametric estimation of association between bivariatefailure times. In the presence of independent right censoring,the support for failure time variates may be restricted and measuresof dependence over a finite failure time region may be of particularinterest. To this end, the reciprocal cross ratio function, weightedby the bivariate failure time density, is proposed as a summarymeasure of dependence over a failure time region. This `relativerisk' estimator is shown to be consistent and asymptoticallynormally distributed, with consistent bootstrap variance estimator.A finite-region version of Kendall's tau, which is suitable forcensored failure time data, is also proposed, and correspondingasymptotic distribution theory is noted. The accuracy of theseasymptotic approximations is studied in simulations and an illustrationis provided.     

Setting up a CLIA-certified laboratory in a student health services clinic

Performing some laboratory tests on site at a student health service clinic may increase efficiency and cut costs for patients. However, with the passage of the Clinical Laboratory Improvement Amendments (CLIA) of 1988, many laboratories in physician offices and clinics have shut down because of increased regulatory requirements. The personnel in one SHS laboratory found that the guidelines proposed by CLIA help assure quality care and are not prohibitive. In this article, the process of applying for and receiving a CLIA certificate in the student health clinic setting is explored.     

The Role of Effort in Shifting Preference for Feedback Stimuli

ABSTRACT

Researchers have examined preference for the format of delivery of feedback, however little research has examined strategies to increase feedback and praise desirability. The current study aimed to evaluate whether preference shifted for stimuli that signaled work and for manager-praise stimuli that were delivered after work. Moreover, we sought to understand if these preference shifts were greater when the work was higher-effort compared to lower-effort work tasks (a phenomenon described in the basic literature as within-trial contrast). The study took place in a simulated work environment. Sixteen university students clicked on a shape that produced the work task, completed a mock medical data-entry task, and received manager-praise on an FR1 and FR20 schedule. At the start of the study and following each contingency exposure trials, they completed a preference assessment for both the shapes and the manager-feedback stimuli. The primary dependent variable was the percentage of preference change for two categories of stimuli – shapes presented at the beginning of trials that signaled which condition participants were in and manager-praise stimuli presented at the end of trials. Preference for the shape stimuli for both high- and low-effort stimuli decreased indicating that stimuli that signal work may become less preferred. Preference for the manager-praise stimuli for both high- and low-effort stimuli increased suggesting that stimuli that follow work may become more preferred. Overall, these data suggest that the conditions under which managers deliver feedback and praise may influence preference for those stimuli.     

Halfway There? Policy,Politics and Outcomes in Community Care

The community care reforms which followed the 1989 White Paper "Caring for People"were apparently focused on addressing the needs of people requiring long-term care, and on achieving improved outcomes and better quality of life.
The agenda set out by the White Paper was for community care in the next decade and beyond. Half way through this decade, we question the extent to which the objectives of promoting choice and independence for users and carers have been achieved. The paper draws particularly on a programme of monitoring conducted jointly by the Nuffield Institute for Health and the King's Fund, based on national and local focus groups meeting over a two-year period. It proposes a framework for evaluation which consists of four components: the definition of desired outcomes; specification of service systems necessary to deliver such outcomes; promotion of access to services; and the development of supporting operational policies and resource allocation mechanisms.
This framework offers a substantial step beyond much of the monitoring of the community care reforms which has taken place to date. This has assessed progress largely in terms of the establishment of new systems and processes. We conclude that such changes were essential building blocks for delivering better-quality community care services, and in the short term it may have been legitimate to view their establishment as proxies for progress towards delivering user-centred services. However, monitoring and evaluation should now be increasingly oriented towards ensuring that these changes are in fact producing the desired service outputs and urn outcomes. We propose that our framework offers one such way forward.     

The use of temporary restraining orders (TROs) as a strategy to address intimate partner violence

One of the most prominent interventions developed to protect victims in domestic abuse cases is the temporary restraining order or "TRO," the purpose of which is to restrain an alleged defendant from further harassment or abuse against a plaintiff. This report analyzes 397 restraining order petitions, and subsequent arrest and conviction data for TRO defendants from 1996 to 1998. Findings confirm that TRO petitioners report many types of abuse and while half of TRO defendants do not re-offend, a small percent of defendants are responsible for multiple police reports, arrests, and criminal violations. Outcome data are discussed for program and policy implications.     

An assessment of the quality of developmental day center playgrounds for exceptional children

This study assessed the playgrounds of developmental day care centers and compared them with playgrounds of regular certified day care centers. Twenty playgrounds, randomly selected from the listing of developmental day centers, were compared with a matched sample of 20 playgrounds from certified day care centers in one state. A revision of Frost's Playground Rating System (1978b) was employed to rate the two groups of playgrounds on content, safety, and function. Data were analyzed using an analysis of variance technique. The quality of developmental day center playgrounds for exceptional children was inferior to that of regular day care center playgrounds in terms of playground content. No significant differences were noted on safety or function.     

Effective targeted and community HIV/STD prevention programs

Community interventions and interventions targeting specific groups at risk of STDs/HIV have demonstrated significant impacts on sexual behavior, particularly condom use and safer sex. The scientific evidence suggests the factors that make these interventions particularly effective include the establishment of community, including business and CBO partnerships; maintainance of the intervention post-research funding; and buy-in by the community or target group. The modification of risky normative beliefs through the use of opinion leaders and role models, and through intervention delivery by peer educators, is an important facet of such interventions. Interventions delivered by health professionals, absent a community base, appear to be unsuccessful. Where cultures or subcultures are targeted, the close involvement of such groups in the design and delivery of messages is critical to their success. Diffusion of interventions through existing social networks further extends the intervention into the community and acts to reinforce and maintain changes in peer norms toward safer sexual behavior. The available data confirm that community or medical infrastructure-based interventions are effective in changing sexual behavior and can reach a wider range of the population than face-to-face programs if they incorporate peer educators as role models in modifying norms, and if diffusion of the intervention is integral to the design.     

Bridging child welfare and juvenile justice: preventing unnecessary detention of foster children

Gaps in service coordination between child welfare and other child-serving agencies are well documented. This article examines the gap between the child welfare and juvenile justice systems and discusses a program, Project Confirm, designed to reduce the problems associated with this gap. Project Confirm aims to improve cooperation between juvenile justice and child welfare agencies to prevent the unnecessary detention of arrested foster children in secure facilities. The program's design is outlined, and implementation statistics and government partner perceptions of the program in its first year of operations are provided. The article also identifies future challenges to implementation and discusses the broader implications of the program. In making this appeal for coordination and collaboration among public agencies, I'm not talking about pro forma integration efforts-I'm not talking about memoranda of understanding or top-level reorganizations that have autonomous agencies vaguely reporting to a single box labeled "human services." Rather, I'm talking about the much more challenging objective of achieving real working partnerships at the front line. (Nelson, 1998, p. 6)     

Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.