The cost of poor quality: an opportunity of enormous proportions

In all organizations, the state of finance is routinely reported in sublime detail for study and action. And yet, anywhere from 20 to 50 percent of the monies involved in that report are never identified as unnecessary and nonproductive. These monies, referred to as the Cost of Waste (COW), are the result of actions that have been taken or must be taken because quality is not served--inappropriate actions are being performed or appropriate actions are not being performed right the first time, every time. Proactively determining, reporting, and monitoring the COW brings a degree of objectivity to the quality management process and provides a powerful internal driver for performance improvement. A 10 step Cost of Waste system is proposed.     

A medicare adult day care model: proposed criteria and available supply

The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting them were: services to be provided directly, 14.6%; multi-disciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings, implications for Medicare funding policy are discussed.     

WHEN SHOULD DRIVERS BE ENCOURAGED TO CARPOOL IN HOV LANES?

Policies to encourage carpooling in high‐occupancy vehicle (HOV) lanes have been adopted in the United States to lower congestion and reduce air pollution. We analytically model highway congestion and other vehicle‐related externalities. Encouraging carpooling decreases total costs when congestion relief in mainline lanes outweighs increased HOV lane congestion. Importantly, entry of new drivers via induced demand can negate the benefits of increased carpooling. Using 10 years of traffic data from Los Angeles we estimate time and route‐specific marginal external costs. Because costs vary substantially across routes, hours, and days, current policies to promote carpooling will often increase social costs. (JEL R41, R48, Q53)     

A Preliminary Qualitative Analysis on the Feasibility of Using Gaming Technology in Caregiver Assessment

This exploratory qualitative study examined the feasibility of utilizing gaming technology that will ultimately assess task performance and stress among caregivers of dementia patients. The long-term goal is to use this unobtrusive application (app) to detect caregiver burnout for the purposes of early intervention. This preliminary study examined participant interface with a specific gaming technology called CAST (Caregiver Assessment Using Serious Gaming Technology). Ten dementia caregivers participated. Participants attended a demonstration and then interacted with a preliminary version of the CAST tablet application. Social work researchers interviewed participants using open-ended questions to gauge interest, technology skill level, and comfort with the app. Participants expressed interest and identified potential ways to further develop the system in order to increase ease of use, decrease time commitment, and improve suitability for daily use. The provided feedback will be used to refine the user interface of the application, which will then be used to monitor caregivers’ stress in future development.     

‘Tourists go home’: anti-tourism industry protest in Barcelona

This profile looks at the wave of at times violent protests against the economic, social and environmental consequences of mass tourism in Barcelona, which came to international attention in the summer of 2017. It outlines the leading role played by left-wing nationalist activists linked to the Candidatura d’Unitat Popular (CUP, Popular Unity Candidacy) political party in the protests. I examine CUP’s direct-action methods, targeting local business interests and foreign tourists, as well as the largely critical response this prompted from the wider anti-tourism industry movement. This profile addresses the CUP’s justifications for the action and the echo effect it had in other parts of Spain. It argues that to understand the events requires a focus on aspects of both continuity and change in urban social movement mobilisation in Barcelona, against processes of neoliberal urbanisation, in which anti-tourism industry contestation is to the fore.     

The Business of Caring: Women's Self‐Employment and the Marketization of Care

Our goal in this article is to contribute to a differentiated analysis of paid caring work by considering whether and how women's experiences of such work is shaped by their employment status (for example, self‐employed versus employee) and the nature of care provided (direct or indirect). Self‐employed care workers have not been widely studied compared with other types of care workers, such as employees providing domestic or childcare in private firms or private homes. Yet their experiences may be quite distinct. Existing research suggests that self‐employed workers earn less than employees and are often excluded from employment protection. Nonetheless, they often report greater autonomy and job satisfaction in their day‐to‐day work. Understanding more about the experiences of self‐employed caregivers is thus important for enriching existing theory, research and policy on the marketization of care. Addressing this gap, our article explores the working conditions, pay and levels of satisfaction of care workers who are self‐employed. We draw on interviews from a small‐scale study of Canadian women engaged in providing direct care (for example, childcare) and indirect care (for example, cleaning).