From QA to TQM

In the decade from 1950 to 1960, two quality-related processes--medical audit and total quality management--were being developed, one directly in the health care field and the other in the manufacturing sector. These processes remained isolated from each other until the mid-1980s. Each would have a separate but major effect on the health care industry.     

From quality assurance to continuous quality improvement

To change from punitive and legalistic QA to positive and productive CQI, both attitudes and methods must change. This is a difficult challenge, but potential rewards for both the organization and its individual members suggest that the effort is worthwhile and deserves high priority. Members of the executive/management team will likely turn to physician executives for guidance on how to proceed.     

Common sense leadership

Common sense has to do with problem solving. In the complexities of everyday human life, we are faced time and again with the need to solve problems. In fact, every situation we face, at least at the first exposure, requires some form of problem solving. When we want food, we have to solve a series of problems from acquisition to preparation to serving and eating. When we deal with organizational needs, problem solving is the daily fare.     

The challenge of world health

2 development specialists have expounded on the demands world health has placed on public health. Striking declines in infant and child mortality occurred with the advent of biomedical and technical interventions in developing countries after World War II. At the same time, these interventions promoted longer lives by curing and/or treating chronic diseases in developed countries. In the 1970s, however, it was apparent that the hospital based, curative approach could not meet health needs and was very costly. In developed countries, biomedical and social sciences showed that chronic diseases did not occur due to modernization but from unhealthy behaviors, diet, and lifestyle. In fact, in 1975, the US Centers for Disease Control announced that unhealthy lifestyles contributed to 50% of all deaths while the medical system was responsible for only 11%. The US and other developed countries then began to promote healthy lifestyles, and in the 1980s, considerable improvements in health occurred, especially among adults. Developing countries which depended on the Western medical model did not experience health gains in the 1970s. Yet developing countries where health systems concentrated on carrying essential services to all people and promoted basic hygiene and sound dietary practices continued to achieve considerable health gains. In 1978, WHO an UNICEF hosted the International Conference on Primary Health Care in Alma Ata, the Soviet Union to hold these developing countries with community based health systems as models of primary health care (PHC). The 1980s witnessed the spread of PHC especially in the form of child survival which focused on oral rehydration therapy and breast feeding. The biomedical and social sciences are needed to move this health policy and program strategy forward. Governments must see to policies that promote healthy people. Political will is needed to make human welfare a high priority.     

Labour migration and the work permit system in the United Kingdom

"The aim of this paper is to examine the effects of the work permit today [in the United Kingdom], using official data. It first reviews the operation of the [labor migration] system and describes the main schemes incorporated. Then, it uses data for 1984-88 to describe the general characteristics of labor immigration through the schemes. Finally, by means of a small random sample of applications and issues, it presents details on particular aspects of the immigration. It demonstrates that current labour immigration through the system is selective: most of those entering with long-term permits are highly skilled, well paid, and moving within the internal labor markets of large transnational corporations." (SUMMARY IN FRE AND SPA)     

Macroeconomic impacts of worker remittances on Arab world labor exporting countries

The author discusses the effect of remittances from workers in oil-producing states in the Arab world on macroeconomic development patterns in non-oil-producing regions. Consideration is given to the impact of remittances on consumption and domestic growth and their interrelationships with foreign exchange. (SUMMARY IN FRE AND SPA)     

Measurement of Hispanic ethnicity in the U.S. census: an evaluation based on latent-class analysis

"Two models, the U.S. census model and the latent-class model, are compared in their application to evaluating measurements of ethnicity. Although the census approach assumes that the response categories of a questionnaire item correspond to groups in the population, the latent-class approach seeks to assess whether any set of response categories can represent observed ethnic heterogeneity. Data collected using the 1990 census Hispanic-origin question and other instruments for measuring ethnicity suggest that the latent-class approach is superior whenever the response categories are not known to be valid. In particular, using the latent-class model, this article rejects the census model's assumption of a single dimension of meaning underlying responses to the Hispanic-origin question."     

Estimating fecundability from data on waiting times to first conception

"This article tests assumptions invoked in the demographic literature to estimate the population distribution of fecundability from data on waiting times to first conception. In continuous time, the key assumption is that waiting times are realizations from a mixture of exponentials distribution. In discrete time, the key assumption is that waiting times are realizations from a mixture of geometrics distribution. The [U.S.] Hutterite data analyzed by Sheps (1965) are consistent with this assumption. Various models, however, have one representation in mixture of exponentials form. A fundamental identification problem plagues the conventional estimation procedure. Our analysis calls into question the conventional practice of checking model specification by using goodness-of-fit tests. The practical importance of the identification problem in duration models is demonstrated."