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.     

Regulation of board-and-care homes: research to guide policy

Information about board-and-care homes reported in the media and in federal committee hearings indicates that they are shoddy and exploitative environments that do not provide adequate care. Research done in board-and-care homes in recent years, however, demonstrates that they can provide adequate care and a satisfying environment for some of the people they serve. Policy at the federal, state, and local levels should be guided by both the need to assure the health and safety of board-and-care residents and the needs of residents and operators identified in scientific studies.     

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."     

Medicine and the question of suffering

Doctors are not health care providers, and medicine is not a commodity. To practice medicine well, the doctor must attend to each patient as a whole person and be faithful in giving care when cure is not possible.