Abstract:
:Improvement will be constrained by the function-based organizational model found in most health care organizations. Most components of the typical organization are driven by the concept of division of labor. The organization needs to challenge the underlying assumptions and reengineer from top to bottom. Reengineering, a disciplined approach to breakthrough change, is complementary to continuous improvement but has several major differences. This article explores the need for reengineering, the essential components of reengineering, how it relates to other approaches to change, ideas on when reengineering is necessary, and the challenges related to reengineering an organization.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Coan Tkeywords:
subject
Has Abstractpub_date
1994-04-01 00:00:00pages
15-26issue
3eissn
1063-8628issn
1550-5154journal_volume
2pub_type
杂志文章abstract:OBJECTIVES:To identify risks associated with delivery of treatment with oral antineoplastic agents in an outpatient setting and to evaluate additional value and feasibility of engaging patients in a proactive risk analysis. METHODS:We conducted 2 separate but parallel failure mode and effects analyses (FMEAs) among pa...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000199
更新日期:2019-01-01 00:00:00
abstract::In 1998, the Veterans Health Administration invested in the creation of the Veterans Administration National Quality Scholars Fellowship Program (VAQS) to train physicians in new ways to improve the quality of health care. We describe the curriculum for this program and the lessons learned from our experience to date....
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200210030-00006
更新日期:2002-04-01 00:00:00
abstract::With costs and competitive pressures increasing, pharmaceutical sponsors and contract research organizations are examining the drug development process. Investigators who conduct clinical studies significantly impact research quality and, thereby, costs. This article reviews current investigator selection methods and ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199907030-00004
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:Metformin is recommended as initial therapy for most patients with type 2 diabetes mellitus. Its most serious adverse effect, lactic acidosis, is a rare entity with a high mortality rate. Despite well-publicized contraindications, metformin is inappropriately prescribed to many hospitalized patients. OBJECT...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31826d1ef9
更新日期:2012-10-01 00:00:00
abstract::The p chart is widely used in health care and other service organizations as well as in manufacturing to monitor the proportion of observations with some particular characteristic for comparing several sources of data or for tracking a single source of data over time. The conventional approach is to use 3sigma limits ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000267449.32629.b1
更新日期:2007-04-01 00:00:00
abstract::Methods to produce change in physician practice patterns are of increasing importance to payers and regulators as well as to physicians themselves. Because some of the strategies being adopted occur without physician input and participation, they have aroused concern in the medical community. We describe the methods u...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1997-07-01 00:00:00
abstract::As a group, physicians strive for quality but often resist quality measurement. Cost, inconvenience, lack of time, mistrust of quality measures, and a fear of what assessment may find are all factors contributing to this resistance. However, quality, in both rich and poor counties, continues to be poor at worse and va...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:2006-04-01 00:00:00
abstract::This article proposes a new class of control charts that may be used for monitoring and improving the quality of care. Unlike conventional control charts that rely on observed performance data, these charts use risk-adjusted data in addition to the observed data. The resulting time-ordered charts are capable of reduci...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200301000-00004
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Although often used in health care settings as a method for continuous quality improvement, experience with the breakthrough collaborative in nonclinical health care settings is limited. In this article, we report pilot data from a social services collaborative conducted in 2007 to 2009 in Sweden, with speci...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181c58e20
更新日期:2009-10-01 00:00:00
abstract::The Agency for Health Care Policy and Research pain guidelines and implementation theories were used in this improvement initiative to ensure that evidence-based pain management reached every provider and patient in a large tertiary care hospital. Implementation strategies, products, and outcome measures are described...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199907020-00004
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The mission of nonprofit health care clinics is particularly challenging to fulfill given the large number of uninsured and underinsured people they serve. In addition, these clinics feel pressure to provide services in an efficient manner to prevent patient no-shows and encourage the continua...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000215
更新日期:2019-07-01 00:00:00
abstract::The physician-patient relationship is an essential part of end-of-life planning, including discussions of advance directives (AD). Physicians likely to encounter AD issues with their patients were identified and queried as to their knowledge, opinion, and experience with ADs. Though most physicians felt ADs were helpf...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200008030-00004
更新日期:2000-04-01 00:00:00
abstract::Patients' perceptions provide valuable insight into areas for improvement and opportunities for strategic planning. Using both quantitative and qualitative research methods, the topics of what drives patient satisfaction, what delights patients, and what disappoints patients were examined. A case study approach was us...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1997-04-01 00:00:00
abstract::A lost surgical specimen prompted an investigation of both the human processes and the systemic factors involved in surgical specimen handling regarding how health care organizations approach medical error prevention and patient safety promotion. Quality improvement techniques and the conceptual error model of James R...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200110010-00006
更新日期:2001-10-01 00:00:00
abstract::We present an approach to assessing the impact of surveillance for surgical site infections and providing feedback to surgeons on their progress, as part of continuous quality improvement. Adjusting for patient risk factors using the Standardized Mortality Ratio, there was a marked decrease over time in both SMR (1.3 ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199806030-00006
更新日期:1998-04-01 00:00:00
abstract::To see the world systematically through the practice of systems thinking means to see the relationship in the phenomena we experience. The systems view is not just another way of improving an object, a process, or even services. It should not be viewed as a method that is focused only on "quality." The intrinsic value...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199807010-00004
更新日期:1998-10-01 00:00:00
abstract::The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health c...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000181
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns. ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000198
更新日期:2019-04-01 00:00:00
abstract::In an environment where there is increased demand for hospital beds, it is important that inpatient flow from admission to treatment to discharge is optimized. Among the many drivers that impact efficient patient throughput is an effective and timely discharge process. Early morning discharge helps align inpatient cap...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000049
更新日期:2015-01-01 00:00:00
abstract::Recently in this journal, F. Alemi (Qual Manage Health Care. 2004;13(4):216-221) proposed the use of Tukey's Control Chart because of the unique benefits associated with nonparametric inferential statistics including robust performance with (1) low N sizes, (2) nonnormal data, and (3) the presence of outliers, However...
journal_title:Quality management in health care
pub_type: 评论,杂志文章
doi:10.1097/00019514-200504000-00006
更新日期:2005-04-01 00:00:00
abstract::Should the United States require mandatory reporting of medical errors within the health care system? Many barriers to medical error reporting currently exist and have made it difficult to establish a nationwide reporting system. As such, individual states have begun to address this issue one state at a time. This art...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000344594.48510.82
更新日期:2009-01-01 00:00:00
abstract::A variety of approaches are available to monitor and quantify the frequency of medical errors and the harm associated with them. The University HealthSystem Consortium Patient Safety Net provides a categorical, rank-ordered approach for designating harm associated with medical errors but does not lend itself to routin...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181fa074e
更新日期:2010-10-01 00:00:00
abstract::The Ritz-Carlton Hotel Company won the Malcolm Baldridge National Quality Award in 1992. One key to its success is its strategic planning process. This two-part article reviews the Ritz-Carlton's approach to strategic planning. In particular, it describes (1) the role of senior leadership in the planning process and (...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1993-07-01 00:00:00
abstract:CONTEXT:Residents often fail to escalate narcotics to ensure pain relief in patients with cancer because of fear of overdose. A computer simulation of patients in pain may provide a way to improve management without fear of harm. We developed a pain care simulation to train residents. STUDY DESIGN/MEASURES: Thirty-one ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000326722.70708.0d
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Inability to obtain timely medications is a patient safety concern that can lead to delayed or incomplete treatment of illness. While there are many patient and system factors contributing to postdischarge medication nonadherence, availability and insurance-related barriers are preventable. P...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000264
更新日期:2020-10-01 00:00:00
abstract::There are various methods to get some projections of health indicators that do not always produce satisfactory results. Our aim is to establish the rules for obtaining reliable projections, using simple models. In the procedure proposed here, there is no need, as in many other techniques, to directly connect the level...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:2006-07-01 00:00:00
abstract::In a previous article (M. K. Hart, Qual Manag Health Care. 2003;12(1):5-19), the authors presented risk-adjusted control charts applicable for attributes data. The present article discusses a similar class of control charts applicable for variables data that are often skewed. The key feature of these charts is their a...
journal_title:Quality management in health care
pub_type: 评论,杂志文章
doi:10.1097/00019514-200404000-00003
更新日期:2004-04-01 00:00:00
abstract:PURPOSE:Adherence to new guidelines for the use of ipecac syrup, gastric lavage, cathartics, and activated charcoal by a poison control center was studied with a quality improvement framework. METHODS:The rates of gastric decontamination were monitored through an electronic case record system. In February 2002, a revi...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200610000-00008
更新日期:2006-10-01 00:00:00
abstract:INTRODUCTION:Real-time location systems (RTLS) and Lean management approaches have been employed to improve patient flow in clinical settings. This study explored the feasibility of using these methodologies in an outpatient resident ophthalmology clinic. METHODS:Patients, providers, and staff in Wilmer Eye Institute ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000075
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVES:This article explores and describes key processes facilitating the integration of neophyte graduate nurses into safe and effective organizational systems and processes as part of a hospital's overall local clinical governance and clinical risk management (CRM) program. METHODS:This study was undertaken usin...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000316994.02039.80
更新日期:2008-04-01 00:00:00