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. METHODS:We used operational data and baseline (ie, pre-Lean implementation) surveys of 1333 physicians and staff in 43 primary care clinics located across a large ambulatory care system. Segmented regression with interrupted time series analysis was used to identify clinics with highest improvements in workflow efficiency, physician productivity, and patient satisfaction following Lean redesign. We conducted independent-samples t tests to identify contextual features of clinics that showed greatest improvements in performance outcomes. RESULTS:Clinics with highest increases in efficiency had most prior experience with quality improvement, compared with all other clinics. Efficiency gains were also found in clinics reporting highest levels of burnout and work stress prior to redesign. Highest improvements in physician productivity were associated with a history of change, staff participation, and leadership support for redesigns. Greatest improvements in patient satisfaction occurred in least stressful environments with highest levels of teamwork, staff engagement/efficacy, and leadership support. CONCLUSIONS:Our findings encourage careful evaluation of clinic characteristics and capacity to effectively implement redesigns. Such evaluations may help leaders select interventions most appropriate for certain clinics, while identifying others that may need extra support with implementing change.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Hung DY,Harrison MI,Liang SY,Truong QAdoi
10.1097/QMH.0000000000000198subject
Has Abstractpub_date
2019-04-01 00:00:00pages
70-77issue
2eissn
1063-8628issn
1550-5154pii
00019514-201904000-00002journal_volume
28pub_type
杂志文章abstract::This article briefly describes natural induction approach to knowledge discovery, and then applies it to the problem of bad habit relapse prevention by analyzing patients' diaries. Natural induction seeks patterns in data that are in forms easy to understand and interpret, because they resemble those in which humans r...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000308640.89602.b1
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVES:Although 65% of the hospitals in Taiwan claim to be applying the clinical pathway concept, most hospitals do not implement this concept effectively. The purpose of this study was to determine the reasons for the improper or inappropriate application of the clinical pathway design in hospitals. METHODS:This ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200601000-00007
更新日期:2006-01-01 00:00:00
abstract::Like many organizations, Continental Rehabilitation Hospital of San Diego designs and communicates templates and targets for desired changes in behaviors and tracks results. It recognizes and celebrates successes and struggles with its failures. A recent case example demonstrates the importance of generating immediate...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199706010-00007
更新日期:1997-10-01 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:PURPOSE:Medical home care has been identified as a model for improving primary care delivery and population-specific quality and safety outcomes. Questions remain how this model affects older adult quality. This systematic review addresses 2 important questions: Are quality and safety outcomes associated with medical h...
journal_title:Quality management in health care
pub_type: 杂志文章,评审
doi:10.1097/QMH.0000000000000041
更新日期:2014-10-01 00:00:00
abstract::The aim of this study was to explore and evaluate managers' views of a large-scale improvement program, including their experiences and opinions about improvement initiatives and drivers for change. The study is based on a survey used in 2 nationwide mappings of improvement initiatives and developmental trends in Swed...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31828bc276
更新日期:2013-04-01 00:00:00
abstract::While data collection is fundamental to any scientifically based effort, health care improvement teams often report that it is one of the most frustrating aspects of their work. Groups that do succeed in gathering some data can also sometimes find that the data they have worked so hard to obtain does not really help t...
journal_title:Quality management in health care
pub_type: 杂志文章,评审
doi:
更新日期:1994-01-01 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::This article reviews studies of the effects of medical organization structure on quality and cost conducted over the past three decades. Topics of inquiry have proceeded from the organizational to the individual provider level and from the inpatient to the ambulatory level. The article presents the findings of these s...
journal_title:Quality management in health care
pub_type: 杂志文章,评审
doi:10.1097/00019514-199503040-00002
更新日期:1995-07-01 00:00:00
abstract::The U.S. Healthcare Fellowship in Quality Management at Hahnemann University was developed by a managed health care organization and health science university in order to train physicians in the theory and practice of quality management and clinical outcomes measurement. This article describes in detail the program co...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1996-10-01 00:00:00
abstract:AIMS:The purpose of this quantitative descriptive correlational study was to assess for presence and degree of critical thinking skills among perioperative (OR) nurses. BACKGROUND:Critical thinking has become a multidisciplinary "buzz phrase"; however, critical thinking, reflective thinking, or mental discipline was d...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181dafec7
更新日期:2010-04-01 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::Today's health care programs are being scrutinized like never before and yet few clinicians and managers know how to show the value of programs without time-consuming outcomes research. This is especially true for new and innovative programs that are dependent on outside funding and may not have enough time to show an...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200109040-00005
更新日期:2001-07-01 00:00:00
abstract::Quality is an illusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of ca...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200008040-00002
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:Organizational health literacy is the degree to which an organization considers and promotes the health literacy of patients. Addressing health literacy at an organizational level has the potential to have a greater impact on more health consumers in a health system than individual-level approaches. OBJECTI...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000162
更新日期:2018-04-01 00:00:00
abstract::The authors collected data from the record of a patient who had recently undergone coronary bypass surgery and used these data to construct control charts. The control charts helped them to interpret the variation in several clinical parameters and to evaluate the clinical responses to this variation. ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1994-10-01 00:00:00
abstract:BACKGROUND:The obesity epidemic threatens to shorten life expectancy and reduce the quality of life for large segments of the population. The purpose of this study was to develop a decision rule for referral to a weight-loss program on the basis of the relationship between body mass index (BMI) and self-rated overall h...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000281061.15108.f8
更新日期:2007-07-01 00:00:00
abstract::A control chart can be an effective way to display process data over time. It can differentiate common cause variation from special cause variation through the application of several probability-based interpretation rules. In addition, a control chart can be helpful in evaluating the effectiveness of a change. There a...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200109030-00003
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:We explored the associations between opioid dose and multiple measures of pain. STUDY DESIGN AND MEASURES:Thirty-two consecutive patients admitted solely for an acute exacerbation of cancer-related pain or for surgery were followed for their entire hospital stay (115 days of pain). For each hospital day, we ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000009
更新日期:2013-10-01 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::The patient-centered medical home model of primary care requires increased collaboration in care delivery. Recent studies suggest that such a collaborative model of care is aided by physician leaders who practice an inclusive approach to leadership; however, they do not empirically demonstrate what such strategies loo...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31825e876a
更新日期:2012-07-01 00:00:00
abstract::The American patient and consumer groups are increasing pressure on physicians and health care organizations to improve and document the quality of care that they deliver. A leading cause of inadequate care is the significant variations in medical practice that cannot be explained by patient differences, which persist...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199908010-00003
更新日期:1999-10-01 00:00:00
abstract::"Quality" of care has become one of the main foci of the American health care system during the last 20 years. As costs escalated in all areas of health care, the purchasers and consumers of health care have begun to demand accountability for the products they purchase. The initial focus of the system was "quality of ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200407000-00005
更新日期:2004-07-01 00:00:00
abstract::Given the revolutionary changes occurring in the health care industry, there is increasing agreement that academicians and practitioners must collaborate to identify and prioritize major educational outcomes for health care management. Several competency initiatives have been undertaken or completed in health care and...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200211010-00006
更新日期:2002-10-01 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 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::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::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::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::The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3182134b3c
更新日期:2011-04-01 00:00:00