This article describes the art and science of continuous performance measurement and applications for quality improvement in anatomic pathology. Numerous novel benchmarks derived from multi-institutional data acquired from the College of American Pathologists Q-Probes quality improvement program are illustrated as they relate to specific disciplines in anatomic pathology and aspects ...

BACKGROUND: Students in the health professions must internalize the subject matter--professional knowledge--to acquire the necessary skills to serve as practitioners. Yet the ability to engage in continuous improvement is attainable only when combining professional knowledge with improvement knowledge. It is a challenge to strike a balance between theoretical teaching and ...

This article identifies and reviews key elements of quality improvement programs for an endoscopy unit. The new paradigm of quality improvement seeks to improve all performance, and does not simply focus on the low outliers as in the traditional "quality assurance" program. The organization and key elements are emphasized, including ...

To implement an effective and efficient quality system in a network of established environmental testing laboratories requires a committed long-term effort that is potentially fraught with multiple obstacles. This presentation discusses one state's ongoing efforts at implementing such a system. First is the need to convince management of the rationale ...

OBJECTIVES: To describe the perceived effectiveness of using the Total Quality Management (TQM) approach to quality improvement in both academic and nonacademic EDs, and to discuss some important barriers to effectiveness of TQM programs. METHOD: A mail survey of 100 EDs was conducted with telephone follow-up. Hospitals were randomly selected ...

The history of audit is traced over the past 30 years demonstrating how it has come to dominate attempts to improve the quality of patient care in British general practice. Nevertheless it is still uncertain whether audit usually or occasionally yields such improvements. There is much more to learn about ...

OBJECTIVE: To establish a system of Continuous Quality Improvement (CQI) which does not require substantial resources in a clinical setting. SETTING: A busy department of obstetrics and gynaecology. METHODS: The system is based on seven elements: (i) comprehensive accumulation of data; (ii) involvement of all faculty members and the majority ...

Just as quality programs have evolved into organization-wide performance improvement efforts, the quality professional's role has expanded, bringing new challenges and expectations. The quality services umbrella, an operational framework for a total systems quality process, helps organization leaders and quality professionals identify organizational functions that contribute to overall performance. This ...

In writings on the theory of valuing, many take the position that impacts on the relevant outcome dimensions should be aggregated to arrive at one summary assessment of program merit. A contrary position is taken here, specifying that the impacts should be kept separate and unweighted and expressed only in ...

In the aerospace industry, typically 60 percent of a product's cost and 70 percent of the lead time are due to purchased material. To affect price and customer responsiveness, improvement initiatives must be extended into the supply chain. Many companies have developed supply base management systems that include long-term agreements ...

Certification of supplier generally means that the supplier provides acceptable quality, on-time delivery at the lowest cost. Companies have devised numerous methods, criteria, formats, and approaches to certifying suppliers. Many of these are too complicated, not understandable, administratively difficult, or fail to be objective. If you have struggled with how ...

As health services face increasing pressure to meet the expectations of different stakeholders, they must continuously improve and learn from their experience. Many fail in attempts at continuous improvement programs because managers have not understood the complexity of making changes in organisations with multiple subcultures and interests. This article examines ...

The transmission of moving pictures to remote locations is an important part of telemedicine. Although the first videoconferencing demonstrations were performed in the 1930s, the technology is still fragmented and its quality is sometimes too poor for it to be useful. Conventional television technology is analogue (the fundamental television standards ...

The Vermont Oxford Network is a voluntary collaborative group of health professionals committed to improving the effectiveness and efficiency of medical care for newborn infants and their families through a coordinated program of research, education, and quality-improvement projects. In support of these activities, the Network maintains a clinical database of ...

In many studies, ergonomics has been shown to influence human performance. The aim of this paper was to demonstrate important ergonomics influences on quality in industrial production, from the perspective of interactions between humans, technology, organization, and work environment. A second aim was to elaborate on the implications of these ...

One of the greatest obstacles to bringing drugs to market is one of the most complex--the human mind. Despite the billions invested in R&D, a fundamental issue in drug development is that most patients' responses are enhanced or affected by the "placebo effect." An ongoing methodology for reducing the impact ...

The licensing procedures reviewed above provide a framework for the production of pure, safe, potent, and efficacious veterinary biological products. The licensing, inspection, and testing activities of the Veterinary Biologics program provide the oversight necessary to ensure the continued availability of high-quality veterinary biological products in the United States.

A holistic view is essential for quality initiatives such as Total Quality Management (TQM), Standard No. ISO 9001:1994 (International Organization for Standardization [ISO], 1994), Concurrent Engineering, Business Reengineering, and Business Process Improvement. The challenge is knowing how to transition from this theoretical concept to implementation. The relationship between quality interest ...

Most systematic reviews rely substantially on the assessment of the methodological quality of the individual trials. The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of randomized clinical trials (RCTs). The invited participants were experts in the field ...

There is intense competition between managed care organizations (MCOs) in the USA based on cost and benefit coverage, but scant attention to differences in quality. Consumer preference for 'choice' has stimulated the growth of overlapping networks of providers across competing MCOs. These networks have tended to perform less well on ...

Clinical laboratory investigations used to aid antimicrobial chemotherapy of serious infection include routine sensitivity testing and, in the case of those drugs with a narrow therapeutic range, routine assays for therapeutic monitoring to assist with dosage individualization. Tests must be of a sufficiently high quality to be clinically useful. Laboratories ...

Performance improvement activities in telemedicine may be placed into five categories. (1) Licensing and credentialing. Telemedicine overcomes geographical boundaries, but its reach is constrained by state laws on licensing. Some states require a state license, whereas others grant "consultation exemptions" for out-of-state physicians. Simple renewable licenses do not guarantee quality. ...

What effects will the implementation of the quality standard ISO 9000 have regarding working conditions and competitive advantages? Which are the most important change process characteristics for assuring improved working conditions and other desired effects? These are the main questions behind this study of six furniture-making companies which implemented ISO ...

To evaluate the impact of a program on basic handwashing quality, a before-after audit was performed in a university hospital. We defined a 13-step protocol to describe a proper basic handwash (BHW). The proportion of BHW that satisfied this checklist increased significantly, from 4.2% before the program to 18.6% after, ...

As a result of recent national events involving high-profile murder cases, medicolegal death investigation has begun to slowly receive the attention it deserves. Despite continued local problems of financial support and political control, the development of regionalized centers of forensic excellence is gradually improving the access of rural and suburban ...

A Quality System for Placental Blood Banking aimed at the transplantation of haematopoietic stem cells to related and unrelated allogeneic recipients is described. It includes the organizational structure, procedures, processes and resources needed to implement quality management. The Quality System described in this article is based on ISO 9002, a ...

The lessons learned in industry can be applied to anaesthetic departments. Progress and development are part of improving quality, and evidence is emerging that improved quality can reduce costs. Improving quality requires anaesthetic departments to develop a clear customer focus. Education, training, research and quality improvement are essential components of ...

Many Saudi companies, in their journey to improve quality, efficiency and competitiveness, are pursuing and obtaining the ISO 9000 certificate. Many studies have evaluated how to implement ISO 9000 in different sectors, but none have analyzed the effectiveness of ISO 9000 certification (costs and benefits) on improving the overall quality ...

Companies are currently abandoning vertical integration in order to focus on their core competencies and capabilities. As a result, higher percentages of their products are being provided by suppliers. In today's global marketplace, customers can demand and receive products that possess excellent quality. In order to remain competitive, companies must ...

Mislabeled umbilical cord blood specimens were identified as an important and difficult problem to solve. Quality improvement principles were employed after education-based interventions failed to achieve measurable improvement. A small interdisciplinary working group of key stakeholders investigated, designed, and evaluated interventions for a solution. This article describes a system-based change ...

Some of the first telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, occupational counselling, consultation and teaching. In 1996 videoconferencing was used for a total of 249 hours, which increased to 434 hours ...

This report presents a summary and analysis of the continuous quality improvement and organizational change and redesign initiatives undertaken by the unit and service boards organized under the auspices of the HORIZONS Project. Board initiatives were identified and summarized by staff through interviews with the chairpersons and representatives of the ...

"This study investigates the influence of school quality (measured at the high school level) on 1980 to 1990 population and employment change for nonmetropolitan fringe and hinterland census tracts in South Carolina. A Boarnet variation of the Carlino-Mills model is used to examine the interdependence of population and employment change.... ...

BACKGROUND: Increasingly, blood centers worldwide are turning toward the ISO (International Organization for Standardization) 9000 Quality System Standards to meet regulatory demands of public authorities, competitive demands within their industry, and cost requirements from their customers. CASE REPORT: The South Texas Blood and Tissue Center is the first blood center ...

For the past few years, blood banks within and outside of hospitals have been required to develop a documented quality assurance/quality improvement program to comply with regulator guidelines and accreditation standards. Concerns have been raised that the cost of compliance could exceed any plausible return on this investment. Unfortunately, little ...

During the last decade our office use of photographs to document patient treatment has increased. Many photographs were wasted because of poor quality, others because of mismatched views. Storage was cumbersome, and retrieval was time-consuming. The objective was to produce better quality photographs cost-effectively, with a user-friendly camera system. A ...

The Chronic Illness Management Research and Development Project (CIMRDP) was created as part of an effort to implement clinical process improvements in HealthSystems Minnesota, a vertically integrated care system in Minneapolis. CIMRDP's objective is to introduce sustainable improvements in the management of chronic illness. These types of quality improvement efforts ...

Tennalum, a division of Kaiser Aluminum, received the 1995 Shingo Prize for Excellence in Manufacturing. The plant also received the 1995 Tennessee Quality Achievement Award, the criteria for which are based on the Malcolm Baldridge National Quality Award. In 1994, Tennalum received the Clemson University's 21st Century Organizational Excellence Award, ...

Writing high-quality test questions is not an easy task. This report offers a brief summary of how to write more effective multiple choice questions and reasoning questions based on the principles of adult learning theory. The intent of this article is to present a brief overview of information for readers ...

The hypothesis in Study 1 was that positive mood leads people to rely on both central and peripheral features of relationship quality when making global satisfaction judgments concerning their relationship with a spouse or partner, whereas sadness leads people to focus more exclusively on central features. For German university students, ...

This paper reviews the literature comparing the fields of ergonomics and quality, mainly in an industrial context, including mutual influences, similarities and differences. Relationships between ergonomics and the factors: work conditions, product design, ISO 9000, continuous improvements and TQM are reviewed in relation to the consequence, application, and process domains. ...

Performance measures go beyond mortality and cost: Using process steps as performance measures allows providers to easily determine where action needs to be taken to improve quality. One consultant has developed a list of 37 performance measures in nine disease categories and tracks performance using a software program. Here are ...

BACKGROUND: In 1994 the Department of Family Medicine (DFM) at the Medical University of South Carolina (MUSC) developed an innovative infrastructure for continuous quality improvement (CQI) which capitalized on its existing computer-based patient record (CPR) system. CQI PROGRAM: The CPR is a key element in all components of the DFM ...

Revisions to the Merger Guidelines issued by the Federal Trade Commission and Department of Justice may indicate some easing of Federal antitrust enforcement practices of the past. The revisions clarify how claims that mergers are likely to lower costs, improve quality, or otherwise achieve efficiencies are analyzed. The revisions provide ...

A behind-the-scenes look at Mt. Diablo Medical Center's data-driven clinical resource management program shows how this California provider got control of overhead, admission rates, LOS, and resource utilization. See how they used data to target areas for quality improvement and cost cutting, and linked QI initiatives throughout the organization. Plus, ...

As the training of medical students and residents increasingly moves to ambulatory care settings, clerkship and program directors must find a way to use their limited resources to guide the development and evaluation of the quality of these ambulatory-based learning experiences. To evaluate quality, directors must first define, in operational ...

The eclectic mix of participants in the forum had a surprisingly singular focus when it came to the topic of quality in clinical laboratories. All sensed that the time is right for a transition from laws, rules, and inspections to a true quality-based system. Such a system can achieve the ...

Quality by design is a comprehensive program that begins with understanding user needs and continues through (but does not end with) monitoring customer acceptance. Management tools and processes such as ISO 9000 standards and the Food and Drug Administration Quality System Regulations exist to guide medical device manufacturers in quality ...

In the last issue of Healthcare Executive, we introduced the first in a two-part series on quality in healthcare. The series, which is predicated on a five-hour roundtable discussion among eight healthcare leaders, was moderated by Thomas C. Dolan, Ph.D., FACHE, CAE, ACHE's president and chief executive officer, and jointly ...

The principles of total quality management (TQM) were used to improve the infant metabolic screening program in a large urban hospital. Three quality indicators needed improvement; unsatisfactory specimen quality, delayed delivery to the state laboratory for testing, and specimen slips missing the date of collection. A multidisciplinary team identified the ...