This paper begins with historical and other reflections on the nature and importance of quality in medical education. It then identifies and discusses missions of a medical school--which include teaching, research, medical service, continuing education, and social advocacy--and notes that these elements should be complementary and indeed synergistic. Components of ...

In this article we discuss a management construct, called Measures of Effectiveness (MOEs), used by executive leadership at the National Naval Medical Center in its performance of its oversight functions. Three case studies are presented illustrating the usefulness of MOEs for planning, for performance measurement, and for making determinations regarding ...

There is little incentive to change existing protocols or clinical practices of medical conditions in which the results of treatment are considered already to be satisfactory. Our approach to continuing quality improvement (CQI) demands that, even in these conditions, attempts should be made to improve performance further. This report shows ...

The managing director of a medical device company has been heard to refer to his manager's efforts to implement a quality system as his quality "sideline." Another device company that lacks a quality system could lose a significant percentage of its turnover because its major clients require their suppliers to ...

Successful examples of teams and drug use evaluations explore communication strategies to enhance quality improvement of medication use. Topics highlighted include establishing contacts within key departments, creating committee connections, fostering physician and nurse participation, and increasing visibility and maintaining awareness. Multidisciplinary collaboration and linkage between the hospital and the managed ...

The external quality assessment schemes in clinical chemistry are regulated by the guidelines of the Federal Association of Physicians for Quality Assurance in Medical Laboratories (Richtlinien der Bundesärztekammer zur Qualitätssicherung in Medizinischen Laboratorien) which are part of a legal act. The basis of the mandatory quality assessment in medical laboratories ...

Surgical biopsies are often the bedrock of contemporary medical care--the foundation upon which many subsequent and important medical decisions are based. The methods described herein have been found to be very reliable and to produce diagnostic material of high quality. Although some clinics have been reluctant to rely on FNA ...

Obtaining good quality encoded medical information is a major issue for patient documentation, hospital management, and epidemiological statistics. In this paper, the experience of encoding medical information in Geneva since 1978 is described, following 1988 IMIA WG6 recommendations: "There is a need to enhance the involvement of physicians and other ...

Fluctuating asymmetry (FA) refers to the random, stress-induced deviations from perfect symmetry that develop during the growth of bilaterally symmetrical traits. Individual differences in the level of FA may influence mate choice: in a number of species, females prefer to mate with males that have more symmetrical sexual ornaments. As ...

BACKGROUND: Despite widespread agreement that outcome analyses should be followed by in-depth review of the care provided by outlier providers, there are few, if any, reports in the literature describing the effectiveness of this approach to quality improvement. In 1991, the Department of Veterans Affairs (VA) completed a study to ...

Twenty-one Occupational Safety and Health Act (OSHA) standards were identified which contain medical service provisions intended to help in the identification and control of harmful health effects of workplace exposures. The utility and effectiveness of these provisions have not previously been evaluated. All 21 standards were reviewed and assigned numerical ...

BACKGROUND: We had previously observed that a large proportion of peripheral intravenous (i.v.) catheters placed in patients on a regular medical ward at our hospital were unnecessary. We conducted the current study to assess the effect of a quality improvement project led by medicine house staff on the prevalence of ...

After reviewing the environment of cost, quality data collection and analysis, the State Medical Society of Wisconsin Task Force on Quality Assessment and Implementation of Practice Parameters concluded it is critical for the SMS to take a dynamic role in sponsoring the development and use of medical outcomes research. The ...

The dairy industry is faced with increasing governmental and public concern about the safety of the nation's milk supply. New regulations under the Grade A Pasteurized Milk Ordinance require that prescription drugs be properly labeled and that all tanker loads of milk be tested for beta-lactam antimicrobial residues. Concern over ...

Global quality is becoming a major concern for the medical device and diagnostics industry. Good Manufacturing Practice (GMP) regulations aim to guarantee that effective and safe products are produced. However, the overall quality of a device depends on the quality of its components, which are frequently not manufactured by the ...

A major problem for patients and providers has existed since establishment of peer review and authorization agency medical necessity guide lines, because physicians and patients who receive denial of proposed procedures and tests on the basis of so called "medical necessity" presume that the authorization agency considers the proposed procedure ...

As companies traditionally involved in manufacturing for the aerospace and defence sectors come to terms with shrinking markets, their need to diversify into new markets is apparent. The potential for crossover from the aerospace to medical sectors is striking, if not ironic, and the technology that helped produce weapons of ...

The author was asked to share his experiences in developing medical programs within a company with numerous small manufacturing locations. Successful programs at these locations depend on obtaining high-quality occupational medical services in the local community. Policies that drive the content and quality of medical program services within large companies ...

Quality assurance is a topical issue within the software industry, and various methodological solutions aimed at improving software quality have been proposed. Medical software is generally deemed safety-critical and, as such, should be subject to control procedures exceeding those applicable to general-purpose software. The user/purchaser of medical equipment has an ...

A 37-bed surgical unit in a Midwestern Medical Center was the site of 30 day trials of three methods of medication delivery: (a) traditional medication cart, (b) patient point-of-view (PPOV1) delivery of regularly ordered medication by a pharmacy technician to the nurse server once a day, and (c) patient point-of-view ...

A quality system for a medical laboratory should be directed on all fundamental aspects of its function. This implies the obligation to join the External Quality Assessment schemes, and to make use of its results. It means the setting-up of a quality system according to a medical translation of the ...

Eleven clinical comorbidity indices are reviewed with attention to the development of improved assessment of comorbid conditions. Elements that are critical to the indices are reviewed, including their applicability, their inclusiveness, their validation, their correlations with outcomes of interest, their inclusion of functional assessment, their inclusion of severity assessment, and ...

A program for quality assessment of medical diagnostics is proposed, based on detailed, ongoing comparison of clinical diagnoses with autopsy diagnoses. The model requires that the autopsy service itself be subjected to quality control to assure the reliability of the autopsy findings, including the quality of diagnoses made postmortem, and ...

Wilhelm Konrad Roentgen presented a preliminary report on his discovery of x-rays in 1895. In his initial experiments with these rays, he had taken a radiograph of his wife's hand. This picture immediately implied a medical use for the new discovery by demonstrating the bones of the hand. Various aspects ...

Ototoxicity may arise from a variety of medications, chemical solvents, or environmental compounds. The resulting changes in auditory or vestibular function may cause significant morbidity as well as devastating effects on socioeconomic productivity and overall quality of life. Through careful attention to drug selection, dose, monitoring, and antecedent risk factors, ...

The achievements of the healthcare industry in the 21st century will depend on the quality of its leadership. In recognition of the contributions of the new generation of healthcare executives, MODERN HEALTHCARE salutes its 1993 Up & Comers. They are a group of healthcare professionals, all 40 or younger, who ...

BACKGROUND: The accuracy of hand-held analytical systems is dependent on the complexity of the instrument and the technical skills of the tester. We evaluated the analytical performance of the LifeScan One Touch II glucose analyzer when used by persons with various levels of technical skill and experience. METHODS: A medical ...

This project educated a multidisciplinary team on the techniques of continuous quality improvement, which were then used to analyze the total medication cycle process in order to reduce the total turnaround time for STAT and ASAP orders. Members were trained in the appropriate analytical techniques, developed flow charts of the ...

The number of good quality studies on the effect of feedback and reminders on diagnostic and preventive activities in ambulant practice is still low. The interventions and procedures studied differ widely, and the reporting of the results is insufficiently precise. This makes comparison difficult and quantitative pooling impossible. Nevertheless, the ...

We present the plan used to change our 35-bed medical treatment facility to a Deming Total Quality Improvement environment. This was successfully intermeshed with the military hierarchical chain of command and has resulted in a paradigm shift in the least amount of time within the facility. We present this plan, ...

From a practical viewpoint, the close relationships among utilization review, quality assurance/improvement, infection control, discharge planning, social services, and medical records makes it impossible to separate them. Case management combines these traditionally isolated hospital functions into one department in order to perform many related functions simultaneously. It provides a much ...

Legislation and standards applying to medical electrical equipment are reviewed. Although there are no official standards for cardiotocographs, de facto standards can be defined. The paper introduces the present-day performance qualities of cardiotocographs and the factors which affect the quality of the data. The measures used to evaluate the ability ...

The influence of medical and psychosocial variables on sexual outcome in 100 women with systemic lupus erythematosus was examined. Subjects were administered a sexual adjustment interview and scales assessing depression, body image, and relationship quality. Medical data were obtained from patients and physicians. Key predictors of sexual outcome were disease ...

The aridity of Saudi Arabia, in general, makes air pollution studies very important, not just on a local level but also on an international level. A comprehensive field study of atmospheric sulfur dioxide (SO2) concentration was conducted in Jiddah, Saudi Arabia (one of the fastest growing cities in the world) ...

Assessment of quality of life is gaining momentum in areas of medical practice where standard measures of outcome are not sensitive enough to determine treatment strategies. Such methods have not been widely adopted in the surgical specialties, although this is changing. The techniques used are easily understood but they have ...

OBJECTIVE: To compare the self-reported role of nursing home medical directors in 1989 (prior to the implementation of the nursing home reform amendments of OBRA 87 in 1990) with the role outlined in the Joint Commission on Accreditation of Healthcare Organizations Long Term Care Standards Manual. DESIGN: Survey. MEASUREMENTS: Using ...

The Accreditation Council for Graduate Medical Education in the United States has recently required institutions with residency and fellowship training programmes to develop an Institutional Policy Review Document outlining how the educational quality of these programmes is monitored. Whereas departments may have assumed this responsibility in the past, this is ...

One of the highest priorities in today's hospitals is the provision of quality care to patients. The medical librarian has an increased responsibility to furnish quality information to the medical staff. Traditional methods of reference service continue to work well, but it is increasingly important for librarians to become more ...

This paper will describe a successful application of Quality Improvement concepts to the complex Perioperative System at an academic medical center in the Northeast. The initiation of multi-disciplinary teams (including surgeons, anesthesiologists, and nurse managers) will be discussed, as will the steps, skills, and techniques employed. The paper will catalogue ...

In spite of concerns on the part of doctors and hospitals regarding the level of malpractice litigation, they have failed to appreciate the value of effective quality management programmes in minimizing this risk. This paper describes some of the main components of these complex programmes, highlighting the importance of credentialling ...

As the demand for immunohistochemical tests (IHC) extends beyond artistry to more widespread medical diagnostic need, the field requires improvements in quality, reproducibility, speed, and standardization. Automated IHC offers the opportunity to impart new levels of quality, reproducibility, and standardization while reducing labor and reagent costs. In addition, the controlled ...

A twice-yearly audit of a sample of medical records from each department of a general hospital was initiated by a quality assurance committee and pursued for 8 years. Missing entries that were considered obligatory for good medical performance of each service were identified, and the results (expressed as percent of ...

We evaluate the effectiveness of the daily record review (DRR) of 4393 ambulatory medical patients seen at the emergency room department of a teaching pediatric hospital in Paris between 8th January and 11 March 1991. For these patients, 137 potential quality problems were found, 117 of them remaining after discussion ...

The Medical Center for Refugees in Linköping, Sweden, includes a medical ward for refugees and asylum applicants. It was started in January, 1986 and is financed by the Swedish Immigration Board. Sixty percent of the patients are war-wounded and 40% have diagnoses non-related to war. This article describes a group ...

Total quality management (TQM) is a unifying business strategy for achieving and sustaining growth. TQM proceeds, step by step, project by project, to transform the organization into one smoothly working, quality-focused team. For successful implementation of TQM, the small projects are every bit as important as the large ones. The ...

Parkview Episcopal Medical Center in Pueblo, CO, has been implementing a continuous quality improvement (CQI)-driven organization since April 1988. Under the leadership of Michael Pugh, the medical center's president and CEO, Parkview has made great progress in this effort. However, there is much more to be accomplished in the years ...

Evaluating the quality of medical care is a documented activity extending as far back as 1910, when William Flexner, MD, examined the nation's medical schools. Standards promulgated by the federal government and by voluntary accreditation agencies have been primarily responsible for driving the development and widespread use of monitoring activities ...

Current quality of life measuring tools are suited for economic decision making, not to investigate causal processes which lead to patients making evaluations of their lives. An alternative approach is presented based on research into positive versus negative life-satisfaction. Quality of life is a causal sequence of psychological states where ...

Medical case management's purpose is to improve the quality of health care and decrease medical expenses associated with high cost medical cases. Patient satisfaction can be used as a measure of the quality of medical case management. This investigation resulted in a reliable and valid questionnaire for assessing patient satisfaction ...

Because of the demand for accountability and the necessity that the medical transcription department function as a revenue-generating entity within the hospital structure. HIM professionals are rejecting inadequate solutions and looking for long-term improvements in medical transcription quality and productivity. It has been our experience that many hospitals and clinics ...