International journal of health care quality assurance incorporating Leadership in health services最新文献

Purpose: The rising operating cost of providing healthcare is of concern to health care providers. As such, measurement of procurement performance will enable competitive advantage and provide a framework for continuous improvement. The objective of this paper is to develop a procurement performance measurement system.

Design/methodology/approach: The paper reviews the existing literature in procurement performance measurement to identify the key areas of purchasing performance. By studying the three components in the supply chain collectively with the resources, procedures and output, a model is been developed. Additionally, a balanced scorecard is proposed by establishing a set of generic measures and six perspectives. A case study conducted at the Singapore Hospital applies the conceptual model to describe the purchasing department and the activities within and outside the department.

Findings: The results indicate that the material management department has already made a good start in measuring the procurement process through the implementation of the balanced scorecard.

Research limitations/implications: There are many data that are collected but not properly collated and utilized. Areas lacking measurement include cycle time of delivery, order processing time, effectiveness, efficiency and reliability. Though a lot of hard work was involved, the advantages of establishing a measurement system outweigh the costs and efforts involved in its implementation.

Practical implications: Results of balanced scorecard measurements provide decision-makers with critical information on efficiency and effectiveness of the purchasing department's work.

Originality/value: The measurement model developed could be used for any hospital procurement system.

Purpose: To describe how The Red Cross Hospital in Beverwijk, The Netherlands implemented an ISO 9000 quality management system throughout the entire organisation, obtained an ISO 9002:1994 and subsequently an ISO 9001:2000 certificate.

Design/methodology/approach: First, a global implementation plan was written concerning the process obtaining in each department. Once improved, each process was subjected to a procedure, and specific protocols effected. On completion the Quality Manual was put together. Quality management was completed by implementing an internal audit system involving 50 co-workers.

Findings: A number of advantages are found from using ISO. The focus on patients has been re-established. All processes are identified and subject to continuous improvement. Performance measurements were introduced and give an integrated picture of results. Measurements subsequently lead to improvement of quality of care and to quality system improvements. The documentation system serves the organization's needs without leading to bureaucracy. Positive effects on patient safety could be demonstrated compared with ten other hospitals.

Originality/value: Given the need for adequate quality management tools in health care and the need for demonstrating quality, the positive effects reported in this article show how ISO is expected to become more prevalent in health-care organisations.

Purpose: In the USA, health maintenance organizations (HMOs) have pledged to control health care costs. Many patients have complained about the quality of care under the HMO regime and limits imposed on them, particularly access to care. Has quality of care been degraded under the HMO regime, resulting in an impact on patient satisfaction? There have been many studies that have compared the satisfaction of HMO patients with that of patients in the traditional fee-for-service payment system. The aim of this paper is to review HMO patient satisfaction.

Design/methodology/approach: A review of patient satisfaction under managed care arrangements with a focus on HMOs. The article describes the US history of managed care and its effect on the satisfaction of several patient categories including the general population, vulnerable patients and the elderly.

Findings: There is much information available on patient satisfaction with their insurers and most surveys indicate the lack of choice of a provider--a major source of discontent. Therefore, patient protection laws are necessary to avoid abuse.

Originality/value: Patients have little ability or are not willing to rely on the information available when selecting a provider. The paper discusses patient awareness regarding satisfaction surveys and how the latter can be used when patients are seeking care.

Purpose: The purpose of this article is to present a case study that documents how management science techniques (in particular data envelopment analysis) can be applied to performance improvement initiatives in an inpatient physical therapy setting.

Design/methodology/approach: The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery (at a medium-sized medical facility in the Midwestern USA) during the fiscal year 2002. Data envelopment analysis (DEA) was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using non-parametric and parametric methods.

Findings: Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension.

Research limitations/implications: The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling: adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities (or the same disability with other outcome variables, such as Functional Independence Measure scores) may give dissimilar results.

Practical implications: This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics.

Originality/value: DEA has not been applied to rehabilitation, especially in the case where managers have limited

Purpose: The paper reports on the conceptualization and measurement of the employee satisfaction construct at North East Alabama Regional Medical Center (RMC), Anniston, Alabama. The study sought to take a global attitudinal measure of employee satisfaction.

Design/methodology/approach: The employee satisfaction construct was evaluated through the use of an amended Brayfield-Rothe Index (BRI). The Index, in its original form, comprises an 18-item five-point Likert scale with items listed in both positive and negative format. The amended instrument comprised an additional 12 items addressing such issues as organizational culture and satisfaction with existing orientation, human resource policy and practice. The sample was drawn from all employees of the North East Alabama Regional Medical Center, Anniston, Alabama over a two-week period in November 2003.

Findings: The results have proved beneficial in revealing those core dimensions that comprise the employee satisfaction construct, at least as defined through the use of BRI at RMC. The Center has been able to identify those areas where performance should be maintained at present levels and those where improvement is needed.

Research limitations/implications: The research is limited by the fact that it was cross-sectional in nature and in order to track real change/improvement over time, it should be repeated annually. It should also be stressed that the BRI was used to provide a global attitudinal measure of employee satisfaction only. When used as such, the author would recommend a certain amount of qualitative follow-up with willing participants in a focus group forum. This should allow for a richer interpretation of the results.

Practical implications: The results have proved beneficial in revealing those core dimensions that comprise the employee satisfaction construct, at least as defined through the use of BRI at RMC. The Center has been better placed to identify those areas where performance should be maintained at present levels and those where improvement is needed.

Originality/value: The research demonstrates the value and relative simplicity of the BRI method.

Purpose: This study sought to evaluate the impact and sustainability of the Leading Empowered Organisations (LEO) programme on the role of G Grade Nurse Managers, their colleagues and therefore on patient care at CHS.

Design/methodology/approach: A qualitative, inductive research methodology, which employed 360-degree research evaluation, was used. A purposive sample of four G Grade Nurse Managers was included. Each G Grade and eight of each of their colleagues were interviewed. Data were analysed according to the principles of thematic analysis.

Findings: There was evidence of a sustained impact of the LEO programme on G Grade Nurse Managers in relation to competence, action plans, delegation, communication strategies, problem solving, risk taking, leadership and management. The study also revealed a number of significant personal and contextual factors that affected the implementation of the LEO principles. Empowerment, or a lack of it, underpinned much of what occurred in the implementation of the LEO principles by the G Grades into practice.

Originality/value: The findings indicated that both organisational and individual action is necessary to achieve leadership development. Organisations need to ensure that investment in leadership is not restricted to the LEO programme, but that it becomes a strategic priority.

Purpose: Quality has an established history in health care. Audit, as a means of quality assessment, is well understood and the existing literature has identified links between audit and research processes. This paper reviews the relationships between audit and research processes, highlighting how audit can be improved through the principles and practice of social research.

Design/methodology/approach: The review begins by defining the audit process. It goes on to explore salient relationships between clinical audit and research, grouped into the following broad themes: ethical considerations, highlighting responsibilities towards others and the need for ethical review for audit; asking questions and using appropriate methods, emphasising transparency in audit methods; conceptual issues, including identifying problematic concepts, such as "satisfaction", and the importance of reflexivity within audit; emphasising research in context, highlighting the benefits of vignettes and action research; complementary methods, demonstrating improvements for the quality of findings; and training and multidisciplinary working, suggesting the need for closer relationships between researchers and clinical practitioners.

Findings: Audit processes cannot be considered research. Both audit and research processes serve distinct purposes.

Originality/value: Attention to the principles of research when conducting audit are necessary to improve the quality of audit and, in turn, the quality of health care.

Purpose: The purpose of this paper is to define the roles of the key health industry constituents patients, employers, health insurers, hospitals, physicians, Government, pharmaceutical companies and other industry suppliers, plagued with the decline of the health status and affordability in the USA.

Design/methodology/approach: Reviews literature to back up the author's views.

Findings: As health-care demands increase and the constituent roles blur, the industry will experience a gradual convergence. Convergence will redefine and create overlap in the boundaries between the traditional health industry suppliers and in the end this convergence will reshape the future of the health industry.

Originality/value: predicts that the drivers of change--deteriorating public health, poor quality and safety, and unaffordable health care--will continue to accelerate. Convergence will be gradual and the impact may not be immediately obvious, but the long-term outcome will dramatically reshape the industry. For the major suppliers in the industry, recognizing convergence is only the first step. Navigating convergence so the decisions made by an organization are both productive and profitable, rather than debilitating, is a far more complicated endeavor. The decisions made will not only affect the future of each supplier but also significantly impact the constituent at the center of this industry the patient.