bluuebunny/crossref_metadata_2025 huggingface dataset:
Free‐economics: The vision of reformer Silvio Gesell
Authors: Giacomo Preparata Guido , Elliott John E.
Published: September 2004

During the first decades of the 20th century, German Reformer Silvio Gesell (1862‐1930) championed with a certain success the reforming wave of the epoch by complementing ingenious solutions to some of the most important economic issues of his time with theoretical insights that were as radical as they were penetrating. The purpose of this paper is to offer an introduction to such intuitions, whose validity had been recognized even by a few distinguished academics of the 1930s, but which, owing to the extreme complications that eventually mired German intellectual production in its quasi‐entirety before WWII, failed to preserve the deserved consideration, however slight, they had earned when first formulated. A reappraisal of Gesell's contributions, considering the importance of his main themes, may be worthwhile, all the more so as these deal with questions unsolved to this day.
The effects of neoliberal structural adjustment on women's relative employment in Latin America
Authors: Ball Jennifer A.
Published: September 2004

Neoliberal structural adjustment policies (SAPS) have been criticized as having negative effects on women's employment. An analysis of several Latin American countries in the 1980s and 1990s suggests that differences in SAP contribute to differences in the growth of women's relative employment. Countries with less orthodox adjustment policies appear to have had greater growth in women's relative employment than countries with more orthodox policies. This pattern is illustrated with reference to specific countries and is tested for generality using Spearman's rank correlation coefficient, incorporating data from all Latin American countries from which suitable data are available.
Transformation crisis in post‐socialist countries: patterns and causes
Authors: Zukowski Ryszard
Published: September 2004

Discusses the literature on the inter‐country differences in the pattern and magnitude of the transformation crisis in post‐socialist coutries. Describes and analyses the stylized facts regarding the transformational crises in these countries. Summarizes the main explanations for the crisis focusing on the institutional dysfunction‐induced output fall. Presents a model of the system‐switch output decline.
English public library services and the Disability Discrimination Act
Authors: McCaskill Kirsty , Goulding Anne
Published: September 2004

Discusses the results of a research project investigating public library compliance with the Disability Discrimination Act, 1995 (DDA). Gives an overview of the DDA and discusses public library responses to Part III of the Act, covering access to services. Describes the results of the research, which took a case study approach, focusing on public library responses in the three key areas of policies and practices, access and communications. Concludes that standards of service for people with disabilities varies considerably between public library authorities and that, although most libraries are beginning to respond to the DDA, progress is slow and concentrated on the needs of certain groups of disabled people.
Planning the new central academic library
Authors: Hodge Sackett Judy
Published: September 2004

Presents suggestions to be considered in planning a new or renovated academic library. Examples are based on the William T. Young Library, central library at the University of Kentucky. The article is based on a presentation given at the American Library Association Annual Conference, New Orleans, Louisiana, USA, July 1999, as part of the program “2001 a Space Odyssey: Rethinking Library Buildings in a Digital Age”.
Police officers’ belief systems: a framework for analysis
Authors: Worden Robert E.
Published: September 2004

No study has been made to identify systematically the elements of police officers’ belief systems. Most studies focus on one or more attitudes and ignore related findings. Recent research has shown that police are heterogeneous in their attitudes, i.e., officers have divergent views about the ends and means of their functions. This article digests previous research and describes those belief systems which directly affect officers’ behavior. Reviews the typologies of White, Brown, Muir and Broderick and synthesizes these into five types: professional; tough‐cop; clean‐beat crime‐fighter; problem‐solver; avoider. Examines the outlook of these of five types in terms of human nature (e.g. cynicism), processes or outcomes (e.g. job satisfaction), and coercive authority. Calls for better conceptualization and measurement of police officers’ outlooks.
Introduction – the competency movement: its origins and impact on the public sector
Authors: Horton Sylvia
Published: September 2004

This introduction seeks to locate the origins of the competency management in American and British management concerns with declining international competitiveness and the need for more efficient and effective managers. It examines the distinctive American and British approaches and identifies and defines the ideas, concepts and techniques associated with competency in each country. The transfer of these ideas and practices into the public sector accompanied the spread of new public management, which has increased throughout the 1990s. The movement is now an international one prompted by both the OECD and the management consultancy industry. The process of adoption and implementation has tended to be pragmatic and ad hoc but evidence suggests it is now becoming an important vehicle for organisational cultural change. This introduction provides the backdrop for the remaining five articles in this special issue of the journal, which illustrate both developments in theory and practice of competency‐based management within public services.
Privatization ‐ The myth of free market orthodoxy in sub‐Saharan Africa
Authors: Nwankwo Sonny , Richards Darlington C.
Published: September 2004

The phenomenal spread of privatization initiatives in sub‐Saharan Africa since the 1980s created the impression that public infrastructure divestiture is a shortcut to economic growth and development. This has proven not to be the case due to the lack of enabling institutional prerequisites. It appears the case that while much faith is put in the potency of the free market, little thought is generally given to the institutions required for markets to perform their function. Accordingly, this paper discusses some of the embedded institutional failures that have made free‐market development policies a mirage in many sub‐Saharan African countries. Principally among these are corruption and government failures. To check these, it makes more sense to re‐direct attention to the sources of failure rather than the free market ideological thrust.
Managed competition and user satisfaction ‐ The case of Spanish work accident mutuals
Authors: Suárez Eugenia , Ventura Juan
Published: September 2004

Analyzes one of the three options of insurance against workplace accidents that Spanish companies can choose from: work accident and occupational disease mutual insurance companies. Although the taking out of insurance cover is obligatory, the choice is totally voluntary. The fact that these entities manage 90 per cent of premiums destined towards workplace accident cover collected by the Department of Social Security, allows us to assume that user satisfaction must be, consequently, quite high. In order to explore this, a study was made of the incentives that the combination of competition, regulation and ownership generated in these entities, and a postal survey of 443 companies affiliated to mutuals was carried out. Our results confirm the high rate of user satisfaction, although they also reveal some of the limitations associated with managed competition.
Formalizing deployment processes in the US Government
Authors: Hacker Marla E. , Kotnour Tim , Mallak Larry A.
Published: September 2004

The linkage between strategic planning and daily activities within an organization is often obscure. Perhaps as a consequence, many well‐developed strategic plans fail to be implemented, and required goals and objectives are not attained. Strategy deployment processes link strategic plans with implementation activities. Instead of investing more time and energy in improving planning or implementation processes, an organization should first examine the deployment processes used to link strategic plans with action – “deployment processes” may be the missing link in the strategic management system. This paper studies the application of formal strategy deployment processes within three US federal agencies. The strategic management literature provides the basis for the deployment processes analyzed in this study. Following the analysis of each individual case, an overall assessment of existing supporting and restraining forces that should be considered when working to improve deployment processes is discussed.
Image selection and the marketing of downtown areas in London and New York
Authors: Bennett Roger , Koudelova Radka
Published: September 2004

This study explored the processes and influences that helped determine the promotional imagery employed by a number of urban regeneration partnerships in London and New York. Although the degrees of ethnic and cultural diversity in the districts considered were broadly comparable, such diversity was given greater prominence in New York than in London. Partnerships that depended heavily on wider governmental economic development agencies selected promotional imagery that focused solely on attracting business investment, without mention of the ethnic/cultural heterogeneity of the area concerned. Marketing was seen as an important and valuable activity, but was generally regarded as an operational rather than a strategic function.
The public management of national provident funds for state‐led development
Authors: McKinnon Roddy
Published: September 2004

The Malaysian Employees’ Provident Fund (EPF) was created as a mandatory national saving plan in 1951 and has grown consistently. Following two decades of state‐led economic development, substantially funded through EPF contributions, the Malaysian Government is now ostensibly seeking to reduce state intervention in the economy in order to encourage liberalization and thereby engender further economic growth. Tracing the parallel evolution of the EPF and the growth of the Malaysian economy, highlights both the direct role of the EPF in providing soft‐loan capital for state‐sponsored development projects and the indirect role of the fund in underpinning politically effective, but not concomitantly economically efficient, strategies for ethnically rebalancing the economy. Accordingly, in direct contradiction to recent World Bank analyses, concludes that the continuing Malaysian commitment to a publicly managed national provident fund (NPF) is based on both efficiency criteria (in relation to the EPF itself) and effectiveness criteria (in relation to state‐determined investment strategies). Although the success of Malaysian economic development policies inevitably involves a restructuring of the operations and management of the EPF itself, the continuity in the Malaysian commitment to its NPF complements and underpins similar continuities in the active role of the Malaysian state, even in an era of privatization.
Quality Assurance Systems in Sumitomo
Authors: Williams Sian
Published: September 2004

Quality assurance systems in a Japanese tyre factory are described and the lessons to be learned for the delivery of health care are analysed. Selection of staff with the right attitude and values as well as skills is stressed, together with the importance of continual staff development. Commitment to improvement and innovation, encouraged by financial and non‐financial reward systems and supported by senior management, maintains the Company′s leading edge. Quality systems depend on communication centred on the product and linking all members of the production and distribution process, where the next process is the customer.
Aspects of Quality in Health Care
Authors: Morris Barbara
Published: September 2004

Customers′ views of unsatisfactory quality in health care are examined in an attempt to assess what patients expect from the service. The use of Pareto Analysis to meet this end is explained and the findings are discussed.
Managing in Court
Authors: Kaufman Arthur
Published: September 2004

With the current emphasis on medical negligence and increasing awards for damages against doctors and health authorities, it is probably only a matter of time before managers themselves will be required to give evidence in contested cases. With this in mind, some useful suggestions of courtroom tactics are discussed.
Customer Relations Standards for a Health District
Authors: Sims Andrew
Published: September 2004

The aims of a project to introduce customer relations standards to a District Health Authority are discussed. The manner in which staff guidelines are produced and staff action programmes are developed is examined and ways in which the corporate identity of the Health Authority may be changed by improvements in customer services are explored.
Assuring Quality in Community Care
Authors: Williams Sian
Published: September 2004

Following industrial experience in Japan the author presents a model to evaluate and monitor a community mental handicap service. It looks at outcome, structure and process standards for planning, action, audit and improvement in terms of the client, family, staff member, management, community, facility and comprehensive service. The report focuses on the Waikato Hospital Board′s plans to separate the purchase and provision of service using a trust and providing agencies. It concludes that a quality community service requires information be made available to clients and staff to enlarge their vision and enable the production of a life‐style plan from which training needs may be identified. The trust should facilitate staff rotation, inter and intra agency communication. The whole service requires evaluation by an external agency using a social audit. Underpinning all evaluation will be a common well publicised set of values.
Quality Circles: Creating Opportunities for Management and for Staff
Authors: King Billee
Published: September 2004

The monitoring and reviewing of quality in health care and services offered in New South Wales, Australia, is addressed. The use of quality circles to improve the administrative, catering, cleaning and maintenance services of two hospitals in the area are described.
Hospital Quality: Patient, Physician and Employee Judgements
Authors: Batalden Paul B. , Nelson Eugene C.
Published: September 2004

A conceptual model of health care, a theory of quality improvement in health care and the role of patient, physician and employee judgements as part of organisation‐wide improvement are introduced. The conceptual model of health care shows how the practitioner, the locus of care‐giving and the social context interact to meet the needs of patients and highlights potential sources of unwanted variation in outcomes. This theory of quality improvement stresses the continuous improvement of processes throughout the entire organisation to meet the needs and expectations of customers. Basic building blocks for continuous improvement ‐ knowledge of customers, knowledge of work as processes, and statistical and scientific thinking ‐ are discussed along with the need to transform the entire organisation. A method for gaining customer knowledge and for monitoring hospital quality, based on measuring quality from patients′, physicians′, and employees′ judgements of quality, is introduced. The method, called the Hospital Quality Trend (HQT) family of quality measures, is described and its uses to promote organisation‐wide quality improvement are illustrated. Health care work is complex and unique. Careful analysis of the way that work is done and knowledge of the customers in defining and improving quality is essential for achieving better quality and value from the health care system.
The ″Management″ of Demand for Health Care
Authors: Evans Martyn
Published: September 2004

The unacknowledged and obscure mechanisms which “inflate” demand for health care provisions, thereby exacerbating the persistent gap between demand and the resources available to meet it, are considered. It is suggested that the structural scrutiny of emergent medical research ‐ alongside health promotion measures ‐ could be used as a means to moderate health care demand. It is argued that anti‐utilitarian objectives to this approach may be equally levelled at laissez‐faire justifications for unfettered research.
Intermountain Health Care′s Quality Management Strategy: The HELP System
Authors: Grandia Larry D.
Published: September 2004

Intermountain Health Care, a system of 24 acute care, not‐for‐profit hospitals in Utah, Idaho and Wyoming, USA, is focused on with regard to its use of computers to integrate the various clinical, financial and patient‐oriented databases in order to assess variance in terms of quality, utilisation and efficiency (QUE). Examples are given of the studies carried out, and a QUE study on the management of uncomplicated transurethral prostatectomies is detailed. The benefits gained through the use of the system are described in the pharmacy system, in the monitoring of infectious diseases and in the charting of respiratory care.
Is Small Really Beautiful?
Authors: Smith Penny , Bennetts Julie , Pavey Karen
Published: September 2004

As part of a general move to community care and concurrent closure of a 280 bedded hospital, West Dorset Health Authority, as an interim measure two years ago, moved 17 clients with severe learning difficulties and challenging behaviours to three smaller residential units together with two ladies who also showed frequent challenging behaviours. As part of a continuing evaluation of the quality of provision for this group of clients, the authors looked at the present levels of skills of the residents compared with those in evidence three years ago when the 17 were on a secure ward with attendance at a special day care unit. In addition, measures were taken of engagement levels and of the number and type (whether positive or negative) of interactions between staff and residents. For all parameters, significant improvements were evident, supporting the view that small units facilitate the learning of new skills and provide a better quality of life for the residents.
Ensuring Competence in Health Care Managers
Authors: Sims Ronald R.
Published: September 2004

An effective model in teaching for competence in health care managers is presented. The model can also be used in health care education in general as a major strategy for facilitating the development of managerial competence within particular health care professions.
Managing in a Professional Bureaucracy
Authors: Surgeon Keith
Published: September 2004

Successful organisations harness the talents of all their members but especially their most skilled and creative people. In a hospital the most highly skilled staff are professionals working in the “operating core”, providing services directly to users. The existence of a “dual hierarchy” in health care organisations often separates this group from institutional management. A hospital′s success depends, however, on the integration of professional expertise and general management. Professionals and managers must inhabit each other′s worlds. These lessons are applied in a NHS Hospital Unit of Management.
Organisational Audit: A National Approach to Setting and Monitoring Organisational Standards
Authors: Pitt Christine
Published: September 2004

A project in progress within the Quality Assurance Programme at the King′s Fund Centre to consider the feasibility and the applicability of an organisational audit (accreditation) programme to the British health care system is described. It begins with a definition of accreditation and a description of its history and the process itself, before concentrating on the detail of the King′s Fund Centre project.
Health Care: A Critical Comparison of Canada and the UK
Authors: Dixon Maureen
Published: September 2004

An examination is made of the similarities and differences in health care organisation in Canada and the UK. Consumers′ attitudes are discussed, as are the structure and financing of the services, and comment is made on the mode of access to hospital care.
Employment Strategies in Canadian and British Health Services
Authors: Ursell Gillian D.
Published: September 2004

Based on research undertaken in 1988, an examination is carried out of the strategies being pursued by the Canadian and the UK health services in the light of current realities. These include developing employment plans to cope with rising demand, escalating costs and a tighter labour market.
Core Services ‐ The South Tees Way Forward
Authors: Holtby Ian , Ramaiah R.S.
Published: September 2004

The Government White Paper “Working for Patients” asks new District Health Authorities to identify core services which must be provided locally for the benefit of the District′s resident population. South Tees Purchasing Steering Group has developed a list of criteria which could be employed in this task and has proposed a methodology using these criteria to identify which medical conditions must be provided for locally and which could be catered for elsewhere on a best value for money basis. Using this methodology it then becomes possible to establish what proportion of conditions in any specialty require core service provision. The additional problem of sub‐regional specialties is also addressed and a solution offered.
Auditing Mental Health Units
Authors: Owens Margaret , Hurst Keith
Published: September 2004

Embryonic work in the measurement of the quality of care in mental health units is presented. The main thrust of the article is an assessment of the relationship between patient dependency, nursing workload, and quality of patient care. A Psychiatric Nursing Audit is employed in an ongoing quality assurance programme and some preliminary findings are discussed along with the strengths and weaknesses of the method.
Quality Assurance in Practice: Research in Brighton Health Authority
Authors: Walshe Kieran , Lyons Cynthia , Coles James , Bennett Jennifer
Published: September 2004

CASPE Research and Brighton Health Authority have been working together to test a series of approaches to quality assurance in healthcare. In this paper, they give an account of the results of the quality assurance techniques used; discuss the key requirements for successful quality assurance in the NHS environment; and consider the need for systematic evaluation of quality assurance programmes.
Project Approach to Quality Management
Authors: Ward Karen
Published: September 2004

The project approach to tackling complex multidisciplinary problems uses cross‐department project teams of highly motivated people tapping into the many hidden ideas and solutions within the organisation. Key issues are the project leader, its members, its brief and its rational approach to problem solving. Issues such as empowering staff and maintaining momentum are crucial to the success of this approach to quality management.
Obstacles to Total Quality in Health Care
Authors: Koch Hugh
Published: September 2004

As the pressure and concern for quality throughout all hospitals and community services develops, provider units are beginning to appreciate the relevance of management and organisational approaches to achieving Total Quality Service. A brief overview of Total Quality Management in health care is given and the difficulties experienced in introducing such a system are outlined.
What Does Quality Health Care Cost?
Authors: Koch Hugh , Higgs Adrian
Published: September 2004

Achieving the best health care delivery involves a tension between quality and quantity of health care and its cost. Usually the latter ‐ the cost ‐ is debated in terms of its insufficiency. In addition, however, the amount of revenue tied up in “failure costs” or the cost of poor quality can, in any hospital or community service, be appreciable. A model of quality costing to address these issues is outlined.
The Ten Commandments of Customer Service
Authors: Reynolds Stuart
Published: September 2004

The UK Government′s White Paper on the National Health Service, 1989, defined a programme of action aimed at achieving two objectives: give patients, wherever they live, better health care and greater choice of the services available; and produce greater satisfaction and rewards for NHS staff who successfully respond to local needs and preferences. The Paper defines seven key measures, each designed to make its own vital contribution to those objectives. One of these was the introduction of self‐governing hospital trusts, and one of the primary concerns of the Boards of Directors set up to run each of the new Trusts will be the development of a clear customer service strategy; one which combines clinical excellence with the highest standards of customer care. The customer care element of that strategy must combine the best of tried and tested management and organisation theory, with common sense, realism and pragmatism.
Clinical Areas as Learning Environments for Student Nurses
Authors: Collingwood Margaret
Published: September 2004

In January 1989 a working group, made up of college and service staff, was formed with the remit of devising a method of assessing the suitability of a clinical area for student nurses to learn the practice of nursing. The group interpreted the remit as the identification of the quality of the learning environment offered by clinical areas. Other UK nursing colleges had devised methods of assessing the quality of learning environments but the working group felt that those studied were too subjective. The group felt that responses to quality matters which were in the form of statements were too difficult to compare and therefore to use as standard‐setting tools. By means of questionnaires, grading forms and direct observation numerical scores were applied to each factor, giving the possibility of setting numerical standards. A pilot study was undertaken which showed the method to be a feasible approach to measuring quality, although some of the measuring methods used require to be refined and the pilot repeated several times to give values to the figures attained.
The Customer Imperative
Authors: Barrett Vanessa
Published: September 2004

Much of the management effort in the National Health Service (NHS) over the last few years has been directed towards increasing the responsiveness of the service to the consumer. The aims set out in the 1989 White Paper, Working for Patients, are explored, concentrating on the cultural and structural changes within the NHS that, in the area of customer orientation and service, are necessary for success in the new market economy. The involvement of the consumer in all aspects of the delivery of health care is stressed.
What Makes Training Effective in an Organisation?
Authors: Gorman Paul
Published: September 2004

The article looks at the links between training and organisational effectiveness. It argues that the pressures on training are increasing, but that most training that takes place is not rigorously evaluated nor is it linked systematically into organisational goals. It argues that the competence‐based approach offers a powerful tool to link organisational goals and individual development through measurable outcomes.
Quality Issues in Mental Health
Authors: Green Susie
Published: September 2004

Unwilling or uncommunicative customers, lack of consensus over diagnostic definitions and processes of care, and the difficulty of defining outcome measures, account for quality issues being different when related to the psychiatric field than for other branches of health care. Attempts to measure quality of care in psychiatry using preexisting models needs careful review.
Customers and the NHS
Authors: Sage Geoffrey C.
Published: September 2004

The use of the term customer is new in the Health Service. Its use should be made clear and not be used interchangeably with consumer. Organisations have customer‐supplier chains. Focusing on these chains can assess the effectiveness of services to the customer. All organisational processes influence service to the external customer. A successful organisation must satisfy external customer needs. Wants, needs and expectations need clarifying. Patients′ needs are often rationed by the professionals. Because of the complexity of National Health Service (NHS) business and the relative lack of choice of external customers, the responsibility of NHS staff to meet their needs and expectations is greater than in the private sector.
Increasing Health Care Managers′ Sensitivity to AIDS
Authors: Sims Ronald R.
Published: September 2004

A training method is presented that health care managers can use in confronting issues surrounding AIDS in the workforce by requiring the participants to develop an AIDS policy for a health care facility. In addition, emphasis is placed on the importance of health care facilities being proactive in developing AIDS policies which protect employees who become infected with the AIDS virus through their employment.
Medical Audit in the Acute Services
Authors: Fernandez Christophe
Published: September 2004

The integration of Medical Audit within the context of the overall quality issues in health care delivery involve recognising its link to Resource Management and the need for a sound information base. Clear appreciation of issues of confidentiality and training, plus options for integrated multidisciplinary audit complete the audit loop.
The Evaluation of Quality in a Mental Handicap Service
Authors: Hewson Simon
Published: September 2004

A district‐wide evaluation of a residential service for mentally handicapped adults is described. The measures relate to the conditions for a reasonable quality of life for the residents. The results show that, in an ordinary service, client outcomes can compare reasonably with findings published by exemplary projects, although there were marked variations. A direct observation methodology is described which can be applied in services without special resources. Such an approach may help meet the increasing requirements, in Community Care legislation, to monitor the quality of services provided to people with long‐term needs. The role of evaluation in service development is discussed, as is the relation of evaluation to quality. Finally, the key influence of managers on the quality of staff performance is highlighted.
All Change: What is Happening in NHS General Practice?
Authors: Szczepura Ala
Published: September 2004

Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now function (both political and managerial), and considers the power which GPs are beginning to exert, as well as the impact which they may have on the interface between primary and secondary care. Examines the systems being developed for assuring quality in general practice. Predicts an explosion in the need for appropriate information for management and for medical audit in UK primary care, because the context within which general practitioners (GPs) deliver primary care in the NHS is changing rapidly. It is only now becoming evident that this turbulence may well offer major new opportunities to GPs, as well as permanently altering the balance of power in the NHS between primary and secondary care.
Quality Assurance Ward Audit
Authors: Spicer Julie , Walker Sandra , Telford Bert
Published: September 2004

Describes a methodology for measuring standards of patient care available on wards. The quality assurance ward audit is a self‐contained package developed as a management tool to maintain and wheŕe necessary improve quality standards on individual wards. Describes the main features of the package, together with the audit process. These have been designed with practicality, ease of use and consistency of application in mind. Outlines the roles of assessor, ward staff and patients in the audit. Stresses the importance of feedback to staff, and the use of the ward audit as a motivator. Describes the mechanisms for using the audit as part of the management process, not just a one‐off audit event, and outlines some of the positive achievements resulting from use of the quality assurance ward audit.
Effective Health Care Financial Management: A Home Health Care Perspective
Authors: Frosheiser Thomas J. , Kleiner Brian H.
Published: September 2004

Health care financial management is not significantly different from financial management in other industries. The one area of financial management that is unique to health care, and thus requires additional expertise to be effective, is the accounts receivable and billing/collection function. With health care costs in the United States rising faster than inflation, there is considerable pressure on many fronts to reduce or at least contain costs. This pressure requires significant management expertise and attention focused on the accounts receivable (A/R) cycle of a for‐profit health care concern. To be effective, a financial manager must not only stay knowledgeable on the current reimbursement environment, but must anticipate and plan for continued significant changes in reimbursement rates, the method and timing of payment. In addition, the pressure on the volatility of the A/R cycle places significant importance on the other areas of financial management.
Collaborative Care Planning: A Team Approach to Care
Authors: Hewitson Phao
Published: September 2004

Outlines the approach to multidisciplinary team involvement in care planning and clinical audit. Identifies the potential benefits of collaborative care planning following a project with patients suffering myocardial infarction.
FACE‐ing up to Quality
Authors: Quinn Paul , Crothers Marie , Dolan Anne Marie , Cartin Martin
Published: September 2004

Discusses, on the basis of existing quality initiatives, a systematic and integrated approach to mental health care in Northern Ireland. Utilizes two approaches: the Brunel Quality Management System and the FACE‐IQMS model.
Quality Doctors?
Authors: Dash Penelope
Published: September 2004

The isolation of the medical profession in quality management is due to several reasons which are outlined. Identifies ways to redress the balance and involve doctors more.
BS 5750: Quality System in Ambulance Services: Part 2
Authors: Hopkinson Edward
Published: September 2004

The application of BS 5750: Part 2 to the wide range of Ambulance Service activities demonstrates service‐wide commitment to quality assurance and should lead to “customer” confidence and an improvement in competitiveness. Cambridgeshire′s Ambulance Service makes significant strides towards accreditation.
Quality Assurance and Improvement: The Role of Strategy Making
Authors: Telford Bert , Cropper Steve , Ackermann Fran
Published: September 2004

Describes the process by which an NHS provider Unit sought to make quality assurance and improvement a shared concern of professionals and managers. Development of a quality assurance strategy and related action plans pulled together existing quality initiatives in the Unit and set new initiatives in an agreed framework for organizational development. Thus the strategy filled the gap between a statement of organizational values and detailed quality auditing practices at the sharp end. Through the active involvement of professional staff and managers in multidisciplinary and multi‐level project groups, the facilitated processes of strategy making, dissemination and implementation led to significant learning by and development of staff and managers and an unanticipated spill over of energy, enthusiasm and commitment throughout the organization.
Correlating Strategic Variables to Hospital Risk of Failure
Authors: Oswald Sharon L. , Harrison Allison W. , Woerner William L.
Published: September 2004

An empirical study of 71 hospitals in the United States revealed that strategic factors are highly correlated with a hospital′s financial risk position. Finds strong statistical evidence that ownership status, location, and level of service affect the hospital′s financial risk position, as measured by the Financial Viability Ratio Index.
Finding Out What the Customer Wants: Computer‐Assisted Telephone Interviewing (CATI)?
Authors: Breen David , Donnelly R.D. , Chalmers James
Published: September 2004

A population survey was carried out to explore whether responses to health and life‐style questions were similar in telephone owners and non‐owners. Concludes that Computer Assisted Telephone Interviewing (CATI) gives an under‐representation of the socio‐economically disadvantaged and is unlikely to be of great benefit where precision is required.
The Problem with Standards: A Plea for a Behavioural Framework
Authors: Waterman C. George
Published: September 2004

Standards are central to quality assurance; if they are ambiguous or imprecise then the entire enterprise is a waste of time. The way to eliminate ambiguity is to use behavioural language, but this poses problems for workers in the care sector. Problems which centre on the incompatibility of the qualitative‐quantitative dichotomy. Suggests that this problem is largely semantic and that by realigning our perception of nursing activity and problem solving standards can be written which are both precise and analytic.
Napier House ‐ A Quality Assured Home
Authors: George Clive , Casson Steve
Published: September 2004

Describes the development of a quality assurance system in a residential home for the elderly mentally infirm, and its registration under ISO 9000/BS 5750. The two prime objectives of the project were to demonstrate the applicability of the ISO 9000 model to human care services, and to integrate the systematic approach of quality assurance with the human‐centred concepts of a total quality culture. The quality assurance system was developed primarily by the home′s own staff, beginning with their definition of residents′ requirements of the service. Discusses the methods of defining outcome measures, of designing the system, of developing it and of implementing it, together with the difficulties encountered, and the impact of the project on team spirit and on the quality of the service.
Evaluating the Benefits of Standard Setting
Authors: Gott Susan , Murfin Rachael , McSorley Gerald
Published: September 2004

Outlines an approach to the systematic evaluation of the benefits of standard setting as part of a TQM programme, which looks at the systems and culture necessary to monitor and improve quality. Reports on a specific research project, undertaken to analyse the impact of both the processes and end results of setting quality standards.
Total Quality Management: Is There Any Point in It?
Authors: Hawkes Jenny
Published: September 2004

Questions whether people really understand what total quality management is, what it can do to an organization, how the organization can cope with fully espousing a TQM strategy in a general environment in which TQM is not understood. Asks whether there are any benefits for patients, can it be proved, and how long will it take? Explains how a district health authority has approached total quality management and identifies some benefits to customers.
Identifying the Benefits of TQM Projects
Authors: James Ernie
Published: September 2004

Takes initial stock of the benefits that have accrued as a result of five TQM projects carried out in Worthing District Health Authority. Categorizes benefits in terms of the organization, the customer, the employee and benefits in overcoming difficulties.
Outcome Measures for the Elderly: A Contradiction in Terms?
Authors: Green Susie
Published: September 2004

Identifies some of the difficulties which mental health agencies have in evaluating their services, particularly those involving care of elderly patients. Describes a project conducted in a large psychiatric hospital where the concern was to maintain standards during the process of retraction. Describes the impact of the project on staff involved.
Health Authorities and BS5750: A Standard of Purchasing
Authors: Smith John , Hart Steve
Published: September 2004

Reports on the experience of Mid‐Staffordshire Health Authority as the first health authority in the UK to be registered under British Standard 5750 for quality management. Discusses the process and obstacles to achieving certification.
QALYs and Quality Management: A Review of the Literature
Authors: Davis Rowena
Published: September 2004

Much has been written in the past 15 years on the rationing of services, quality of life, and quality‐adjusted life years (QALYs). However, there still seems to be much confusion and controversy as to the meaning of, and use of, the term QALY, by many professional groups. Aims to discuss the nature of QALYs and the use/potential use in the NHS today by referring to the recent literature.
A Framework for Measuring Quality in Health Care
Authors: Lin Binshan , Schneider Helmut
Published: September 2004

Attempts a contribution to the area of health care quality by presenting a framework for thinking about, and improving our understanding of, measuring quality in health care. To achieve this object, addresses the multidimensionality of quality management in health care. Delineates the dimensions of quality measurements in health care, focusing on both output and process issues. Stresses the need for the measures to relate to patient requirements and shows how these measurements can be driven back into care services as a means of facilitating quality improvement in the health care environment. Concludes by discussing the implications of the framework for managers and by providing direction for future research within the context of the framework.
The Health Care System in Greece since 1970: An Assessment
Authors: Apostolides Anthony D.
Published: September 2004

Assesses the health care system in Greece since 1970 through examination of its output and inputs. Concerning output, the country ranks well with regard to adult life expectancy but relatively low in infant mortality. The increasing number of citizens seeking health care abroad does not portend well for quality of care. On the input side, the total number of hospitals has decreased over time, public hospitals have increased and private facilities decreased. There has also been unused hospital capacity; in rural areas there are shortages of health manpower including physicians, as well as equipment. Cultural factors seem to have adversely affected the supply of nurses nationally. Fakellaki , an informal means of paying health‐care providers, is a distinctive and negative feature.
Providing a Personal Service in the Trent Region
Authors: Schofield Angela , Raynes Norma
Published: September 2004

Reports evaluation of the Trent Regional Health Authority′s “Providing a Personal Service” initiative, one of the first major quality management strategies in the NHS. The evaluation highlights the key elements which supported this initiative and suggests some ways in which its progress can be sustained. Many of the comments are applicable to other approaches to quality management.
An Approach to Customer Feedback
Authors: Witty Joy
Published: September 2004

Details an approach to the assessment of organizational performance. Outlines the undertaking of a consumer survey and how feedback from people using health services can be obtained. The aim of the survey was to assess the level of individual/personal care. It included four main phases: qualitative research, questionnaire development, a pilot study and the main survey. Discusses the main survey and its findings in detail. Evaluates the work.
Negotiating Health Contracts: Harmony or Hostility?
Authors: Gourlay Robin
Published: September 2004

Proposes a health contract negotiating model designed to ensure that quality of service is not compromised by confrontational stances taken by providers and purchasers. Shows how a determination on both sides to achieve ends must be matched by an equal willingness to explore mutually acceptable means of doing so, if joint benefits are to be maximized. Describes briefly the negotiating skills necessary to achieve the desired outcome.
Hearing the Patient′s Story
Authors: Brant Sally
Published: September 2004

There are many ways of endeavouring to assess patient satisfaction with health care. When planning a survey of patient views it is important to remember what the objectives of the study are ‐ is it primarily a public relations exercise or is there also commitment to action which will improve the quality of services? Some of the limitations of current survey methods are outlined, together with examples of alternative approaches from the author′s experience. It is argued that if quality is to be defined as the extent to which patient′s needs are met then only individualized patient‐centred approaches, such as critical incident interviewing and care planning, can deliver quality standards for the benefit of individual patients.
NHS Outpatient and Private Outpatient Satisfaction
Authors: Hurst Keith
Published: September 2004

Briefly reviews the literature on private outpatient satisfaction and NHS outpatient satisfaction. Describes the survey of patients in the two settings, focusing on the similarities and differences in findings, especially the differences between the administrative and clinical process in private and NHS OPDs. Discusses weaknesses and limitations in the survey design.
Medical Audit in the Quality Process: A Practical Implementation
Authors: Matchet Andrew , Rose Peter
Published: September 2004

Examines the role of medical audit in the internal market‐driven quality process in health care provision. Explores the requirements to establish an efficient and effective medical audit function in practice and examines the inter‐relationship between medical audit, information technology and training. Explores the practical implementation of medical audit in South Warwickshire District Health Authority, including the outcomes of a specific project on information management technology training for medical staff. Considers the information technology issues in the context of the District Authority also being a pilot site for the implementation of Hospital Information Support System (HISS) running on an IBM AS/400. Demonstrates a cost‐effective PC networked solution to the information requirements of medical audit and quality processes. Training and attitudinal obstacles to medical audit and information technology are tackled by a flexible, action learning approach.
Quality Management and Operational Research Initiatives in a Health Service Context
Authors: Moores Brian
Published: September 2004

Explores the history of quality management, commenting on the work of many of the quality “gurus”. Considers the relationship between quality management and the management science of operational research.
Improving Out‐patient Appointment Systems
Authors: Worthington David , Brahimi Mammar
Published: September 2004

The Patient′s Charter has recently set the standard for hospital out‐patient clinics that patients will “be given a specific appointment time and will be seen within 30 minutes of that time”. Describes the successful application of an operational research/operations management approach to out‐patient appointment systems at the Royal Lancaster Infirmary. Draws the conclusion from a comparison of this and other studies that many hospitals face very similar problems with similar solutions; but that localized studies may often be required to achieve these solutions.