Total quality in health care

Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects.     

Environmental laws in health care

Federal and state regulations regarding the management and disposal of medical waste are currently quite extensive and will only become more comprehensive in the future. The public's heightened awareness and concerns over infectious diseases and discoveries of medical waste on beaches in New Jersey, Alabama, and other states, as well as medical waste being found in open trash bins and at public landfills, has brought to the public's attention the need for governmental intervention into this growing area of concern. Because regulations originating from the local, state, and federal levels have the potential to significantly affect hospitals, it is important that a specific person or department within the organization have a clearly designated responsibility to stay informed and follow up on these regulations. The designated person or department must work closely with the hospital's attorney to make sure that he or she stays current on environmental laws and keeps the institution adequately advised of its legal responsibilities.     

Strategic decision support in preventive health care.

This nontechnical interdisciplinary paper highlights major principles of strategic decision support in preventive health care and points to selected key literature. It begins by looking at preventive health care from strategic perspectives such as determinants of health, health care costs, objectives of prevention, political order constellations and available data. Next, the paper identifies strategic decisions and decision-making to be supported. Having gained strategic perspective, it discusses tools for decision support. These tools are here related to two planning steps (i) assessment, problem and goal analysis; and (ii) design and choice of alternative interventions. Qualitative as well as quantitative aspects of computer-assisted policy analysis in preventive health care are outlined and examples presented.     

Efficiency and productivity change in Ukrainian health care

The study analyses technical efficiency and efficiency change of 193 community hospitals and polyclinics across Ukraine, for the years 1997–2001. These facilities are a subset of the medical institutions in rural Ukraine; they are identical w.r.t. their function in the health system and share the same departmental structure. The data comprise the number of beds in the hospitals, the number of staff employed in the hospitals as well as the polyclinics connected to the hospitals, the number of inpatient and outpatient admissions as well as the number of surgical procedures, lab tests, X-rays performed and the number of deaths and deaths after surgery. Because of the known sensitivity of traditional nonparametric frontier estimators to outlier observations, we employ an order-m estimator, a robust technique, to assess the efficiency of these health care providers as well as changes of their productivity time. The efficiency scores are calculated with an output-oriented model; they are close to unity for hospitals whereas polyclinics seem somewhat less efficient. The Malmquist-indices averaged over all observations are close to unity indicating that productivity does not change over during our observation period. But, depending on the period and the region, substantial deviations from unity can be observed.

Requirements planning systems in the health care environment

An important problem confronting health care administration is cost containment in hospitals. Much of the current high costs can be traced directly to outdated procedures in materials management leading to waste, excessive inventory and unnecessary obsolescence of expensive short shelf life items. In this paper, we illustrate how a modern requirements planning system for surgical supplies was developed for a private hospital in Houston and used to effectively hold inventory levels to the minimum required to support a detailed schedule of surgical procedures. We also discuss some specific problems involved in the transfer of manufacturing technology to the hospital setting.     

SIPP and health care issues.

There are three major areas in health care policy which can be addressed by the data elements in the Survey of Income and Program Participation (SIPP): (1) health insurance coverage and the stability of insurance over time; (2) health disability and its relationship to socioeconomic variables, including unemployment, over time; and (3) health care utilization. The survey does not, however, include information on health care expenditures or on details of visits to providers.     

A note on health care inflation

A key issue in health care reform is the need to contain the inflation rate of the CPI for health care services without substantially reducing the quality of health care. Althought the previous literature has widely debated the causes of increasing inflation in the CPI for health care services, very little has been done to empirically test these arguments. We use an econometric framework that allows us to expressly examine the determinants of the inflation rate of the CPI for health care services. The data cover the period from 1960–1994. The main results provide empirical verification for many of the demand-side and supply-side theories of the inflation rate of the CPI for health care services that have been widely discussed in the literature.     

Distance education for health care professionals

Most health care managers and professionals are unable to think about going to college due to the disruption to their family and their profession. Distance education is an acceptable alternative. Adults can complete courses while remaining at home with very little disruption to their professional and home life.     

The modern health care materiel manager

Today's successful materiel managers must possess a wide range of skills. They must above all be highly adaptable to change and influence others to accept rather than resist change. The role and responsibility of the materiel manager have expanded significantly, requiring higher levels of formal education. In conjunction with this, the quality of communication, both verbal and written, becomes essential. A high degree of human, conceptual, and technical skills must be employed to accommodate the many demands encountered. Finally, the successful materiel manager who feels confident and secure will hire others who do not mirror the manager's style, but rather allow for contrast of expression and technique.     

Effects of domestic multiculturalism on job attitudes in Nigeria: a research note

This study investigates possible cultural differences in job attitudes among the three main sub-cultural groups dominating the entire population of the Nigerian work-force: Hausa (n=80), Ibo (n=119) and Yoruba (n= 151). Several hypotheses were derived from previous knowledge of the three cultures and differences were explored in the relationships between perceptions and attitudes concerning specific aspects of the job. Consistent cross-cultural differences that can be related to characteristics of the cultures studied were revealed with regard to only three motivational factors, namely, interpersonal relations, nature of work and supervision. The overall results seem to indicate that employees' cultural background has little impact on their perceptions of job motivation. However, a number of different personal variables were found to affect responses. Practical and research implications of the findings are discussed as well as directions for future research.     

Inflation and health care costs in metropolitan areas.

This paper reports on an examination of the relationship between increases in health care costs in 23 Standard Metropolitan Statistical areas and various other changes in these communities over the period 1969-1977. The other changes examined consisted of 145 variables divided into 7 categories. The categories were termed demographic, economic, community illness, prices of other goods and services, hospital, physician, and technology factors. The results show that there was little relationship between rates of medical and hospital inflation and the examined variables. Total hospital costs could be related to several of the factors, the most important of which were demographic, economic, and hospital factors.