Guest editorial

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 1 October 2004



Guo, K.L. (2004), "Guest editorial", International Journal of Health Care Quality Assurance, Vol. 17 No. 6.



Emerald Group Publishing Limited

Copyright © 2004, Emerald Group Publishing Limited

Guest editorial

Quality improvement processes, techniques and strategies are critical in health care to achieving success and attaining the competitive edge. Quality improvement is process and outcome oriented, customer driven and involves organizational commitment not only to empower employees, but it also requires a team-based approach to effect change. More importantly, commitment to quality improvement by the governing body and senior-level management fosters quality initiatives and thereby transforms the organization.

The purpose of this special issue is to demonstrate the importance of professionals (managers in health care organizations and systems) and their roles in quality improvement. This reflects the Journal’s commitment towards presenting valuable information, comment and debate on quality issues impacting on today’s health care industry.

Having worked as a practice administrator for several surgical departments for a number of years at a major academic medical center in the USA, I gained first-hand knowledge into the numerous opportunities and challenges faced by health care professionals and managers. I found that one of my primary challenges as a health care manager was dealing with internal and external customers. The most difficult task encountered was being able to satisfy the needs of our customers. Many times, making decisions that may not have been in the best interest of our departments from the point of view of eyeing the bottom line was difficult. Yet, such sacrifices often meant pleasing patients who will repeatedly market our services by telling their friends of our high quality performance.

As I gathered more experience in the field, I was able to apply this knowledge to academia. My dissertation relied on my work experience and focused on exploring managerial work roles in the changing managed care environment of US academic medical centers. I completed my doctorate degree in public administration (although my core concentration was in health services administration) in 1999 and left the practice setting to pursue research. My practitioner’s background and knowledge have been very valuable since they allowed me to integrate real world experience into my research, teaching, and career advisement for my students.

In my current role as an Assistant Professor of Health Services Administration at Florida International University in Miami, Florida, my primary research interests are in the areas of health care management and policy. My publications have addressed political, economic, organizational and management implications in the managed care environment. In particular, I have developed new models for describing the roles of managers in health care organizations.

My research now focuses on the three major challenges facing health care systems in the USA. These are to increase health care access, decrease cost and improve quality. To investigate their impact on changing policies at the state level, my most current research project involves writing of a book to explore innovations in health care policies among all states. I have found wide disparities in quality assurance practices from the 50 states. As a result of this project, it has led me to examine further the need for health care quality improvements from both practical and research perspectives.

This special issue is a product of my search to learn more about quality improvement. It is also a collaborative exploration of advancing research on this topic. The input of many notable researchers in this area helps us to gain a better understanding of what we know and what we seek to learn. In this issue, several papers have been selected for their significant contribution to the dissemination of knowledge in the area of health care quality improvement. They are summarized as follows.

Warburton et al. utilize the plan-do-study-act (PDSA) quality improvement cycle in the implementation of a community hospital emergency department’s screening and referral program to identify seniors at risk. They found that process evaluation and multidisciplinary working group meetings were essential improvement tools. They conclude that the PDSA is a practical and useful tool for improving quality and systems in a real care setting.

Ruiz discusses the total quality program that was established in the Spanish health care system from 1986-1992 and subsequent quality improvement steps that have been undertaken in Spain to implement an integrated quality management system aimed to improve patient safety. A stepwise integration of various industrial approaches, such as ISO 9000 and Excellence Models, and specific health care models, such as the Canadian Council on Health Facilities Accreditation, the Australian Council on Healthcare Standards and the Joint Commission on Accreditation of Healthcare Organizations, were presented in order to focus on the safety of the patient as the core consideration.

Hariharan et al. applied the Analytic Hierarchy Process model, a multiple attribute decision-making technique, to improve the process-based performance of multispecialty tertiary care hospitals. This model was applied to two tertiary care teaching hospitals in Barbados and India. The cumulative performance rating of the Indian hospital was higher than that of the Barbados hospital. The model enabled identification of specific areas where the hospitals did not perform very well, and helped to suggest recommendations to improvise those areas.

Torres and Guo described several approaches for implementing quality improvement initiatives that involve collaborative efforts by all health care professionals and managers to improve patient satisfaction. Approaches include measuring the views of patients, improving patient outcomes with a community-wide effort, and using a Six Sigma method. Each of these programs can be an effective mechanism for quality improvement.

Milne et al. conducted a pilot study of ten voluntary service organisations in one English county to determine the value of their social support role. Results indicate that users and providers held similar views of the nature and value of voluntary sector services. Their study suggests that examining voluntary service organisations may help health care professionals to improve the quality of social support in their locality.

Walley and Gowland evaluated the use of the PDSA improvement cycle within the UK National Health Service using emergency care improvement activity as a source of research evidence. They found that despite an abundance of information on how to implement this type of change, many senior professionals still misinterpret how this should work. Their study suggests that care must to be taken to ensure that empowered employees work toward consistent and appropriate objectives.

McCusker et al. investigated improvements in the quality of patient care through an examination of nurses’ work environments using staff surveys. Data were derived from a cross-sectional survey of 243 nurses from 13 units of a 300-bed university-affiliated hospital in Quebec, Canada. The results confirmed five sub-scales from the Nursing Work Index – Revised (NWI-R), which is a potentially useful tool for comparing the work environments of different nursing units in the same hospital.

Kristina L. GuoAssistant Professor of Health Services Administration in the Stempel School of Public Health at Florida International University

About the Guest EditorKristina L. Guo is an Assistant Professor of Health Services Administration in the Stempel School of Public Health at Florida International University. Professor Guo graduated from Florida International University with a PhD in Public Administration in 1999, and she holds a Master’s degree in Public Health from the University of Miami. Her dissertation investigated the impact of the managed health-care environment on managers in academic medical centers. Prior to joining the FIU faculty, Dr Guo accumulated extensive experience in the health-care field. She was the Assistant Director of the University of Miami’s intellectual property division, where she conducted market and patent research and analyses. As the manager of several physician practices, she was responsible for formulating and implementing strategies to increase the organization’s viability and growth potential. She was Administrator of a surgical division at the University of Miami, where she successfully led its residency program through its accreditation process. Dr Guo’s areas of research include health-care management, organizational behavior, entrepreneurship, and health and public policy, especially those pertaining to policies addressing the various needs of and services for the elderly. She has also developed new models for describing the roles of managers in the current managed care environment. She has published numerous scholarly articles. Professor Guo has recently completed the first draft of her book: Health Care Policy in the 50 States for M.E. Sharpe. She received funding for two chapters analyzing case studies of two of the top ten states: Minnesota and Oregon. Dr Guo has served as Guest Editor for the Journal of Health and Human Services Administration, International Journal of Public Administration and the International Journal of Health Care Quality Assurance,where she developed three symposia focusing on entrepreneurship in health and human services organizations, and quality improvement models, techniques and strategies for health-care managers. Dr Guo has presented her work at various local, regional, national and international conferences. She was the program chair for the Economics and International Business Research Conference and the IVth International Seminar on Hospital Administration sponsored by FIU’s Latin-American and Caribbean Center. In addition to research, Dr Guo teaches several graduate and undergraduate courses in health policy and management, including Health Services Organizations and Management, Ambulatory Care Management, Health-Care Organizational Behavior and People, and Power and Politics in Health Affairs. She has developed innovative teaching techniques and utilizes WebCT, an online teaching tool, to supplement and reinforce student learning. Dr Guo is active in professional and community service. She serves on numerous committees in her program, school and college, including the undergraduate curriculum, scholarship and residency committees in Health Services Administration. She also serves on the School of Public Health committee to study the feasibility of an undergraduate program in public health. Professor Guo is a member of Academy Health, The American College of Health-care Executives and the South Florida Health-care Executive Forum.

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