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This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/14637159510798211. When citing the article, please cite: H. James Harrington, (1995), “The new model for improvement: total improvement management”, Business Process Re-engineering & Management Journal, Vol. 1 Iss: 1, pp. 31 - 43.
This paper develops a methodology for identifying, classifying, and implementing a set of best practices that can increase the quality, reliability, and timeliness of…
This paper develops a methodology for identifying, classifying, and implementing a set of best practices that can increase the quality, reliability, and timeliness of industries that provide maintenance, repair, and overhaul (MRO) services on products. By cataloging and documenting these best “sustainment” practices, one can learn from others' attempts to maintain systems and avoid non‐value‐added processes. The authors identify the knowledge that exists at various research centers and MRO providers at US corporations – wherever the best practices may reside. The paper specifically focuses on the sustainment of US military systems, but it also draws analogies and conclusions for other global product and service providers.
Nursing facility inspections routinely produce statistics revealing sharp disparities in care at both the facility and the state level. But whether high rates of…
Nursing facility inspections routinely produce statistics revealing sharp disparities in care at both the facility and the state level. But whether high rates of deficiencies are more indicative of stringent enforcement of standards, leading to improved care, or ongoing poor quality care remains unclear. Until this question is answered, families of nursing facility residents, responsible public officials and interested professionals, are all unable to make sound decisions about long-term care quality. We employ cross-sectional, panel data to compare states on multiple indices of both care quality and enforcement stringency. We use the multi-method-multi-trait approach to distinguish these concepts. We find that low rates of deficiencies are positively associated with independent measures of high quality care. But, a prominent nursing facility enforcement index likely registers poor quality care more than stringency of enforcement since it is associated positively with independent indices of poor quality care and negatively with independent measures of enforcement. Attentive publics can have reasonable confidence that low rates of deficiencies indicate high quality care. High rates tend to reflect glaring deterioration in care quality. They are less signals of stringent enforcement than of obviously poor care which prompts more visible enforcement activities. Sadly, there is little evidence suggesting that these enforcement measures improve state-level care quality and thus reduce cross-state disparities in the quality of nursing facility long-term care. However, at least some of the factors responsible for sharp disparities in nursing facility care lie within the capacity of states to rectify even in the short term.
A review of benchmarking literature revealed that there are different types of benchmarking and a plethora of benchmarking process models. In some cases, a model has been uniquely developed for performing a particular type of benchmarking. This poses the following problems: it can create confusion among the users as to whether they should use only the unique benchmarking model that has been developed for particular type or they can use any model for any type of benchmarking; a user may find it difficult when it becomes necessary to choose a best model from the available models, as each model varies in terms of the number of phases involved, number of steps involved, application, etc. Hence, this paper aims to question the fundamental classification scheme of benchmarking and thereby the unique benchmarking models that are developed for each type of benchmarking. Further it aims to propose a universal benchmarking model, which can be applied for all types of benchmarking.
The fundamental benchmarking model developed by Camp has been used to benchmark the existing models, irrespective of the type of benchmarking, to identify the best practices in benchmarking.
Benchmarking the benchmarking models revealed about 71 steps in which around 13 steps have been addressed by many researchers. The remaining unique steps were considered to be the best practices in benchmarking.
The proposed model is highly conceptual and it requires validation by implementing the same in an organization to understand its effectiveness.
Though some of the methodologies used in this paper are already available in the literature, their context of application in the field of benchmarking is new. For example, utilizing the benchmarking process itself to improve the existing benchmarking process is an original concept.
Medicaid home and community-based services (HCBS) support community living for three million disabled people in the United States. As a state-federal partnership, these…
Medicaid home and community-based services (HCBS) support community living for three million disabled people in the United States. As a state-federal partnership, these programs are highly variable across states. Because eligibility determination and services differ from state to state, this Medicaid structure becomes a barrier for those HCBS users whose desired futures include cross-state moves.
I examine narratives of citizenship and personhood for Medicaid HCBS users circulating within policy arenas and explore tensions between these and the stories Medicaid HCBS users tell of their own lives. Specifically, I explore the degree to which narratives about Medicaid HCBS users include an affirmation of the right to cross-state movement. My analysis includes data from public statements from policy makers, legislative texts, organizational framings of Medicaid policy, and 18 semi-structured interviews with Medicaid PCA users who desired or pursued cross-state moves.
I conclude that institutional narratives of Medicaid HCBS users are an inadequate representation of the stories told by those who rely on this program and, in consequence, programs stemming from policy fail to offer services that would allow service recipients to pursue their objectives.
Medicaid HCBS policy is part of a broader story of disability rights progress over the last four decades, making its role as an obstacle to cross-state movement a bit of a paradox. This paradox points to the value of narrative analysis in calling attention to invisible contradictions and the need for institutional and organizational change.
Improving business processes is the key to increased profits and market share. This article presents a new, systematic approach to improving the efficiency, effectiveness, and adaptability of these critical processes which make the difference between success and failure.
At the center of its core, Health Care is the application of a general body of knowledge to the needs of a specific patient. For centuries, this knowledge was generally regarded as the property of the healing professions and the individual clinician, not necessarily of the health care delivery organization. Managerial practice also had a tendency to treat this knowledge as an attribute of the provider, thus focusing on the resources clinicians used as they provided care and on the hotel-type functions associated with inpatient institutions. That is, there was a deliberate differentiation between management practice, focused on business processes, and clinical practice, focused on the activities and decisions of diagnosis and treatment. Though often described as bureaucratic and incrementally changing, health care is also a very dynamic and innovative field. Around the globe, research scientists, private industries, academics, and governmental and nongovernmental agencies continue to work in innovating new ways to provide better care, find cures, and improve health. At the same time, health care delivery has been undergoing a gradual but important change. Patient care, once the domain of the individual practitioner, is becoming the domain of the care delivery organization. Additionally, the mission of these organizations is shifting. As science, technology, care processes, and care teams have become more complex and diverse, the way in which the activities of care are organized and the institutional context in which they occur have become an increasingly important determinant of the effectiveness and efficiency of that care. As a result, the object of management has changed. In response to these changes, health care managers have started focusing on the management of the care as well as the management of the institutions in which the care takes place, thereby creating a set of ‘Best Practices’ which are briefly described in this paper along with how the process of innovation is developing in the health care system.
The Nursing Home Reform Act (NHRA) was adopted and implemented to improve the quality of care that residents receive in nursing homes by having state inspection agencies…
The Nursing Home Reform Act (NHRA) was adopted and implemented to improve the quality of care that residents receive in nursing homes by having state inspection agencies issue deficiencies for substandard care. Yet, there is a great deal of variation in the average number of deficiencies cited by state inspectors. The goals of this study are twofold: 1) to identify the impact of political factors on the variation in deficiencies and nursing home compliance, and 2) to provide the Health Care Financing Administration (HCFA) with a strategic planning model that will help to improve its ability to oversee state implementation of the NHRA. Political party control of the governorship and legislative houses accounted for significant amounts of variance in deficiencies.
If the proper strategies are used to change the business process, high quality and high performance will return to the U.S. workplace.