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Argues that the economic integration of the EC′s 12 member nations into a single community and the elimination of barriers to free trade will not result in a single health‐care system. However, the closer relationships among the member nations and the members′ individual desires for competitive advantage in the new marketplace will, inevitably, lead to an interest in comparing health‐care systems along cost and quality dimensions. Without a common currency for quality assurance, such comparisons will be time consuming, costly and of questionable validity. Consensus must be achieved on the following: the essential elements in a database for health care quality assurance; common classification systems for key elements in the QA database; standardized conventions for coding practices to ensure data validity and reliability. Suggests an assessment of current practices in health data collection in the member nations; a pilot project to assess the feasibility of developing a common currency for quality assurance, and an EC‐wide symposium to discuss data comparability issues as next steps.

Fundamental hospital management reforms, enacted in 1990, focus on competition for National Health Service (NHS) contracts between public and private hospitals and the option of self‐governing trust status for NHS hospitals. The need to challenge the status quo in the NHS is discussed. Initiatives leading to self‐governance are reviewed. The Freeman Hospital′s model for the cultural change which is prerequisite to self‐governance is presented. The Freeman Hospital, Newcastle upon Tyne, a national pilot site selected by the NHS Management Executive to develop new management systems and practices, is among the first self‐governing hospital trusts in the NHS.

States that growing numbers of experienced adult professionals are pursuing higher education on a part‐time basis and are enrolling selectively in university and workplace‐based undergraduate, graduate, and continuing professional education programs. As competition for this growing population of lifelong learners increases, the assessment of student satisfaction requires more attention. This article discusses the advantages of focus groups – a structured group interview technique – over other techniques for assessing the satisfaction of adult learners, presents key aspects of focus group methodology, and provides a case illustration of focus group methodology applied to quality improvement in a professional master’s level management program that serves adult professionals who are employed full‐time in the health professions.

Reviews available literature on gender bias and the process of medical care. Current findings point to possible gender bias in treatment protocols for kidney and cardiac patients. Other clinical conditions have not been studied. Identifies methodological challenges to such research and discusses the need for further research.

Scientific study of order and chaos suggests alternatives to both of the following conceptualizations: organizational boundaries as barriers and the boundaryless organization. Explores a path metaphor for boundaries and considers the path metaphor′s implications for leadership style and change management.

Examines the nature of performance measurement in the NHS in its relation to the principal objectives of a public health service. Argues that existing measures (bed and theatre utilization, budget deficits, and so on) can give rise to situations which are in conflict with such objectives. Suggests performance measures should reflect the purpose of a public health services. One way this may be achieved is by use of an adjusted or weighted throughout measure which provides an indication of the level of utilization of (largely) fixed resources. Once adopted as a performance measure, throughput efficiency, established in the context of clinical objectives and available resources at unit level gives rise to quite different conclusions as to the effectiveness of existing health care delivery than has traditionally been the case.