Quality Improvement Projects in Health Care: Problem Solving in the Workplace
Author: Eleanor Gilpatrick
In the current atmosphere of closer scrutiny of healthcare practices and procedures, front-line managers and health care providers must investigate potential problems in their work environment, whether at the behest of upper management, in order to meet Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards, or through their own sense that "we're doing something wrong." For the investigator with limited previous experience in evaluation or research, the prospect of undertaking this kind of investigation can appear daunting, to say the least. Quality Improvement Projects in Health Care was written just for this individual. Author Eleanor Gilpatrick, a seasoned investigator and professor of health services administration, provides a review of the basic terminology and guidelines for carrying out "nuts-and-bolts" quality improvement research. She then demonstrates how such a research project can be implemented through 14 case studies involving actual health care situations. Altogether, the cases speak to a broad array of issues and potential pitfalls for the unwary investigatorùand they show that progress can be made in even the most difficult circumstances. Quality Improvement Projects in Health Care will be of interest to students and professionals in health sciences administration, nursing, allied health, and public health.
Charles Runge
This is a manual of quality improvement for healthcare managers. It is presented in two parts: ""Basic Concepts & Manual,"" and ""Cases."" The purpose is to provide a specific, concrete how-to manual for quality improvement. This objective is somewhat worthy. As the author suggests, there is little how-to information in the current literature. However, most of the tools the author describes are presented in the quality improvement training sessions offered by many health services organizations. Nonetheless, the book definitely meets the author's objectives. According to the author, this book is for ""problem solvers and quality improvers in health services organizations and for students preparing to join them."" The author's target audience is appropriate. The book is most valuable for department managers, service chiefs, and front line supervisors, and somewhat valuable for the senior administrators who oversee them. The author is a credible authority, based on her academic credentials, experience collaborating with health services organizations, and the book's content. All of the common quality improvement tools for each phase of the quality improvement process, including problem identification, cause analysis, solution identification, implementation, and monitoring are described. The author makes extensive use of examples (charts, graphs, tables). The case examples are appropriate and instructive. This book represents a significant contribution to the literature in exactly the manner in which the author intends -- a detailed how-to manual for front-line problem solvers. The content is accurate, well organized, and very clearly presented. While much of the content is already coveredelsewhere, this book can serve as a useful reference when the details of training fade, as they inevitably do.
Doody Review Services
Reviewer: Charles Runge (Froedtert Memorial Lutheran Hospital)
Description: This is a manual of quality improvement for healthcare managers. It is presented in two parts: "Basic Concepts & Manual," and "Cases."
Purpose: The purpose is to provide a specific, concrete how-to manual for quality improvement. This objective is somewhat worthy. As the author suggests, there is little how-to information in the current literature. However, most of the tools the author describes are presented in the quality improvement training sessions offered by many health services organizations. Nonetheless, the book definitely meets the author's objectives.
Audience: According to the author, this book is for "problem solvers and quality improvers in health services organizations and for students preparing to join them." The author's target audience is appropriate. The book is most valuable for department managers, service chiefs, and front line supervisors, and somewhat valuable for the senior administrators who oversee them. The author is a credible authority, based on her academic credentials, experience collaborating with health services organizations, and the book's content.
Features: All of the common quality improvement tools for each phase of the quality improvement process, including problem identification, cause analysis, solution identification, implementation, and monitoring are described. The author makes extensive use of examples (charts, graphs, tables). The case examples are appropriate and instructive.
Assessment: This book represents a significant contribution to the literature in exactly the manner in which the author intends:a detailed how-to manual for front-line problem solvers. The content is accurate, well organized, and very clearly presented. While much of the content is already covered elsewhere, this book can serve as a useful reference when the details of training fade, as they inevitably do.
Booknews
Gilpatrick (health services, City U. of New York) provides the basic terminology and guidelines for carrying out nuts-and-bolts quality improvement research, and demonstrates how to do it on 14 case studies from real life. For middle-level managers and administrators who need to conduct chronic or acute research at the department or service level, she explains data collection design and analysis related to organizational processes and outcomes. She does not consider the clinical evaluation of treatments. Annotation c. by Book News, Inc., Portland, Or.
Rating
4 Stars! from Doody
Interesting book: Comptabilité Financière Avancée
Reconcilable Differences?: Congress, the Budget Process, and the Deficit
Author: John B Gilmour
Gilmour traces the development of the congressional budget process from its origin through the emergence of reconcilliation and Gramm-Rudman-Hollings. He shows how changes in process have brought about far-reaching shifts in congressional power, and explains why they have failed to control the explosion of budget deficits.
Throughout the last decade budgetary issues have dominated the national political agenda as the deficit has skyrocketed to previously unimaginable levels. In this important book, John Gilmour traces the continuing quest of Congress over the last fifteen years to reform its budgeting system in the hope of producing better policy. He shows that the enactment of the Congressional Budget Act of 1974 and the introduction of the reconciliation procedure in 1980 have produced a budgetary system in which congressional majorities can get what they want, provided only that they can agree on a comprehensive budget policy. From his thorough analysis, Gilmour concludes that, while the reforms have not produced balanced budgets, they have eliminated procedural obstructions to the adoption of a coherent budget.
New budget procedures have transformed the way Congress works. Before the reforms of 1974 and 1980, Congress had an extremely fragmented, disintegrated budgetary system in which the budget emerged almost haphazardly from the independent actions of numerous committees. Gilmour shows that reconciliation procedures in the budget process makes total revenue, total expenditures, and the size of the deficit matters of deliberate choice, consolidating decisionmaking to an extent unprecedented in the history of the modern Congress.
Yet, despite the striking structural andprocedural changes, and despite its highly majoritarian features, the budget process has failed to reduce dissatisfaction with congressional handling of money. Deficits have been larger, not smaller, and overall spending has gone up. Gilmour deftly shows that the massive budget deficits of the Reagan years were due primarily to the failure of the House, the Senate, and the President to agree on how to reduce spending or increase taxes enough to eliminate the deficit. Responsibility for budgetary failure, he argues, must rest with Congress and its inability to reach consensus, not on the new budget process, which, given what we can expect from procedural change, has been quite successful.
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