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Striving Toward Improvement: Six Hospitals in Search of Quality.

Striving toward Improvement: Six Hospitals in Search of Quality. Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations, 1992. 297 pages. $55.

From a group of 60 hospitals identified as being involved in quality improvement, six were selected for case studies. The average census of the selected hospitals ranged from 72 at a community hospital to 622 at an academic medical center. The case studies are uniformly presented and analyzed as to demographics, history, philosophy, strategy, QI process, QA/QI relationship, education, QI support, and physician involvement. Each study indicates the basic theory or combination of theories of total quality management and continuous improvement that was adapted at the hospital.

There is a thoughtful foreword to the book by Donald M. Berwick, MD. There is a chapter on shared experiences that notes the characteristics that are common to al QI theories:

* QI is driven by the leaders of the organization. Active involvement is essential.

* Customer-supplier relationships are developed and understood through designed processes.

* There is a move away from inspection-based management to improvement of processes.

* All employees are involved in the exploration of processes.

* Formal problem-solving methods and statistical tools are used.

The next chapter is a record of a roundtable discussion led by a JCAHO representative and leaders from each of the six hospitals, who were brought together to discuss the differences and the similarities in their programs. Of spe- cial interest are their comments on "Implementing QI--the Rollout," "Barriers/Resistance," "Medical Staff Involvement," "Cultural Change," and "External Environment." In acknowledging the hospitals' progress, several years of effort are evaluated, rated as ranging from 30-60 percent of the way to the final status. One succinct comment is that "25-50 percent of all costs in our hospitals are due to poor systems that create waste, rework, needless complexity, malpractice medicine, and wrong clinical decisions."

There are future projections, an epilogue, and an excellent overview of the tools that can be used in QI. For any person or organization that is searching to learn more about TQM and CQI, this should be an invaluable report. With the theories and the experts that abound, any approach initially has to be confusing. This report should be comforting, because it documents how each hospital finds its own design. Most important, significant progress in quality improvement will take time. It is not a quick fix.Laurence G. Roth, MD, FACPE, Medical Director, Genesee Memorial Hospital, Batavia, N.Y.
COPYRIGHT 1992 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Author:Roth, Laurence G.
Publication:Physician Executive
Article Type:Book Review
Date:Sep 1, 1992
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