There is a widespread perception that intrinsic motivation of professional personnel and public reporting of results together are not enough to foster, let alone guarantee, dependably satisfactory outcomes of care. It follows that some sort of tangible rewards-incentives-are necessary to achieve good outcomes. This perception is universal, not just an American phenomenon. A natural response is the development of incentive plans characterized as "pay for performance," or P4P. Kimberly J. Wilson presents a summary of the current developments in P4P plans in countries other than the United States. The author points to the inconsistent results achieved in the course of this development and to the need for further research in evaluating the processes involved.
Hospital personnel have long recognized difficulties in implementing many of the changes that are incidental to achieving best practice goals. In her report of a prospective study, Pavani Rangachari addresses the role, dynamics, and content of unit-level communication in implementing the central line bundle (CLB) protocol designed to reduce and eliminate catheter-related bloodstream infections.
Two models of quality improvement (QI) education within a health care organization are contrasted by Katherine Brownlee, Tamra E. Minnier, Susan Christie Martin, and Pamela A. Greenhouse. The traditional model, predominant since the 1970s when the movement was called Quality Assurance (QA), involves the establishment of a central office and authority as the in-house agency responsible for formal QA methodology development and education throughout the organization. The last 2 decades have seen the movement's name change from QA to QI, reflecting the shift in perception and objectives. In recent years, in response to other structural changes in health care organizations, QI programs and their responsibility for institutional oversight and education have been decentralized within the health care organization. The authors trace and analyze the complex path taken by this development at the University of Pittsburgh Medical Center.
In what could be the concisely organized groundwork for a seminar addressing the important distinctions between probability and nonprobability sampling, Rocco J. Perla, Lloyd P. Provost, and Sandra K. Murray give an exhaustive comparison of the 2 approaches, providing examples. Their conclusions would support the use of nonprobability sampling in QI research.
It is probably safe to say that at any given moment, somewhere in the world, some hospital or hospital department is (a) planning, (b) launching, (c) implementing, or (d) assessing a Lean Thinking program. The reported experiences in implementation and their impact on patient care can be instructive for other groups that may be contemplating trying out the Lean Thinking approach. Waqar Ulhassan, Christer Sandahl, Hugo Westerlund, Peter Henriksson, and their coauthors present a case study of the planning, implementation, and results of the Lean Thinking strategy in the cardiology department of a teaching hospital in Sweden.
A practical approach to satisfying documentation requirements painlessly can be counted on to stir interest in clinical staff. John R. Stanford, Chad B. Carpenter, and Arthur DeTore cite the perceived time-wasting documentation requirements of Best Practices protocols. To streamline the process and facilitate compliance, they present a nurse coordinator model that is in use in a cardiac program.
In a Veterans Administration Medical Center, the staff observed that the therapy and self-management training being provided to patients with diabetes were not effective for some patients. The staff's working theory was that this group of patients would experience greater benefit from the training if they were brought together in a special peer group where they could share their experiences and benefit from the insights of patients with similar diabetes management problems. Karen Homa, Mark Detzer, Jennifer Morgan, Elizabeth Derry, and their coauthors report on the formation and operation of a dedicated Diabetes Specialty Clinic program that provides a setting for this behavioral approach. Of special interest is the authors' analysis of the perceived successes and limitations of the project.