The winter 2008 issue of the Quality Management in Health Care, focusing on pay for performance, experienced an embarrassment of riches. Space limitations based on production considerations required that we postpone printing 2 of the articles in the pay-for-performance collection until the current issue. Those articles, "Pay for Performance and Medical Education Strategies: Strategies for Preparing Physicians of the Future," by Sarah Augustine and David Litaker, and "Pay for Performance in Hospitals: Implications for Nursing and Nursing Care," by Judy M. Bodrock and Lorraine C. Mion, lead off this issue. Pay for performance with its implications for many aspects of medical, nursing, and hospital care is a subject that merits attention in more than 1 issue of a journal.
Waiting for health care services, whether for a prescription to be filled or in a months-long queue for an elective operation, is a universal experience and a popular subject of discussion. Julie M. Slowiak, Bradley E. Huitema, and Alyce M. Dickinson explore the effects of 2 different intervention programs on customer satisfaction in a hospital outpatient pharmacy. On the basis of an exhaustive analysis of the literature, Sara A. Kreindler pinpoints 7 system factors that contribute to excessive waiting times for health care services, both inpatient and ambulatory.
Speaking of time and differing perceptions of it, Monica Ortendahl argues that differences in time and health perspectives potentially affect clinical decisions and, therefore, the quality of care.
Timothy Hoff explores the relationship between the clinical setting and the attitudes and behavior of residents in dealing with clinical errors and issues of patient safety. He reports the results of a study carried out in 3 settings-the emergency department, surgical services, and the medical intensive care unit. Various behavioral measures of the learning and application of safety concepts were calculated and compared among the services.
The issues of autocorrelated data and false-positive results are serious concerns in using statistical process control to measure patient outcomes. Alok Madan, Jeffrey J. Borckardt, and Michael R. Nash present a method for correction of autocorrelation and an autocorrelation-corrected X-S chart that may provide quality managers with a new and important tool for handling autocorrelated data.
Successful integration of entry-level professional personnel into an organization's culture is as vital to a hospital as to any other complex organization. Megan-Jane Johnstone and Olga Kanitsaki explore the key steps facilitating the\break process as it applied to a cohort of new professional nurses during their introduction to an Australian hospital's program of clinical risk management and patient safety measures.
Translating clinical guidelines and standards into actual measures taken in patient care is not always easy. Michael Fung-Kee-Fung and his colleagues suggest that the successful implementation of guidelines should consider tools and expertise from other disciplines. With a Canadian hospital's surgical oncology service as the site, they identify 4 essential organizational processes that they recommend be used in developing plans to implement performance standards in the health care setting.
Neuhauser proposes that we look at the possibility of extending the statistical methods employed in quality assessment and improvement to the process of personal individual quality improvement. He argues that statistical process control methodology can be widely applied in many ongoing health conditions. He cites such conditions as hypertension, diabetes, or obesity, in which many patients are instructed to keep food, medication, and exercise diaries. He points out that methodological rigor must not dictate the choice of statistical method in personal quality improvement-as he comments, "QI is about what works."
Jean Gayton Carroll, PhD
Editor