Distinctiveness of management in a university psychiatric hospital as a public health institution.

The distinctiveness of management of a university psychiatric hospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values.

[Assessment and certification of hospital care in Germany]. / Bewertung und Zertifizierung von Akut-Krankenhäusern in Deutschland.

The increasing call for evaluating and certifying the quality of hospital care is to be seen in connection with the need for more transparency in the German health care system. Hospitals can have themselves evaluated or compared on four levels of quality: the level of medical, nursing, and organizational core services, the level of the quality system of the hospital, the level of the internal quality management, and the level of business excellence. The external comparisons of hospitals legally established in Germany deal with the evaluation of core services of hospitals. All the other levels are covered by holistic evaluation and certification procedures following the models of the EFQM and the ISO, the genuine medical certification systems (KTQ and JCI), or peer reviewing. Each of them has different objectives and all are applied in German acute care hospitals. However, their methods are not yet fully developed and certainly will have to be further optimized in view of the forthcoming changes in the German health care system.

[Quality assurance and total quality management in residential home care]. / Qualitätssicherung und Qualitätsmanagement in der stationären Altenpflege.

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

[Quality management in hospital departments. References for implementation and basic requirements]. / Qualitätsmanagement an Krankenhausabteilungen. Hinweise zum Einstieg und grundlegende Anforderungen.

Every hospital department has to install a basic quality management system within the next years. This is necessary for two reasons: The legal regulations and the introduction of a payment system based on diagnosis related groups. The very first beginning often is the hardest part of quality assessment work. This paper shows how to start with TQM everywhere--without inadequate expense and by own means. Basis for this is the identification of a couple of important targets, procedures and risks at the pit face. Further developments and the political background is outlined.

Clinical integration and new options for academic medical institutions in network development.

The author outlines two options, made possible by developments in antitrust law, that can create a favored role for academic health science centers as well as for stand-alone medical schools and teaching hospitals, using the unique strengths of these institutions that are often considered weaknesses by the marketplace. The first option is the development of clinically integrated collaborations that need not be either system-wide or necessarily governed by total quality management processes, or involve the characteristics of ownership typical of the usual integrated delivery systems. The second option is the development of new clinical "products." Each option encourages creative financing, legal, medical, and governance approaches and makes it possible for centers, medical schools, and teaching hospitals to build multi-provider collaborations that are in harmony with their missions and different from the less-compatible integrated delivery systems that they often seek to build. The author provides an extensive background on antitrust law to explain the two options and the criteria for crafting them within antitrust law. He then describes how antitrust law applies to multi-provider networks and in particular to academic health science centers and free-standing medical schools and teaching hospitals, and gives examples of the kinds of fruitful collaborations these institutions could engage in. He urges those institutions to realize that if they keep faith with their best characteristics in creative new ways (such as those suggested by his article), they will thrive in the years ahead.

QI as resolution to a major lawsuit.

BACKGROUND: In 1991, in response to a lawsuit filed in 1974, the Texas Department of Mental Health and Mental Retardation (TXMHMR) became the first major state agency in Texas to implement a systemwide effort to implement quality improvement (QI) in its Quality System Oversight (QSO) program. QSO: The QSO approach includes a uniform internal hospital management structure focusing on teams and data-based decision making; the development of uniform work processes for each of the issues cited in the lawsuit; and a uniform set of procedures for determining compliance, including the establishment of numeric targets for which each hospital is accountable. CASE STUDY: At one TXMHMR hospital, patient records in a monthly random sample were below the performance target. Data showed that approximately 40% of the patients leave the hospital (many for a community mental health center) before a treatment plan (at 14 days) is developed. Based on a team's recommendations, a uniform assessment package is being developed for use by all TXMHMR hospitals and community mental health centers. THE NEXT STEP: In 1994, again in response to external pressures to improve quality, TXMHMR used a simplified version of the Malcolm Baldrige National Quality Award criteria for organizational self-assessment. Two pilot sites have developed action plans for improving performance as indicated on the self-assessments. SUMMARY AND CONCLUSIONS: The QSO program, put into place as a result of a lawsuit, provides a structure and database for TXMHMR to efficiently and effectively manage the performance of all hospitals in the system. All but one of the eight hospitals have exited, or are close to exiting, the lawsuit.