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Biomedical subjects

J T Ziegenfuss

Publications and source records attributed to J T Ziegenfuss.

At least 19 recordsLinked to original sources
PubMed2000

Creating the strategic future of long-term-care organizations.

The operating environment in the health care industry is turbulent--organizations are expected to adapt or die. This paper addresses the structure of a strategic planning process for long-term-care organizations. Nursing homes, assisted living (personal care) facilities, continuing care retirement communities, adult day services centers, hospice programs and home- and community-based agencies face both opportunities and threats. The authors recommend an eight-step process for strategy making: plan to plan; external analysis; internal analysis; vision; matching current and future strategies; strategy choice; action and linkage to operations and budget. A case example illustrates the concepts. Long-term-care leaders are encouraged to plan for their future or face a future planned by competitors and regulators.

Health Facility Planning↗
PubMed1998

Engineering quality through organization change: a study of patient care initiatives by teams.

This report presents a summary and analysis of the continuous quality improvement and organizational change and redesign initiatives undertaken by the unit and service boards organized under the auspices of the HORIZONS Project. Board initiatives were identified and summarized by staff through interviews with the chairpersons and representatives of the boards and review of records. Forty-nine projects from the three pilot units were identified. Each project was classified according to outcome--positive, negative, mixed, and unknown. Sixty percent of initiatives had positive outcomes, and only three initiatives (6%) were negative. Case characteristics were summarized according to board identification, problem, outcome indicators, data baseline, proposed and selected solutions, implementation strategy, monitoring plan, results, change issues, and lessons learned. The study concludes that the board initiatives embody the HORIZONS Projects approach to improving patient care and improving quality of working life for staff and doing so in a budget-neutral manner. The HORIZONS boards process has moved the organization toward more open, collaborative forms of decision making than hitherto practiced.

Cooperative Behavior↗
PubMed1996

Improving the quality of health services organization structure by reengineering: circular design and clinical case impact in an academic medical center.

Innovation to improve the quality of structure and process in health care organization is reported in this case example of change in an academic medical center. Interactive planning and the circular organization design concept were the driving principles and methods. This report presents the needs for and initial obstructions to change, planning and project design work, a description of the change process, and illustrative accomplishments to date--two cases, one of conscious sedation policy and one of nuisance pages. Evaluative criteria for judging the progress and lessons of the project regarding key design characteristics also are included.

Academic Medical Centers↗
PubMed1996

Medical and health administration education in managed care: needs, content and readings.

With both public and private reform initiatives moving toward managed care, curriculum designs are timely and useful to a diverse audience. This paper discusses the need for and design of education in managed care in medical schools and health services programs. The pressures for offering education regarding managed care are derived from interests of various actors of the health system e.g. regulators, purchasers, providers and consumers. The content of education in managed care is defined in seven areas: (1) managed care and health systems design-history and concepts; (2) environment and governmental policy; (3) models, products, services, outcomes and quality; (4) managed care economics and finance; (5) organization and strategic management; (6) legal issues; and (7) future designs/redesigns. Education in managed care is delivered by universities, professional associations and private training and development corporations. All can benefit from a dialogue on curricular content.

Curriculum↗
PubMed1995

Ombudsmen, patient complaints, and total quality management: an examination of fit.

BACKGROUND: In response to mounting health care costs in the United States and Canada, there is considerable national discussion of health care quality, including the importance of assessing and monitoring patient satisfaction and of responding to complaints. Many physicians and health care administrators cringe at the mention of using patient complaints and satisfaction levels as quality measures; others perceive the need to develop multiple source indicators of patient care. At the same time, leaders are seeking programs and methods that contribute to the continuous improvement of all aspects of health care organizations. DISCUSSION: The use of patient ombudsmen and patient complaints in quality management programs is reviewed and the relation between the two functions--ombudsmen/complaint handling and total quality management--is discussed. Purposes, objectives, problem-solving processes, program operations, data use, and the outcomes of ombudsmen efforts are reviewed. Since ombudsmen programs value patient feedback, empower customers, and help contribute to the diagnosis of organizational areas for improvement, they are consistent with the intent and workings of quality teams. The activities of ombudsmen can contribute to the broader effort to manage the whole organization toward the continuous improvement of quality.

Canada↗
PubMed1995

Academic health centers and HMOs: a systems perspective on collaboration in training generalists physicians and advancing mutual interests.

Academic health centers (AHCs) and health maintenance organizations (HMOs) often hold each other at arm's length because of fundamental organizational differences. AHCs view HMOs as too intrusive in the clinical management of patients and too concerned with the financial bottom line. HMOs view AHCs as organizationally fragmented and expensive in providing health care services. AHCs must expand their primary care networks and reassess their mission and public accountability in training a more balanced physician workforce. HMOs are growing rapidly and need well-trained generalist physicians to support that growth. This paper uses an organizational systems model in examining AHCs and HMOs to identify common needs, mutual interests, areas for potential collaboration, and bridging strategies. These include health care systems development, professional education, information management systems, and health services research. As the financing and delivery of health care continue to change and to become more integrated, both organizations have much to gain from collaboration.

Academic Medical Centers↗
PubMed1995

Ten tools of continuous quality improvement: a review and case example of hospital discharge.

Concepts and methods of continuous quality improvement have been endorsed by quality specialists in American Health care, and their use has convinced CEOs that industrial methods can make a contribution to health and medical care. For all the quality improvement publications, there are still few that offer a clear, concise definition and an explanation of the primary tools for teaching purposes. This report reviews ten continuous quality improvement methods including: problem solving cycle, affinity diagrams, cause and effect diagrams, Pareto diagrams, histograms, bar charts, control charts, scatter diagrams, checklists, and a process decision program chart. These do not represent an exhaustive list, but a set of commonly used tools. They are applied to a case study of bed utilization in a university hospital.

Data Interpretation, Statistical↗
PubMed1995

Culture audits: a tool for change.

The culture audit, which has five phases--needs awareness, diagnosis, planning, action, and evaluation--is a critical tool for easing cultural transformation in healthcare organizations. The objective of the audit--usually conducted by outsiders--is to help leaders better understand the current culture and adapt the culture to enhance organizational performance. Most leaders contract with an outsider to facilitate the needs exploration process, often with the guidelines of an advisory team of managers and staff. During the diagnosis phase, the audit team chooses the data-gathering methods, collects and analyzes the data, and develops a model of the culture. The third phase of the culture audit involves planning interventions. Once leaders have a clear picture of their organization's culture, they must ascertain whether the culture will enhance or impede the changes demanded by healthcare reform and an increasingly competitive environment. During the action phase, the culture begins to move toward its desired future. This transition generally requires change in all the organization's systems, including technology, structure, rewards, decision making, budgeting, and managing. Finally, the organization assesses the impact of its culture on its performance. Using the original diagnosis as a baseline and the organization performance goals, the evaluation process maps the changing culture against the benchmark beginning and the goals.

Data Collection↗
PubMed1994

Toward a general procedure for quality improvement: the double track process.

Quality improvement efforts are the focus of leaders in many fields. While we have emerging examples of successful efforts we have fewer presentations of the pathways to follow. This paper offers a general procedure based on a Double Track model. Two procedural processes are offered: (1) at the whole organization level, Track 1, as a strategic means to quality improvement; and (2) at the project level, Track 2, for an operational path to quality improvement work at the team level. It is suggested that successful efforts follow this Double Track effort already and that further identification and elaboration of the pathway will speed diffusion of quality improvement efforts.

Humans↗
PubMed1993

Beyond quality improvement teams: sociotechnical systems theory and self-directed work teams.

Increasingly, businesses are reporting successful implementation of self-directed work teams. In health care, team-based structures in both clinical and nonclinical areas are now rapidly emerging. This paper describes the linkage between the literature of sociotechnical systems theory and current applications of self-directed work teams, and outlines the organizational processes used to design and implement them. Several examples of self-directed work teams in industry and health care systems are provided. As much of the existing literature on self-directed work teams is from industry, there is a need for case reports and further research on their current applications in health care systems.

Decision Making, Organizational↗
PubMed1993

The administrative and clinical rationale for the total organization approach to continuous quality improvement.

In our view TQM and CQI represent important innovations in the continuing effort to develop higher performance organizations. Never before has the need been so great to improve quality while at the same time constraining, or reducing, costs. An increasing number of health care organizations can document their experiences that as quality goes up, costs can come down. The contribution of these new approaches is in some sense the wedding of many long established methodologies--the scientific method, statistical quality control, planning, joint problem solving, participative management, and empowerment of the work force. While this recognition could lend support to those who label this new model a fad, that perception denies the linkage of TQM/CQI to the greater stream of innovations pushing us toward ever-greater organizational excellence. Can we not take the philosophy and methods that are potentially useful and try them experimentally? Let our empirical tests tell us of their contribution. We believe the concepts and procedures of TQM/CQI will help us to be better in years to come, even though we highly respect our starting point.

Economic Competition↗