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PubMed1999

[Comparison of accreditation procedures, ISO 9000 certification procedures and total quality management. Personal experiences and application of quality assurance in a department of radiology and medical imaging].

Management of quality assurance protocols in a radiology department can be done by using several tools or models. Some are specific like accreditation manuals issued by some organizations, others like the ISO 9000 certification and the Total Quality management are more general and already well known by manufacturers. In order to implement a process of quality improvement, we have reviewed three models of quality assurance: evaluation in total quality based on the European model "EFQM", accreditation based on booklets from French cancer centers and Canadian radiology centers and, finally, accreditation based on the ISO 9002 certification model. Based on results of our comparative study, these three tools of quality management are not contradictory and may be complementary. However, they can be compared in terms of constraints they impose, of their historical background, of the criteria evaluated as well as the role of different teams. In conclusion, we suggest that directors of radiology department interested in implementing a quality assurance program first evaluate their department using the Canadian accreditation model issued in 1993 which is useful to become familiar with this new concept of quality. In a second step, a self assessment using the EFQM has to be done in collaboration with all members of the administration board in order to integrate all parameters and to share this protocol with all decision makers. The last step is to consolidate the organization of the quality assurance protocols by means of the ISO 9002 certification.

Accreditation↗
PubMed1999

The basics of high-performance supplier certification.

Certification of supplier generally means that the supplier provides acceptable quality, on-time delivery at the lowest cost. Companies have devised numerous methods, criteria, formats, and approaches to certifying suppliers. Many of these are too complicated, not understandable, administratively difficult, or fail to be objective. If you have struggled with how to fashion a supplier certification program and how to have suppliers effectively embrace your program, this article is for you. It describes how to reduce the requirements to simple one-page format; details; three basic measures of performance that deal with quality, delivery, and cost; and provides several measurement-driven improvement actions. Supplier certification provides a simple, objective, mutually beneficial method of achieving high-quality, on-time delivery at the lowest cost.

Certification↗
PubMed1999

Reliability and sensitivity of suicide certification in higher-income countries.

World Health Organization age-, sex-, and cause-specific mortality data for the United States and 19 other democratic higher-income countries were utilized to assess the reliability and sensitivity of suicide certification for purposes of cross-national research. Data are found to be highly reliable across age and sex (rs > 0.92; P < 0.001). Relative discrepancies between official suicide rates (putative lower limits) and projected upper limits vary widely internationally. Austrian and Dutch suicide certification is the most sensitive. Least sensitive is certification for certain subpopulations in Finland, Greece, Ireland, Israel, and the United Kingdom. We recommend similar analyses be performed for routine, low-cost surveillance of suicide data quality, and to guide choice of population groups for multivariate comparative research.

Adolescent↗
PubMed1999

Evaluation of certification in the Milk and Dairy Beef Quality Assurance Program and associated factors on the risk of having violative antibiotic residues in milk from dairy farms in Michigan.

OBJECTIVE: To determine whether certification in a Milk and Dairy Beef Quality Assurance Program (MDBQAP) was associated with a reduced risk of having antibiotic residues in milk and to define specific management factors that may have predisposed dairy farms to having violative antibiotic residues in milk. SAMPLE POPULATION: 124 dairy farms in Michigan that had > 1 violative residue in milk during 1993 and 248 randomly selected control farms in Michigan that did not have violative residues in milk during 1993. PROCEDURE: A pretested structured questionnaire was mailed to case and control farms. A conditional multivariate logistic regression model was developed to determine risk factors associated with having a violative antibiotic residue in milk. RESULTS: Certification in the MDBQAP did not significantly reduce the risk of having a violative antibiotic residue. Annual treatment of > 10% of a herd for metritis was associated with a reduced risk of having a violative residue. Evidence suggested that a routine request for a milk processor to perform residue testing was associated with a decreased risk of having had a violative antibiotic residue, but routine on-farm residue testing was associated with an increased risk of having had a residue. CONCLUSIONS AND CLINICAL RELEVANCE: MDBQAP certification was associated, although not significantly, with a reduced risk of having violative antibiotic residues in milk. Risk factors significantly associated with violative antibiotic residues are addressed by various critical control points in the MDBQAP and may be indicators for strengths and weaknesses of MDBQAP.

Animals↗
PubMed2000

Autopsies and death certification in deaths due to blunt trauma: what are we missing?

OBJECTIVES: To determine the frequency, body region and severity of injuries missed by the clinical team in patients who die of blunt trauma, and to examine the accuracy of the cause of death as recorded on death certificates. DESIGN: A retrospective review. SETTING: London Health Sciences Centre, London, Ont. PATIENTS: One hundred and eight deaths due to blunt trauma occurring during the period Apr. 1, 1991, to Mar. 31, 1997. Two groups were considered: clinically significant missed injuries were identified by comparing patient charts only (group 1) and more detailed injury lists from the autopsies and charts of the patients (group 2). OUTCOME MEASURES: Chart and autopsy findings. RESULTS: Of the 108 patients, 78 (72%) were male, and they had a median age of 39 years (range from 2 to 90 years). The most common cause of death was neurologic injury (27%), followed by sepsis (17%) and hemorrhage (15%). There was disagreement between the treating physicians and the causes of death listed on the death certificate in 40% of cases and with the coroner in 7% of cases. Seventy-seven clinically significant injuries were missed in 51 (47%) of the 108 patient deaths. Injuries were missed in 29% of inhospital deaths and 100% of emergency department deaths. Abdominal and head injuries accounted for 43% and 34% of the missed injuries, respectively. CONCLUSIONS: The information contained on the death certificate can be misleading. Health care planners utilizing this data may draw inaccurate conclusions regarding causes of death, which may have an impact on trauma system development. Missed injuries continue to be a concern in the management of patients with major blunt trauma.

Adolescent↗
PubMed2000

[Current status of the discussion on the certification of so-called "Trichinella-free areas"].

In the last century already, Friedrich Albert Zenker and Rudolf Virchow have provided the essential prerequisites for the examination of pork for Trichinella in Germany. According to Directives 64/433/EEC and 77/96/EEC, this examination is still required in all member states of the European Union (EU) for trade between EU countries and for pork imported from third countries. According to Directive 64/433/EEC (Article 6, para 2), the examination of swine for Trichinella may be dispensed with if, on the basis of epidemiological studies, the stocks are found to be free from Trichinella and there is an efficient system of ante-mortem and post-mortem examination and control. However, it had been impossible to introduce these provisions into practice due to the fact that criteria were lacking. Therefore, the Scientific Veterinary Committee of the European Commission established a working group which has elaborated a concept for the certification of Trichinella-free pig stocks. The concept includes, inter alia, definitions of the essential components of "non-endemic area" and "Trichinella-free stock" and the requirement to be complied with for certification. Details are given on measures taken to control continued compliance with the certification requirements, the reporting and documentation system and the measures to be taken when trichinellosis is detected at a certified farm.

Animals↗
PubMed2000

[Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].

The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.

Ambulatory Care↗
PubMedDate not supplied

[Social implications of physician professional and certification quality].

The paper analyzes the social implications of the professional quality of physicians and of their process of certification. The adequate competencies of physicians are especially relevant in countries that have broad social asymmetries and cultural plurality. This diversity of social and epidemiologic conditions demands a profile of physicians able to work in a wide range of environments and able to achieve the best professional practice, making the best use of the available resources for medical care. Medical competencies and quality of care are interrelated. The process of coupling universal knowledge and local conditions creates a synchronic diversity of professional practices. Medical certification must be viewed as part of the process of diffusion of innovations. The development of a variety of abilities to cope with innovations contributes to the production of a diachronic diversity of medical practices. In the light of continuing quality improvement, it is necessary that certification systems be articulated with both continuing medical education and the accreditation and progress of healthcare institutions. Otherwise, there is the risk of increasing inequality in medical practice that, in the last analysis, blames the victim.

Certification↗
PubMed2000

[Certification of cause of death in Tunisia].

We have led a study about 2251 death witch are declared during 1996 in the Great-Tunis. Results are following: The hospital deaths are as many betters certified that the physician is a specialist. The cause mention rate is about 88.6% for death observed by specialists against 28.5% for those observed by internists. Paradoxically, a precise cause mention is best for deaths that are observed outside hospitals and when the physician is an internist. Badly define morbid states represent 17.1% of outside hospitals mentioned causes against 30.8% in the Hospital. They represent 12% of causes mentioned by internist against 30.1% of those mentioned by specialists. Despite death medical certificate obligation, the strong proportion of badly defined morbid states characterizes death causes. We hope that this situation will be improved by the new model usage of the witch will be introduced since 2000. This certificate mentions death causes distinguished in initial, immediate and associated. This certificate has be the object of the decree n degree 99-1043 of 17 may 1999.

Adolescent↗
PubMed2001

The need for DSA certification: the dental surgeons' perspective.

This study investigated the perceptions of dental surgeons on training and performance of Dental Surgery Assistants (DSAs). A questionnaire survey was sent to all practising dental surgeons in Singapore. It was found that 8.2% of respondents felt that the current standard of DSAs was good while 80.5% felt that the current standard was either adequate or poor. 71.5% felt that there was a need for DSA certification and 76.5% reported that they would send their DSAs for certification training. The results suggest an underlying need for formal training towards DSA certification.

Adult↗
PubMed2002

[Does systematic evaluation of sickness certification II lead to less use of health insurance?].

BACKGROUND: The increasing prevalence of disability pensioning in Norway has led to several attempts at strengthening the proactive role of the National Insurance System (NIS) in cases of long-term sick-listing. Since 1988, a special medical certificate is required after eight weeks of sick-leave. The aim of this study was to examine whether systematic evaluation of this medical certificate by NIS officers and NIS medical consultants could reduce future health insurance expenditure. MATERIAL AND METHODS: In 1994 a randomised study using a paired design of the NIS local offices in the county of Hordaland was undertaken. All eight-week medical certificates in the intervention group (N = 2,237) were systematically reviewed, whereas standard routines were used for the control group (N = 1,764). RESULTS: After three years, no significant differences were observed between the two groups in health insurance utilisation. INTERPRETATION: We conclude that local NIS offices are unable to use the information in the eight-week sick notes to effectively influence future utilisation of health insurance. The reason may be that NIS offices lack the skills necessary for early intervention in long-term sick-listing.

Adult↗
PubMed2002

[Quality management in the hospital environment: ISO 9002 certification: our experience].

The nephrology-dialysis department of the Havre's hospital has launched a project of certification ISO 9002 in 1996, based on reflections from the centers of dialysis Upper Normandy. The problems encountered were mainly the lack of ways, a bad documentary structure, false ideas on the quality and a bad perception from the client. With the help of a quality manager, il has enable the project to advance and finalized, obtaining the certification of activity. In june 2000 "Procedure of taking in charge all the patient's medical and para-medical cost in the center of the Nephrology-Dialysis service" of the GHH (Hospital Group of the Havre) has brought not only the certificate but notable improvements on the level of documentary management, the errors, relationship clients-suppliers and projects of collaboration with the other services of nephrology dialysis of France.

Certification↗
PubMed2002

A Graduate Certificate and Master in General Practice Psychiatry by distance education--1998-2001.

BACKGROUND: The General Practice Psychiatry Program is a collaborative initiative between two universities and two professional colleges. Since 1998 it has offered general practitioners a one year part time Graduate Certificate, and a two year Master of General Practice Psychiatry. The learning is by distance education and multimode, including text packages sent out, tapes, teleconferences and two annual residential weekends with role plays and didactic teaching. OBJECTIVE: To describe the development of a Graduate Certificate and Master in General Practice Psychiatry. DISCUSSION: The program has been well supported with 141 general practitioners enrolling in the Graduate Certificate and 48 in the Masters during 1998-2001. General practitioners have been enrolling from around Australia, with rural, female and more experienced GPs predominating.

Adult↗
PubMed2002

[Occupational hearing loss: new principles of certification].

Noise-induced hearing loss, together with presbyacusis, are the most prevalent causes of the functional impairment of the inner ear in an adult population. The authors discuss briefly the epidemiological, diagnostic and medical certification issues. The paper is focused on the new legislation that brings about considerable changes in the procedure of medical certification of noise-induced hearing loss. Both the definition of the pathology and new principles for its certification as an occupational disease were intended to harmonize Polish regulations with respective legislation of the EU countries.

Certification↗
PubMed1976

Field work experience ratings and certification examination scores as predictors of job performance and satisfaction in occupational therapy.

The American Occupational Therapy Association's certification instruments, the Certification Examination for Occupational Therapists Registered and the Field Work Performance Report, were examined in terms of their ability to predict future job performance and satisfaction of occupational therapists. A job satisfaction questionnaire was administered to 208 occupational therapists, and their supervisors rated them on a job performance instrument. The resulting correlations between these work adjustment variables and the previously administered certification instruments failed to reveal any predictive ability. Some plausible reasons for these negative results and possible directions for further research into this professional screening process were explored.

Certification↗
PubMed2003

[Certification of quality in catheterization laboratories: from the requirements of GISE to ISO 9002].

National and regional health plans are being issued, where the implementation of quality assurance programs is fostered. The ISO 9002 certification has been chosen in several units and hospitals as a guarantee of the processes being followed in patient care. One major limitation, however, of the ISO 9002 certification is that--despite accurate control of all procedures--it does not imply control of the output, i.e. patient outcomes. Insofar as Cardiac Catheterization Laboratories are concerned, a Quality Certification Program has been issued by the Italian Society for Invasive Cardiology (GISE) in 1998. This program was based on the general structure of the ISO Norms, and requires consideration of a number of indicators pertaining to both the process of health care delivery, and the outcomes of patients. Careful application of such indicators and reference standards to specific items of the ISO 9002 Norms (namely, items 10 and 18) may improve the applicability of the latter to the process of patient care, with greater attention to the satisfaction of both "customers" and "operators".

Cardiac Catheterization↗
PubMed2002

[Professional competences in certification in occupational medicine as a subject of postgraduate training].

In the Nofer Institute of Occupational Medicine, Łódź, teaching programs, contents of classes and teaching personnel of all postgraduate training cycles in occupational medicine were assessed (at the end of classes using a special questionnaire) by the students in the years 1998-2001. The evaluation studies with the help of a questionnaire on the self-assessment of acquired competencies were also carried out during this period. A comparative analysis enabled to define the degree in which particular courses (training cycles) concerning directly certification in some domains of occupational medicine, performed in 2000-2001, contributed to the increased professional competencies perceived by the students. Furthermore, of the whole list of occupational medicine subjects taught in 1998-2000, those concerning directly certification were separated, characterized quantitatively and qualitatively and compared with other aspects of special training in occupational medicine. One the basis of a specific evaluation study of the testing questions, performed in 1999, the quality of some questions on certification used in the tests of knowledge in occupational medicine was described.

Adult↗
PubMed2003

Introduction of a board certification system for the Japanese Society of General Hospital Psychiatry.

The importance of board certification systems is increasing in parallel with changes in the social conditions surrounding general medical practice. The same is also the case for consultation-liaison psychiatry, a subspecialty of psychiatry. As a consequence, in April 2001 a board certification system for the Japanese Society of General Hospital Psychiatry was introduced. The clinical abilities required for liaison psychiatrists in this system can be summarized as follows: the ability to adequately treat patients with physical/psychiatric comorbidity or somatization, the ability to form an appropriate and adequate relationship with patients with physical diseases and to collaborate with medical and surgical professionals, and to have a good social and ethical awareness of general medical practice. The conditions required to obtain certification and the issues that remain to be addressed are also discussed.

Certification↗