Team briefing and quality circles prove their value.
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In 1996, the North Heart Center, part of North Memorial Health Care in Robbinsdale, Minn., invested over $30,000 in a quality improvement project. Hospital administration put its support behind the effort when results began to show better outcomes, more efficiency, improved patient and provider satisfaction, and cost reduction in the system. The purpose for North Heart Center was to reduce mortality rates by 50 percent. A team of between eight and 12 people met weekly and kept to a focused and aggressive schedule. A fast-paced, action-oriented schedule helped the team maintain, its momentum throughout the process, allowing a steady stream of smaller accomplishments that moved toward the overall goal. The team found that though there was resistance, people ultimately joined when they saw the process worked. A process-flow diagram helped chart every step of any given process. The team found that people focus better on one or two variables rather than attempting to do too much at one time. Examining results to see what works and what doesn't was the next step, followed by summarizing and then redesigning the cycle to try again. Posting data in appropriate areas proved effective in eliciting support throughout the organization. The team worked hard to cultivate trust for the ideas people brought to the table. Completion of North Heart Center's initial project took several years and focuses now on reducing atrial fibrillation in cardiac surgery patients.
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Health care in general, and nursing in particular, is experiencing dramatic changes in worker values, economic realities, and management theory. All three areas of change move toward actively involving employees in organizational decision making. Although nursing managers have implemented a variety of systems to gain employee participation, "Quality Circles" seems to be the most promising method currently available. This article describes some techniques for effectively implementing Quality Circles within a nursing organization.
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Compares the general conception of the performance appraisal system as evidenced in yesterday's and today's attitudes and goes on to prognosticate the approach of tomorrow. Radically proposes the removal of such a system altogether, switching from performance appraisal to systems analysis, involving feedback from external (customer/supplier) as opposed to internal (management) sources. Also extends the paradigm shift to salaries, communications and promotion, and highlights training as a vital component, if Deming's seminal eleventh and twelfth points are to be realized.
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Peter R. Scholtes has a unique perspective on what it takes to build a world-class quality organization: A transformation of the relationships, environment, and dynamics within and between individuals and groups throughout an organization. He brings an organizational development perspective to quality management and, in particular, to the approach and practices advocated by W. Edwards Deming. This interview explores Mr. Scholtes' in-depth understanding and sometimes controversial views on quality improvement teams, team training, and performance appraisal.