Jonathon S. Rakich

Strategic Quality Planning

he champions of quality assert that an organization that improves the quality of its services T or products will enhance its performance and competitive position. W. Edwards Deming described a chain reaction in which elimination of variability in processes brings decreased costs, improved productivity and quality, and enhanced competitive position. Michael Hammer indicates that the radical redesign of processes through reengineering leads to dramatic breakthroughs in performance, quality, and costs and, therefore, improved competitive position. In this article I present a strategic quality planning (SQP) model that integrates the continuous quality improvement (CQI) and reengineering philosophies, along with the plan-do-check-act (PDCA) method for process and quality improvement. Quality of services and products in health services organizations “includes two dimensions: conformance to requirements and fitness for use-both of which include satisfying customer needs and meeting customer expectations” (Rakich, Longest, and Darr 1992,408). Among the quality considerations are questions such as Are there defects? Was the service appropriate? Was it on time? Did it meet customer needs? and Was the customer delightedthat is, did the service or product attributes exceed the customer‘s expectations? Customer focus, both internal and external, is a fundamental tenet of both CQI and reengineering. Those two philosophies about quality and how to achieve it address the organization’s processes and its resource use and seek to improve productivity. A strategic approach to quality is referred to in the literature as hoshinpkznning. It, too, is customer oriented, primarily externally focused, and seeks to achieve breakthroughs in organization performance, quality, and competitive position. Hoshin is a Japanese word meaning “shining metal compass” or “pointing direction.” (Melum and Collett 1995, 15; Campbell 1997, 1). Hoshin planning is also known as focused planning, policy deployment, or strategic quality planning (Stonestreet and Prevost 1997, 616). It is a way of linking quality initiatives such as CQI and reengineering to the organization’s strategic planning process (O’Brien et al. 1995, 21). It identifies improvement activities and focuses them on a few critical processes that are considered key to meeting customer needs, improving quality and performance, and enhancing the organization’s competitive position (Hyde and Vermillion 1996, 28; Horak 1997, 2-4).

Organizational leadership in hospitals.

Hospitals face very dynamic environments and must meet diverse needs in the communities they serve and respond to multiple expectations imposed by their stakeholders. Coupled with these variables, the fact that leadership in these organizations is a shared phenomenon makes organizational leadership in them very complicated. An integrative overview of the organizational leadership role of CEOs in hospitals is presented, and determinants of success in playing this role are discussed.

Canada's Universal-Comprehensive Healthcare System

The Canadian healthcare system consists of provincial- and territorial-based health insurance plans that provide universal-comprehensive coverage for medically necessary hospital and physician services, the public funding of healthcare with no financial-access barriers, and the private delivery of care. A profile of the Canadian system and its expenditures fosters some noteworthy comparisons between Canadian and U.S. healthcare.

International Healthcare Expenditures: Spending Totals and Public Satisfaction among the OECD Nations

As an introduction to this Hospital Topics theme issue on international healthcare systems, our guest editor and one of our authors present aggregate health expenditures and public-satisfaction data from member nations of the Organization for Economic Cooperation and Development. Although healthcare funding is not the explicit focus of this issue, it underlies most of the points raised, and however the health systems examined here may vary in structure or impact, financing remains a shared challenge and one of our best base lines for comparison.

United States physician payment reform: background and comparison with the Canadian model.

This study reviews the new prospective Medicare Fee Schedule that will be used to pay United States physicians and compares it with the Canadian method of physician payment. The research basis and independent reviews of the resource-based relative value scale, and its conclusions and implications are also examined.

Problem solving in health services organizations.

Health services organization managers at all levels are constantly confronted with problems. Conditions encountered that initiate the need for problem solving are opportunity, threat, crisis, deviation, and improvement. A general problem-solving model presenting an orderly process by which managers can approach this important task is described. An example of the model applied to the current strategic climate is presented.

State health insurance initiatives: what the literature is telling us.

The absence in the United States of a comprehensive national health insurance system has left a significant number of people either without coverage or with only partial (and inadequate) coverage. Individual states have sought to remedy this through a number of initiatives, but the majority have been incremental in nature, not universal. Sifting through the extensive literature on what states are doing and have been doing, the author reveals the nature of their attempts (and their infrequent successes) and provides issues and questions that must be dealt with before a system acceptable--and accessible--to all can be achieved.

An analysis of hospital union election activity: 1985-1987--by hospital ownership, size, and system, and employee organization and bargaining-unit size.

During the three-year period 1985-1987, there were 238 elections in nongovernmental, short-term hospitals to determine whether or not unions would represent the employees. Unions had a success rate of 47.1 percent, similar to that of earlier years. This study reports these election results by hospital and election characteristics. For hospitals, the analysis includes elections by census region, ownership, bed size, and multi-institutional characteristics. For elections, the analysis includes the nature and type of election, employee organization, and employee bargaining-unit-size characteristics. This study concludes that the number of union elections decline as hospital bed size increases, and the union success rate is curvilinear and higher in both small and very large hospitals; union success declines as bargaining-unit size increases. Investor-owned and nonprofit, religious hospitals that are members of multi-institutional systems have lower union success rates than nonsystem hospitals do in their ownership category. However, unions are much more successful in multi-union and decertification elections compared with single-unit elections and initial recognition elections.