The official journal of the National Association for Healthcare Quality

JHQ 164 - Canada: Agreement Between Patient and Proxy Information About Colorectal Cancer Therapies
David Johnston, Suzanne Tough, Maria Verhoef, Heather Bryant
Abstract: Proxies, such as next of kin, often provide information to healthcare professionals about a cancer patient they know, particularly when this information is not available from the patient. Understanding the extent to which proxies offer reliable information about patients is important for improving the quality of patient care and also for assessing the quality of research, evaluation, and administrative data when proxy response is utilized. This study determined levels of agreement between information reported by colorectal cancer patients and by their proxies about complementary and alternative medicine obtained by questionnaire response. Patient-proxy agreement was also compared for conventional therapies, patient demographics, lifestyle, and symptoms.

JHQ 165 - Canada: An External Quality Review Process-The Wellspring Model
Esther Green, Eunice Gorman, Karen Bartlett, Laura Brooks, Cynthia Struthers
Abstract: Wellspring is a group of cancer support centers in Ontario, Canada. The centers provide information, support, and coping-skills programs for people with cancer and their families. To ascertain that all centers provide the same high quality of programs, the board at Wellspring established a panel of external oncology experts and asked them to establish a process to review program quality in each center. This article outlines the process undertaken to provide quality improvement in a nonprofit charitable organization.

Singapore: Hospital Capacity Prediction by Fuzzy Linear Regression 
Linet Ozdamar, Arun Kumar
Abstract: Strategic planning for hospital inpatient capacity is important in providing quality healthcare service at a reasonable cost. This study estimates annual average hospital length of stay (LOS) as an aggregate quantity for all private and public hospitals in Singapore. Because LOS depends on a patient’s medical history as well as on the severity and type of illness, it is a random variable that involves a wide spread. Hence, providing an accurate estimate for LOS poses a challenge but is very valuable. In this article, a multivariate fuzzy linear regression (FLR) model is developed for predicting aggregate annual LOS. The results show that FLR can provide accurate point and interval forecasts, although the amount of training data is small and the spread is wide.

Interview with a Quality Leader
Frank May on Healthcare Quality Issues in Australia and the United States
Deborah M. Flores
Frank May has been responsible for establishing and developing large-scale clinical support services for community-based medical practitioners.

Israel: A Comparison of Army Personnel Satisfaction Rates in Different Primary Healthcare Settings
Oren G. Benyamini, Yehuda Baruch, Giora Martonovits, Yuval Weiss, Paul Benedek, Nisim Ohana, Yaron Bar-Dayan
Abstract: The Israeli medical corps has recently been examining different primary healthcare settings for home-front career army personnel. This study compares the satisfaction rates of this unique population in different primary healthcare settings. Previously validated patient-satisfaction surveys were conducted 4 months apart in 10 large primary care clinics that treat home-front army career personnel. Satisfaction was highest in a civilian hospital–based primary care clinic. The specialized military career personnel clinics produced less satisfaction than the hospital setting, according to the survey; however, the differences were not statistically significant. Patient satisfaction was significantly lower in the classic military-based general practices. The hospital setting of civilian primary care created higher satisfaction in aspects of accessibility, availability, and interpersonal relationships. However, the patients’ perception of quality of care was lower than in the other settings.

Poland: Quality Monitoring of Therapeutic Processes in a Small Treatment Center for Children
Piotr Grudowski
Abstract: This article presents the case of the first ISO 9001:2000-certified small healthcare organization (the Center for Therapy and Rehabilitation) providing therapeutic and rehabilitation services for disabled children in Northern Poland. Elements of the process-oriented healthcare quality system implementation, initial benefits, and the organization’s quality system structure and process descriptions are described. Particular attention has been paid to assumptions and methods used in monitoring of therapeutic processes at the Center. The initial benefits of the system are also presented.

Taiwan: Improving Radiography Through Application of Six Sigma Techniques
Yan-Kwang Chen, Jerry Lin, Cheng-Chang Chang
Abstract: The healthcare industry has shown significant recent growth potential in Taiwan. Associated financial problems have grown considerably since 1995, when national health insurance was implemented. Taiwan’s healthcare bureau began to change the primary quantity-based healthcare expense payment method to a case-based payment model. Hospitals are now challenged to minimize healthcare waste. This article examines the application of manufacturing-based Six Sigma methods to an X-ray radiography improvement project to reduce the defect ratio of films for a teaching hospital in Taiwan. It was determined that (1) analysis of customer satisfaction data helped the Six Sigma improvement team identify critical quality elements; (2) the Six Sigma level in this healthcare project is lower than that in the manufacturing industry; (3) the improvement opportunity and the time required for the project had a direct correlation to the importance ascribed to the project and the cooperation received; and (4) process change can be made more quickly in the healthcare industry than in the manufacturing industry.