Objective: The goal of medical care in twenty-first century is to pursue a safe, effective, patient-centered, timely, efficient and equitable service system. The mission of medical professional providers and managers of medical institutions depends on controlling ¡§quality¡¨, i.e. medical essence and existence of medical institute. In order to raise surgical medical service quality in medical centers, the perioperative visit becomes an important index of medical quality in surgery. Therefore, this study investigated the effect of surgical medical quality in one southern medical center carried out the perioperative visit. Method: The samples were from patients undergoing surgery in one medical center. From March 1 to June 30, 2008, we conducted structural questionnaire to gather 505 cases. The contents of the perioperative visit included the visit for patients in the early stage of surgery, the care in the middle stage of surgery, and the visit for patients in the later stage of surgery. Based on the contents of the visits, this study analyzed the influence of demographic characteristics (including sex, age, surgical divisions, anesthesia, marital status, past medical history, surgical experience and blood types, etc.) on medical quality (including the decrease of anxiety, the raise of medical service satisfaction, the loyalty of returning to the original hospital and self health cognition, etc.). The collective data analyzed by descriptive statistics, One-Way ANOVA, independent-sample T test were compared the difference between the groups by Bonferroni correction. Result: The results indicated that the decrease of anxiety was not affected by sex, marital status, past medical history, surgical experience, and blood types, but was dependent on age, divisions and anesthesia. For the age group, the results of 21-40 year-old people were the most significant. For surgical divisions, the results of patients in orthopedic system were the most significant. The increase of medical service satisfaction was not affected by sex, past medical history and surgical experience, but was dependent on age, divisions, anesthesia, martial status and blood types. For the age group, the results of 21-40 year-old people had the highest satisfaction. For surgical divisions, the results of patients in orthopedic system had higher satisfaction than others. The health cognition and loyalty of returning to the original hospital was not affected by sex, age, divisions, anesthesia and past medical history, but was dependent on martial status, surgical experience and blood types. Conclusion: Therefore, the results suggested that medical institutions, professional clinical staffs and researchers should timely correct perioperative contents and make an integral care plan for medical teams to join in order to perfectly provide a personal, familial, whole and integral medical care and then to achieve the essence of medical quality.

After the implementation of national health insurance, the health care industry has entered into a new era. The public not only ask the hospital for medical technology and expertise, but also more focus on the quality of care. The quality of health care has become a successful key factor for hospital management. The biggest problem of quality management faced by a hospital is that no one can clearly describe the organizational structure, business process, and information system which are related with the medical quality management. Provided that no one could completely describe the quality management system, neither a tool to represent and analyze the quality management system, it is impossible to achieve a nice and sound quality management throughout the hospital. This research uses a quality management model as an example, introducing service-oriented medical quality management model (SOMQMM) to corporate restructuring and process improvements. Service-oriented management model, using the service-oriented theory and method, is able to effectively describe the organizational structure, business process, and information system all in one. ontribution of this research is through the structure-behavior coalescence (SBC) service-oriented theory and method to create a new management tool and quality management model. From this model, we can clearly describe how we can do better quality of care for the medical industry, and integrate the quality management to the organizational structure and business process. Hence, provide the dynamic quality of information system to the manager as the basis for adjustment and management.

Abstract Background: Emergency department (ED) overcrowding has become a significant problem throughout the large medical centers, leading to possible threatened medical quality, causing raised stress levels among staff and patients in EDs, and most importantly, adversely affecting patient outcomes. Due to its complexity, a large concerted group effort will be needed to increase awareness, implement proposed solutions, and make a change. ED overcrowding is a multifaceted problem that will require a multifaceted solution. Methods: We set up the "Input-Throughput-Output" model provides a structure for examining the factors that affect ED access, quality and outcomes. Using this model, we clarify the issues of ED overcrowding into three stages, propose ways to obtain needed information in each stage, test the strategies and then evaluate their outcomes. We utilized the analytic hierarchy process (APH) method to measure the weights of the physician¡¦s stress and arrange more efficacious and flexible duties accordingly. Results: This is a prospective study investigating ED overcrowding at this medical center from January 2008 through December 2009. Hospitals developed and implemented a number of best practices revolved around patient flow initiatives, specifically looking to improve input, throughput, and output. Conclusion: This study suggests that a decrease in ED overcrowding can be achieved through ongoing collaboration of the indicators and the implementation of best practices via the Input-Throughput-Output model.

¡eAbstract¡f The difference of medical diagnosis and its related effect is important to medical quality consistency and medical care cost-effectiveness. At present, the specialists including radiologists, chest medicine doctors & family medicine doctors able to perform X-ray diagnosis of foreigners¡¦ physical examination would cause the difference of flow fluency & consistency of medical quality in foreigners¡¦ physical examination. Due to the shortage of studies in discussing the difference among doctors¡¦ diagnosis in our country, the study is an experimental cross-section design that focuses on the diagnosis difference of 3595 foreigners¡¦ chest X-ray among 3 different specialists. The result of research may be useful for making policy of public health and be referent to the quality control and management in the hospital. According to the result, the X-ray diagnosis of lung TB showed no difference between specialists & hospital levels in Chi-square analysis, but the diagnosis consistency of kappa between every 2 doctors was so fluctuant among 10 doctors, the kappa value ranged from ¡V0.005 to 1.0. Besides, the consistency of kappa among either 10 doctors, 4 chest medicine doctors, 3 radiologists or 3 family medicine doctors were poor, and the kappa value ranged from 0.035 to 0.2. The highest kappa was 0.18629 among 3 family medicine doctors, while the lowest kappa was 0.038197 among 4 chest medicine doctors. The other studying result also showed low consistency of kappa among 10 doctors in X-ray diagnosis of lung abnormality, the kappa value ranged from ¡V0.009 to 0.375. Besides, the low consistency of ICC was also noted among 10 doctors in X-ray diagnosis scores of lung abnormality. ICC value ranged from ¡V0.0159 to 0.5540. The exploration of doctors¡¦ difference in X-ray diagnosis of lung was under no interference of medical payment system. If the X-ray diagnosis followed the standard of CDC, only requiring the abnormal TB, 3 specialists would show no difference in X-ray TB diagnosis. Therefore, the first line family medicine doctors who see the foreigners directly would also fit to make the diagnosis of X-ray lung TB. Moreover, due to the family medicine doctors understand the foreigners¡¦ history than other specialists, if the family medicine doctors make the diagnosis of X-ray lung TB, the overall examination procedure would be fast and better. From the article review, the consistency was low among doctors in many medical diagnoses, such as chest X-ray, cytology, CT scan, breast sono, emergent chest X-ray, KUB and skeletal X-ray. Due to the low consistency, there were researchers making effort and doing study to suggest that the doctors could elevate the consistency and reliability by continual discussion and learning. However, our country is short of study in discussing the difference among doctors. From the study result, the variation of consistency is huge. Whether it would affect the medical behavior of doctors, such as overusing the related tests or medicine having influence on patients¡¦ health and safety, further studies will be needed.

In recent years, the buccal cancer in Taiwan has been ranked the fourth among the top ten leading causes of cancer death, and the first among people at the prime age ( 25 ~ 44 years old ). Since people at the prime age are usually the main bread winners in the family and the main contributors in the economic development of the society, how to prevent the occurrences of buccal cancers or how to provide proper medical service to buccal cancer patients has become an urgent topic of the present medical industry. It is pointed out that the incidence of buccal cancers is frequently related to men¡¦s smoking, diet habit and their chewing of betel nuts. Especially in Kaohsiung-Pingtung area in southern Taiwan, the population of chewing betel nuts is much higher than that in other metropolitan cities. Thus, the incidence of buccal cancers is in vogue in this area. The aim of the present study is to discuss the key factors affecting the quality of medical treatment on buccal cancer patients under the management system of E-Da Hospital. Based on this model, we wish to further apply it to other disease treatments as well and to make E-Da Hospital become a characteristic medical center in the near future. This thesis adopts the Analytic Hierarchy Process (AHP) to exploit the multi-estimate criteria models of the medical quality. The first layer is the key factor for medical quality to buccal cancer patients at E-Da Hospital. The second evaluation criterion is divided into three aspects: namely, ¡§the hospital image of medical service¡¨, ¡§the available administrative resources¡¨, and ¡§ the convenience for patients¡¦ taking medical treatment¡¨. The third layer is the twelve evaluation characteristics. From this point of view, we can easily understand why patients choose E-Da Hospital as their priority. The interviewed participants are composed of the surgeons, the nursing staff, the administration personnel at E-Da Hospital, and the buccal cancer patients and their family members. Fifteen effective questionnaires are collected. Based on the Analytic Hierarchy Process, each subject is interviewed throughout and the result is verified by ANOVA. Based on the present study, we have found that the key factors of the management system for medical quality to buccal cancer patients at E-Da hospital are listed below in sequence---¡§the hospital image of medical service¡¨, ¡§the convenience for patients¡¦ taking medical treatment¡¨, and then ¡§the available administrative resources¡¨. Among the twelve evaluation characteristics, the critical top five ones are ¡§medical team work¡¨, ¡§medical effects¡¨, ¡§equipment novelty¡¨, ¡§home visit after operation¡¨ and ¡§ the convenience of transportation¡¨ in order. Several recommendations have been made to hopefully improve the management system and medical quality at E-Da hospital by strengthening the in-job training to the physicians and nurses and renovating medical equipment continuously. Besides, it is expected to set up buccal cancer patient club in the near future in order to achieve ¡§the Five Whole Attendance of Cares¡¨ - the whole person, the whole family, the whole team, the whole journey, and the whole community. Meanwhile, some proposals have also been made to the related health departments of the government so as to promote education on cancer prevention, to create and develop economic & effective cancer sieve checks in order to reduce the possible waste on the consumption of the medical resources and make them benecifical to the health for all. In so doing, we hope that our government can stress its long-term planning and investment on improving its medical service and enhance its medical quality thereby.

Clinicians rely heavily on accurate laboratory results to diagnose and treat their patients. Laboratory errors can occur in any area of total testing phases, but more than half of the errors occur in the preanalytical phase. Framed by the total quality management theory, the purpose of this multiple case study was to explore medical laboratory managers' strategies to reduce preanalytical errors. A purposive sample of 2 organizations with laboratories in southern California participated in semistructured face-to-face interviews. Company A had 2 participants and 3 participants participated in the study from Company B. Each participant had at least 5 years of laboratory experience, with a minimum of 2 years of management experience in preanalytical testing, and had completed one project to minimize laboratory errors. Thematic analysis exposed 5 main themes: quality improvement, recognition, reward, and empowerment, education and training, communication, and patient satisfaction. The participants highlighted the need for organizations to concentrate on quality management to achieve patient satisfaction. To achieve quality services, medical laboratory managers noted the importance of employee engagement, education and training, and communication as successful strategies to mitigate preanalytical errors. The recommendation for action is for laboratory leaders to review and apply effective strategies exposed by the data in this study to reduce preanalytical errors in their medical laboratory. Positive implications of this study include reduction of preanalytical errors, increased operational cost, and improved patient experience.

L’objet de cette thèse est de considérer les coûts et la qualité comme les doubles produits de l’organisation mise en œuvre dans la production de soins. Les soins dispensés que l’on peut mesurer par leur qualité et leurs coûts dépendent directement de cette combinatoire. De ce considérant découle la question de recherche que l’on peut formuler de la façon suivante: « les coûts ne peuvent-ils être dans certaines conditions les sentinelles de la qualité ? ».Le mot « sentinelle » a une double référence, celle donnée par le dictionnaire au sens de personne qui a la charge de faire le guet et de prévenir en cas de risque d’intrusion mais aussi celle de l’image du ganglion sentinelle, premier ganglion pouvant être touché par le cancer qu'il est donc important d'analyser pour évaluer l'extension du cancer.Par un parallélisme des formes, c’est cette image qui dit le mieux notre hypothèse. Les coûts sont la face visible de la qualité. La recherche bibliographique sur le sujet montre l’émergence de cette question dans la littérature hospitalière. Le champ d’application de la thèse concerne l’hémodialyse. La vérification empirique a été réalisée auprès d’un échantillon multicentrique.La méthode de recherche a consisté à repérer à partir de l’analyse du méta processus de prise en charge d’un patient dialysé les processus majeurs représentant 80% des coûts et à décomposer chaque processus sous la forme d’un vecteur à trois dimensions exprimé par des indicateurs de coûts, des inducteurs de qualité et des indicateurs de qualité. Les mesures des indicateurs de qualité ont été confrontées aux données des bases nationales et aux référentiels formulés par les praticiens.Des mesures réalisées tout au long du processus de prise en charge évaluent la relation Coût/Qualité.Les résultats empiriques valident l’hypothèse dans certaines limites / The purpose of this PhD dissertation is to demonstrate that costs and quality stem from the organization of healthcare production. The measured quality and costs of medical care directly depend on this. From then on, under which conditions costs are to be considered as quality sentries? « Sentry » refers both to the dictionary definition (a sentry being in charge of keeping watch and of warning in case there is an intrusion) and to a « sentinel node », which is the first ganglion that is contaminated when getting a cancer. This last image particularly fits our thesis: costs are the visible face of quality. This Phd thesis deals with haemodialysis. Empirical verification was conducted with a polycentric sample. The research methodology consists in identifying the main processes dealing with the treatment of a dialysed patient. Those processes represent 80% of the overall costs; they are decomposed into a three dimensional vector (costs indicators, quality inductors and quality indicators). The measures associated with the quality indicators are confronted with national databases and with the reference documents, which are designed by the practitioners. Measures have been implemented during the whole caring process so as to evaluate the relation costs/quality. Empirical results confirm the generic hypothesis to a certain extent.