This is a book that addresses some of quality issues in healthcare delivery. It emerges as a result of a conference, the Fourth International Conference on Strategic Issues in Health Care Management held in 2000. It has 16 chapters, divided into five main sections – healthcare system, quality improvement, variations, user involvement and patient's choice. Given the different quality issues and setting, a brief review of each chapter is given below:
Chapter 1. A brief description/background on three generic models of integrated health services/delivery systems in US since 1980 and prescribed five lessons learnt in order to develop an effective system.
Chapter 2. A theoretical argument about improving healthcare efficiency and responsiveness through innovation and creation of new technologies. The author presents a model of process innovation to support the development of wholesale service technologies/clinical care technologies.
Chapter 3. This chapter compares the strategies employed in the USA and UK in changing doctors’ behaviour and practice variation in primary health care. The policies of the US‐managed care organisations were briefly discussed while in the UK, the author talks about clinical governance's strategies and the problems impeding change.
Chapter 4. This chapter is titled as “Health reforms and quality of care: lessons learnt from Ghana and Central America”. Most of this chapter is about “quality assurance” – “what is” and “what kind of QA policy ensures good quality of care”, “Universal QA package?” and “how to put in practice”. The authors barely discussed the QA strategies in Ghana and Central America.
Chapter 5. This chapter documents the process and findings of a pilot study to set key performance indicators in the mental healthcare sector in St Andrew's Group of Hospitals. Using the Kaplan and Norton's balanced scorecard framework, key performance indicators were illicited from clinical and non‐clinical staff, and stakeholders, namely the purchasers, and referrers. The author also outlines the lessons learnt and difficulties encountered in the process of the identifying the key performance indicators.
Chapter 6. An interesting chapter describing in detail the processes of bed management systems at three NHS trusts, i.e. the Liverpool's University Hospital Aintree Trust, Salford Royal Hospitals NHS Trust and South Manchester University Hospitals Trust. The bed management systems in the latter two Trusts were benchmarked against those in the Aintree Trust. Process flowchart detailing the patient journey from start to admission, placement and stay, were provided. The authors found many variations within the processes of the four flowcharts among the three Trusts and could not deduce what is the best practice.
Chapter 7. A chapter seeking possible lessons for the UK by examining the legislation and regulation in the USA that aimed to improve quality of care for the elderly and the nursing home environment. Much needs to be done at policy level to improve the quality of care in the nursing homes in the UK.
Chapter 8. The author describes the various approaches used to promote quality improvement in health care over the past two decades in the UK – regulatory oversight, professional self‐regulation, project‐based quality improvement, continuous quality improvement/total quality management, performance measurement and management, public release of performance data, evidence‐based practice, individual and organisational learning, change management strategies, and market‐based strategies. Some of the major changes owing to these diverse strategies are listed and the author argues for “the need for more joined up thinking about quality improvement that seeks to exploit the favourable factors within each of the various strategies..... to provide coherent, interlocking, mutually reinforcing strategies – not magic bullets working in isolation”.
Chapter 9. This chapter reports the findings of a study in Dundee, Scotland, aiming to establish whether variation in emergency medical admission is determined by the quality of primary care offered by general practitioners. At population level, doctor factors are unlikely to have a significant impact on emergency medical admissions. Variations between general practices’ emergency admission rates is determined by patient factors (age and deprivation).
Chapter 10. A critical review of literature to look for lessons learnt on variations in general practitioner referral rates. Four categories of explanation were discussed, pertaining to the characteristics of patient, practice, GP and access to specialist care. The “appropriateness” of variation is also discussed.
Chapter 11. This chapter reviews the history of the diclosure in the US, evaluates the use and impact of published data and suggests ways that other countries could learn from the US experience.
Chapter 12. This chapter is about performance measurement systems and findings of an empirical study on “soft” and “hard” information used in assessing hospital performance. The implications arising from the theoretical review and study were also discussed.
Chapter 13. The findings of a study to examine what older people (> 75 years) expect of health and social care in the community – what do they consider to be the most important outcomes of care for overall quality of life and their views compared with those of professional carers.
Chapter 14.This chapter reports the views and preferences of lesbian and gay consumers of healthcare services.
Chapter 15. This chapter is about the health care policy and development of the Moari people in New Zealand.
Chapter 16. This final chapter of the book documents the alternative models of maternity care in the UK and the barriers to change.
To conclude, this book is suitable for readers from different backgrounds who are interested in specific areas of quality of services and care. The book provides some excellent sources of information and lessons learnt, particularly those of the empirical studies. For one, chapter 5 includes an additional dimension, those of the stakeholders (purchasers and referrers) in deriving a mental health unit key performance indicators, which is often ignored in this type of activity. Chapter 6 provides an in‐depth discussion and refreshing account of three bed management systems in three different hospitals. Some of the chapters provide readers with a historical background of the healthcare delivery in the UK. For example, chapter 8 provides a background to the various quality improvement policies and approaches of the UK government and this is useful for students or readers who want an overview of quality improvement initiatives for the last two decades. Those who want to know more about the different types of maternity care models and evidence of their effectiveness in the UK can refer to chapter 16. Four of the chapters offer lessons learnt from America.
This book also addresses the views of the minority groups which are often neglected at the policy, implementation and health delivery levels. In the UK, views of the elderly people are discussed in chapter 13, while the subject in chapter 14 is the gay and lesbian consumer group. Outside of the UK, the healthcare policy that marginalised the Moari people of New Zealand is also discussed in chapter 15 and chapter 4 briefly discussed the quality assurance initiatives in both Ghana and Central America.
