Clinical process improvement as a means of facilitating health care system integration

BACKGROUND

In recent years many health care providers, physicians, hospitals, and managed care organizations have undergone significant reorganization in both delivery and financing systems. This has created new organizations called integrated or organized delivery systems. Sentara Health System (Norfolk, Va), one of these new integrated entities, developed a unified strategy for clinical process improvement for the entire organization. This system-wide approach had unanticipated problems and benefits.

METHODS

The Sentara Health System created a team responsible for coordinating clinical process improvement activities across its hospitals and ambulatory physician sites. A steering committee directed this team to improve the organization and delivery of care for specific high-cost, high-volume, or problem-prone disease for physicians to manage. A standardized approach aimed at coordinating care across sites was the cornerstone of these activities.

RESULTS

Significant improvements in patient outcomes and a concomitant decrease in costs of care were accomplished for multiple diseases and procedures. These projects uncovered unanticipated barriers to implementing improvement projects in a complex health care system which make implementing these activities far more difficult than for an individual hospital with its medical staff.

CONCLUSION

Coordinating clinical improvement activities across multiple hospitals and other sites of care in a complex integrated delivery system serves important purposes in addition to improving patient care. These projects were an important cultural change agent to transform the individual components of the system into one that is capable of delivering care continuously across multiple sites. Standardization of care practices, policies, and procedures is considerably enhanced by coordinating these activities across the entire system.

Science policy advisory councils in France, the Netherlands and the United States, 1957-77: a comparative analysis

The evolution of high-level science advisory councils in France, the Netherlands and the United States is reviewed in the light of common trends in the relationship of science and government over the past twenty years The creation of the councils came as a response to similar needs of governments m the domestic and international spheres. The subsequent decline of the advisory councils in all three countries is attributable to the 'bureaucratization' of science policy-making, a slower rate of growth in R&D expenditure, a more goal-oriented approach in governments' sponsorship, changing public attitudes towards science and technology, and the intrinsic difficulties faced by the council members in acting both as scientists and as political advisors. The revitalization of the councils in the mid-1970s was similarly inspired by emerging needs and institutional developments affecting all three governments In turn, the distinctive features of each council derive from underlying differences in political organization and culture. These differences are revealed in governmental conceptions of science policy; in the role played by scientists in public affairs; and in the organization of scientific and technological interests in political decision-making.

Stimulated rotational Raman scattering from para-H(2) pumped by a CO(2) TEA laser

We have observed stimulated rotational Raman scattering (SRRS) from para-H(2) pumped by a CO(2) TEA laser operating on the strong P- and R-branch transitions of both the 9.4- and 10.6-microm bands. Small signal gain for the Stokes wave in excess of 80 dB has been obtained for TEM(00) pump powers of 8.5 MW in a multiple-pass gain cell cooled to liquid-nitrogen temperatures.