Lessons learned from an early attempt to implement CQI principles in a regulatory system

This article describes the Quality Assurance Project (1978-1982), which was developed as a demonstration project by a Wisconsin research team and was intended to implement and evaluate new methods for carrying out the regulatory roles of facility and resident assessment in Wisconsin nursing homes. The new method included (1) a screening process to distribute efforts between sanctioning and process improvement, (2) role changes that would move surveyors beyond problem identification toward education and consultation, and (3) a resident review process based on efforts to find systems-level problems. For the first three years of the project (reported here) certain principles were followed, many of which were similar to those of continuous quality improvement (CQI). Although this is an imperfect example of CQI implementation in a regulatory organization, it contains important lessons that may be helpful in integrating the CQI philosophy into other external review efforts.

[Analysis of the place of regulation of C-11 transmitters at the Tele-electronic Works "Telkom-Telfa" in Bydgoszcz from the point of view of visual hygiene]

The authors performed a detailed analysis of 100 positions of regulation of the C-11 transmitters in the "Telcom-Telfa" ++Tele-electronic Works in Bydgoszcz. It was determined that the requirements for the condition of the eyes and the lighting at this workstand are considerable. Conclusions and recommendations tending to improvement of the working conditions are drawn up. Proposed is eventual rationale leading to the reduction of the eyestrain and facilitation of the work.

State regulations governing infection control issues in long-term care

OBJECTIVE

To examine states' regulations governing infections and infection control in long-term-care institutions.

DESIGN

Collection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid.

MAIN OUTCOME MEASURES

Rules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)-infected patients, and (6) infection control were compared.

RESULTS

There were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge.

CONCLUSION

Uniform federal standards for long-term care would probably provide a better and more economical way to ensure quality of care in these institutions.

The emerging healthcare environmental manager

The following speech was delivered in November 1991 by Dr. Lerner at the New England American Society for Healthcare Environmental Services [ASHES] regional conference. It concerns issues vital to the management of environmental and occupational health and safety in healthcare facilities and should be read by hazardous materials managers and hospital CEOs alike.

[Hygienic evaluation of the capacity of preschool institutions in relation to planning and equipment of group facilities]

The area of the group premises in child preschool centers (50 m2) with the existing number of children in a group (25) does not provide hygienic conditions for the organization of regime requirements. Physiological studies of the functional status of children, ergonomic calculations and pedagogical observations made it possible to recommend that the number of preschool groups should be decreased down to 20 children.

OSHA: new player in the battle against AIDS

The Federal agency's far-reaching proposed standard on preventing exposure to HIV and HBV infection in the workplace will probably become final by next year. What prompted the standard and what does it call for?

Incarcerated adolescents. The need for the development of professional ethical standards for institutional health care providers

Large numbers of children are incarcerated in juvenile correctional facilities each year in the United States. These children suffer from a wide range of physical and psychiatric illnesses and are in critical need of professional health care services. This article summarizes the health care needs of these children and documents the ethical problems faced by health care professionals who work in juvenile institutions. The adequacy of current ethical standards as a source of guidance and support for institutional health care professionals is reviewed and a series of recommendations for the development of comprehensive health care standards is set forth.