[Jury prize of the Austrian National Prize 2018 : 12 years European Foundation for Quality Management (EFQM) at the University Eye Clinic Graz].

Background: The European Foundation for Quality Management (EFQM) approach has been successfully implemented in healthcare but reports about EFQM awards at university clinics are lacking so far. Can a non-profit organization, such as a university eye department successfully compete with profit companies from industry for the National Prize of the Federal Ministry for Innovation and Business in Austria?

Material And Methods: Following successful committed to excellence (C2E) assessments in 2008 and 2010, a 70-page corporate report was compiled strictly according to the EFQM logic (latest version 2013), consisting of basic concepts, criteria matrix and results/approach/deployment/assessment and refinement (RADAR) logic, which formed the basis for an 1‑day assessment in 2018. Special emphasis was laid on the development and presentation of the strategy by means of the X‑matrix (according to Hoshin-Kanri) between the University Eye Department and its shareholders, the Styrian Hospital Association (KAGes) owned by the Federal State of Styria and the Medical University financed by the Austrian State Federal Ministry.

[Qualitative analysis of lean management in healthcare: perspectives of Austrian and Swiss experts].

Rationale, Aims And Objectives: The hospital sector is under considerable pressure to change. On the one hand, demographic change plays an important role and, on the other hand, the rapid development of medicine and nursing care can be attributed to the pressure to change. The Lean Management concept, which originated in the automotive sector, represents a successful management method for meeting these growing challenges.

[Successful implementation of the EFQM management model at the Department of Ophthalmology in Graz].

Background And Objective: In the context of legal requirements and scarcer resources, the implementation of a quality management (QM) model will provide a competitive advantage or a site warranty for a hospital. For 3 years, the Department of Ophthalmology in Graz has been working with the EFQM model and has now accomplished the first level quality award, namely "Committed to Excellence (C2E)". The project work towards achieving this C2E-award is described below.

Misguided surveillance: physicians' roles in medical care assessment. Part II.

In his article last month, Mr. Gliebe showed that no consensus has been reached on what the indicators of quality of medical care are actually measuring. In this article, he emphasizes that judgments of overuse or misuse of ancillary services and laboratory tests cannot be made without first judging quality of care, yet quality measurement capabilities are minimal.

Misguided surveillance: public actions and medical care assessment.

The public has accused physicians of overusing or misusing ancillary services and clinical laboratory tests, and government agencies have been entrusted to help eliminate performance of these so-called unnecessary services. Here, the author documents the confused and contrary evidence that became the basis of established public policies toward monitoring physician performance or behavior. In next month's issue, the author will examine physicians' roles in medical care assessment.

The way we Teach… Cost Containment.

With the spiralling cost of medical care in industrialized nations, it is vital that physicians should be aware of the cost of the care they provide. Students, it is suggested, should be made aware of cost considerations before forming definitive conceptions of 'appropriate' medical behaviours. This article describes the cost containment curriculum currently operating at the Medical School of Ohio.

Student peer review of diagnostic tests at the Medical College of Ohio.

Students in their clinical clerkship performed retrospective reviews of their peers' laboratory usage patterns. Data covering the patient's history and physical examination, problem list, and treatment plan had been completed by students during internal medicine and pediatrics rotations. This information, along with the first day's diagnostic orders, was provided to community medicine clerkship students who then evaluated the cost and medical necessity of diagnostic tests ordered in light of the problem information.

Involuntary deviance: schooling and epileptic children.

There exists in schools an unwritten set of presuppositions defining "normalcy." Students going beyond these boundaries of normalcy are encouraged (sometimes punitively) to change their behaviors. However, there is a growing awareness that not all children going beyond normalcy do so willingly.

Diagnostic testing as a cost factor in teaching hospitals.

The interpretation of laboratory tests by resident physicians is an integral part of the process of medical education. Therefore, the resident's awareness of the validity, reliability, and usefulness of laboratory tests and their alternatives, coupled with an analytical dialog between the supervising attending physician and the resident can help limit the ordering of diagnostic tests to what is logically and scientifically appropriate. Such a dialog may partially address the issue of teaching cost-effectiveness within the graduate medical education curriculum.

Diagnostic testing as a cost factor in teaching institutions.

Clinical data are analyzed to examine the degree of reliance residents in training place on diagnostic tests and procedures in patient management and the extent of educational costs incurred for patient care in a teaching hospital. To help limit the ordering of diagnostic tests, resident trainees need to be kept aware of the validity, reliability, and diagnostic utility of specific laboratory tests in certain clinical situations.

Evaluating inpatient costs: the staging mechanism.

Inpatient records at a short-term hospital over two years were analyzed according to the stage or degree of severity of their discharge diagnosis to examine their utilization of services. Patients with a more severe disease stage for surgical and medical conditions generated substantially higher total charges, ancillary charges, and had longer lengths of stay. At the 75th percentile (representing that value at which three-quarters of the cases fall below it in magnitude), increases in total charges from Stage I to II for ulcer of stomach, appendicitis, and diverticulitis were 103, 168, and 110 per cent, respectively.

Faculty consensus as a socializing agent in professional education.

To assess the effectiveness of the professional socialization process in a professional school, this study focused on emerging attitueds of nursing students, perceived limits of their role, nursing autonomy, and rights of patients. Student attitudes were compared to attitudes of instructors to determine if socialization was taking place. Consensus among student attitudes was found to increase during the educational program, and attitudes of nursing students did approach those of their instructors.