Healthcare systems engineering: an interdisciplinary approach to achieving continuous improvement.

This paper argues that a systems approach can significantly enhance healthcare improvement efforts in patient safety, service quality and healthcare cost containment. The application of systems thinking to healthcare improvement encompasses three key principles: the systems perspective of healthcare processes, structured problem solving and the closed loop of continuous system improvement. These are encapsulated in a conceptual framework of continuous system improvement, which includes a reference architecture model and an analysis and design process model.

Characteristics of smoking cessation guideline use by primary care physicians.

This study, based on a random sample mail survey of Missouri primary care physicians, identifies: (1) the extent and predictors of these physicians' awareness, agreement, adoption, and adherence to tobacco cessation guidelines; and (2) their knowledge/ beliefs about tobacco interventions. While primary care physicians play a key role in helping patients quit smoking, guidelines are not widely followed. "Reliance on respected colleagues for advice" was the one variable consistently identified as a predictor of guideline compliance.

Executive management studies: the application of real-time science in health administration education.

While sound scientific research, such as randomized controlled trials (RCTs), has produced findings leading to significant gains in healthcare, real-time science learning gives administrators and providers a way of responding to immediate need and rapid change while improving performance and the quality of care delivered. Real-time science learning is a cycle of team reflection on and exchange of theory and practical knowledge that produces many benefits for the individual, the organization, and the healthcare field. By questioning principles and analyzing information, teams generate recommendations for organizational improvement as well as develop their individual abilities to address other unforeseen demands in differentcontexts.

Guideline attribute and implementation preferences among physicians in multiple health systems.

Objectives: Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments.

Subjects And Methods: Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma.

Physicians' perceptions of institutional and leadership factors influencing their job satisfaction at one academic medical center.

Purpose: Academic physicians' perceptions about their institution's function and leadership should provide insights toward improving faculty recruitment and retention.

Method: The authors surveyed 105 non-management and non-emeritus physicians who had been hired by (57%) or left (43%) the University of Missouri-Columbia School of Medicine (MUHC) in 1991-1998. The questionnaire measured both the importance and the availability of 14 institutional and leadership factors and the physicians' perceptions of satisfaction with their careers.

Health care system and insurer support for smoking cessation guideline implementation.

Physician use of clinical practice guidelines (CPGs) is disappointingly low in the United States. Much emphasis historically has been placed on the individual clinician to implement use of guidelines in practice. Recently, the Public Health Service issued an updated set of smoking cessation guidelines that include recommendations not only for patients and physicians, but also for health care administrators, insurers, and purchasers.