TQM as a managerial innovation: research issues and implications.

TQM is a managerial innovation that is likely to have profound consequences on the delivery of health services. As an innovation, it is important that attention be given to the fundamental research issues associated with implementation and impact. Using a variance and process perspective, selected research issues are identified within organizations and among work units within these organizations. The variance perspective at both the organizational and work unit level considers the explanation of impact and adoption at a particular point in time. The process perspective considers the particular steps or events in the overall adoption process. The managerial implications for each perspective are discussed.

Facilities planning: opening and activation.

Making your facility work is the real objective. Getting it designed and built are only the means to this end. The authors of this article examine the transition that occurs in the later stages of construction as an institution prepares to occupy and use a new facility. Practical guidelines are presented for equipping the project, training personnel, and accomplishing the move-in.

Operant conditioning in relation to natural EMG during rapid human walking.

Interactions between specific operant conditioning and ongoing treadmill walking have been characterized in several previous investigations of mechanisms that coordinate locomotion. The present study examined a higher walking velocity in which contractile forces and, by inference, reflex behavior, might be more powerful. Two subjects walked on a motor-driven treadmill at 0.90 m/sec. As in past work, at 0.45 m/sec, a conditioning regimen constructed a test operant in the following way. With training, a green light that flashed approximately 200 msec after heel strike on every third step produced, after operant reinforcement, a 100-500 msec electromyographic burst in the rectus femoris (RF) muscle before the end of a 500 msec performance duration. Reinforcement consisted of a tone that sounded after each response and indicated success or failure. Burst durations were shorter than had been typical at a lower treadmill speed, a characteristic that could favor rapid matching of contractile patterns to more rapidly changing conditions. No evidence was gained of interference from stretch reflexes or any other ongoing inborn behavior. The resulting rapid walk was as well coordinated as that seen at lower velocity, to argue for increased emphasis on the role of learning in normal locomotion and to improve pathological walking.

A new perspective on multiinstitutional systems management.

To negotiate acceptable environmental accommodations, multiinstitutional systems undertake four types of solutions or transformations: environmental manipulations, internal process modifications, strategic modifications, and most drastically, total reconfigurations. It is helpful to examine the determining factors of these transformations and to look at which types of management use which transformations.

The policy effectiveness of health services research: a reconsideration.

It has often been asserted that health services research (HSR) has been either epiphenomenal or entirely ineffectual in influencing the formation of policy. In this examination of the HSR-policy relationship that assertion is contested; the authors conclude that there has been a relationship between HSR and policy, at least public policy. A diagrammatic framework is presented to describe the HSR-policy nexus in an attempt to facilitate an understanding of how future efforts in the conduct of HSR might be most effective.