[Jury prize of the Austrian National Prize 2018 : 12 years European Foundation for Quality Management (EFQM) at the University Eye Clinic Graz]. / Jurypreis des Österreichischen Staatspreises 2018 : Zwölf Jahre EFQM (European Foundation for Quality Management) an der Universitäts-Augenklinik 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 1­day assessment in 2018. Special emphasis was laid on the development and presentation of the strategy by means of the X­matrix (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. RESULTS: The total points score in the recognized for excellence (R4E) assessment 2018 was 500-550 points, which prompted the jury to award a jury prize of the Austrian National Prize (focus: participative leadership). Potential for improvement, which needs to be worked on in the near future was the alignment of core processes with the main performance indicators of the University Eye Department, which arises from its mission consisting of patient care, research, teaching, training and public relations activities. The development of the strategy with the shareholders has developed from a potential to a strength compared to the R4E assessment from 2017. CONCLUSION: Feedback from the assessor team after the site visit is the greatest added value for a university eye department and/or business enterprise. Improvement measures can be effectively derived following the RADAR logic and lead to a higher quality standard/score and improved performance.

[Successful implementation of the EFQM management model at the Department of Ophthalmology in Graz]. / Erfolgreiche Umsetzung des EFQM-Management-Modells an der Universitätsaugenklinik 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. STUDY DESIGN AND METHODS: EFQM stands for European Foundation for Quality Management, an organization that was founded in 1989 by the EU, together with 14 leading enterprises. In the EFQM model, the maturity of an organization in terms of quality is determined through the achievement of a number of quality awards. The C2E award is the first of these awards. At the beginning of our work for the C2E level, the strengths and weaknesses of the Department of Ophthalmology were determined by means of an EFQM questionnaire. Three improvement measures with the highest impact on the performance of the clinic were identified by the questionnaire: 1. The hospitalization of a cataract patient. 2. The lack of information between the various professional parties. 3. The lack of knowledge within the professional groups of the objectives and strategy of the Department of Ophthalmology. RESULTS: These areas requiring improvement were targeted, addressed and improved in a 6-months project work, structured by the EFQM model. The project work as a whole, the results obtained and the corresponding written documentation were evaluated positively in a 1-day assessment by Quality Austria. DISCUSSION: The EFQM model is a challenging quality management model. After the necessary training of project members or under the supervision of experienced quality managers, the EFQM model may be successfully applied to patient care, teaching and research in a department of ophthalmology.

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. He maintains that since medical care review is mandated, it should be based on valid data obtained from the clinician involved in the patient's treatment. Thus, he suggests as a possible solution focusing on the individual clinical case.

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. Application of such cost control programs, before students form definitive conceptions of treatment, may contribute to more cost-conscious behavior in their future medical practice.

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. The phenomenon here termed "involuntary deviance" represents a way of perceiving and dealing with special students. An example, the case of children with epilepsy, is presented to illustrate the need for health educators and other educators to be familiar with such medical problems and, among their students, to help decrease the social stigma attached to some of these conditions. This need will become more urgent as the practice of mainstreaming students becomes increasingly prevalent.

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. Ancillary charges for these diseases showed even greater increases, 167, 200, and 160 per cent, respectively. Components of ancillary charges revealed similar trends. The results suggest that a twofold review mechanism incorporating length of stay and charges, using the staging technique, would make the review procedure more discriminating in identifying cases appropriate for review.

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. Degree of faculty consensus was suggested as a major determinant of the effectiveness of the socialization process in professional schools.