Quality-adjusted life-years and other health indices: a comparative analysis.

This article provides a descriptive overview of both unadjusted and adjusted health indices that are being applied in the current health-services research literature. We describe, give examples, and discuss a variety of the better-known health indices. Summary tables that compare health indices across dimensions, such as level of analysis, weighting methodology, preference measurement, and longevity measurement, are also included. Our goal is to provide information about similarities among and differences between health indices and enhance understanding of comparative health-outcome measurement. An extensive list of references is included to guide the reader toward additional discussions of metrics and methodologies. Given the multitude of health indices reported in the literature, this descriptive and comparative overview provides a framework for understanding these metrics in the context of health-outcomes research.

Reengineering the work of caregivers: role redefinition, team structures, and organizational redesign.

Health care organizations are implementing new patient care delivery models with the expectation that operations reengineering will bring dramatic improvements in cost, quality, and patient satisfaction. Together with the fundamental redefinition of caregivers' work roles, the adoption of reengineering principles features the organization of work activities around team structures such that teams are considered the basic unit of work performance. This article draws from reengineering case studies to consider how hospitals are operationalizing team care concepts at the patient care unit level. Using a classification of caregiver work that distinguishes care production and care management tasks, evolving care team models are discussed through a conceptual framework that defines a continuum of team delivery strategies. The team models are illustrated by brief case examples.

The effective use of patient satisfaction data.

Demonstrating the importance of patient satisfaction as a measure of health services quality, health care organizations are increasingly investing in information systems for the collection and manipulation of patient satisfaction data. Unfortunately, these information resources are often squandered as a variety of methodological, organizational, and psychological obstacles work to prohibit the productive use of patient satisfaction data. This article discusses the challenges that health care managers and clinicians face in effectively using patient satisfaction data and identifies statistical, operations management, and managerial-specific skills that these individuals should possess to use satisfaction data successfully.

Service recovery in health services organizations.

Service recovery is defined as that part of quality management designed to alter the negative perceptions of dissatisfied consumers and to ultimately maintain a business relationship with these consumers. This article explores the theoretical and operational implications of service recovery in health services organizations. A framework that defines the range of possible service recovery actions is presented. Next, the benefits of and obstacles to service recovery in health services firms are discussed, and solutions for overcoming these obstacles are presented. Finally, the critical components of an effective service recovery program are described, and an agenda for empirical research on the efficacy of service recovery activities is proposed.