Schulz R I, Greenley J R, Peterson R W
Med Care. 1983 Sep;21(9):911-28. doi: 10.1097/00005650-198309000-00007.
A common objective of health services is to provide high quality care at the least cost, yet some services achieve these objectives better than others. Moreover, there are questions about relationships between cost and quality: do higher expenditures usually result in higher quality, or, conversely, is it possible to provide higher quality of care at expenditure levels that may be lower than other institutions? This paper reports on a study of 13 acute inpatient psychiatric units in which a range of quality and direct cost outcomes was found. Some units had higher quality and lower direct costs than the others. Some had higher quality and higher direct cost, some had lower direct costs and lower quality as well, while another group had lower quality and higher direct costs. Differences in costs and quality were found to be related more to management than to patient, staff, environmental, or institutional characteristics of these units. The findings of this study suggest that proactive management that focuses on organizational outcomes, that makes consequences of operation visible, and that promotes mutual coordination will achieve higher quality and efficient performance.
卫生服务的一个共同目标是以最低成本提供高质量护理，但有些服务比其他服务更能实现这些目标。此外，成本与质量之间的关系也存在一些问题：更高的支出通常会带来更高的质量吗？或者相反，是否有可能在低于其他机构的支出水平上提供更高质量的护理？本文报告了一项对13个急性住院精神科病房的研究，研究发现了一系列质量和直接成本结果。一些病房的质量高于其他病房，直接成本却更低。一些病房质量高且直接成本高，一些病房直接成本低且质量也低，而另一组病房质量低且直接成本高。研究发现，成本和质量的差异更多地与管理有关，而不是与这些病房的患者、工作人员、环境或机构特征有关。这项研究的结果表明，积极主动的管理注重组织成果，使运营结果可见，并促进相互协调，将实现更高的质量和高效的绩效。
