Penchansky R, Macnee C L
Department of Health Services Management and Policy, University School of Public Health, University of Michigan, Ann Arbor 48109-2029.
QRB Qual Rev Bull. 1993 Jun;19(6):182-9. doi: 10.1016/s0097-5990(16)30614-5.
A new conceptualization of the related activities QA, RM, and UR may allow an organization to ensure appropriate, proficient, and satisfactory care and to ameliorate the consequences of bad outcomes. Three processes incorporated into the conceptualization are essential to ensuring excellence, as are specific attributes of the care process. The difference in initiation of activities (reactive versus proactive) is part of the model; relationships among the essential activities and processes and between reactive and proactive activities are suggested; and viewing data sources or collection as separate from the processes and activities is suggested. Areas for development and research within the conceptualization that are inadequately understood include data sources and analysis methods useful for the processes needed, evaluation of the consequences of different reactive activities, and the usefulness of TQI activities for setting goals or standards and for changing behavior. Implementing such an approach to ensuring excellence would be a challenge. It is hoped that this formulation will assist in communication among those working to ensure excellence; promote analysis of whether current organizational structures for ensuring excellence and for cost containment are creating redundance, competition, or gaps in needed activities; broaden the perception of the possible and/or appropriate scope of some activities, such as the inclusion of proactive preventive care and the provision of special high-risk programs; and assist in the identification of areas of needed research and development.
对相关活动质量保证（QA）、风险管理（RM）和利用审查（UR）的一种新的概念化理解，可能使一个组织确保提供恰当、专业且令人满意的护理，并改善不良结果的后果。纳入该概念化理解的三个过程对于确保卓越至关重要，护理过程的特定属性也是如此。活动启动方式的差异（反应性与主动性）是该模型的一部分；提出了基本活动与过程之间以及反应性与主动性活动之间的关系；并建议将数据源或数据收集与过程和活动分开看待。在该概念化理解中尚未得到充分认识的有待发展和研究的领域包括对所需过程有用的数据源和分析方法、对不同反应性活动后果的评估，以及全面质量管理（TQI）活动在设定目标或标准以及改变行为方面的有用性。实施这样一种确保卓越的方法将是一项挑战。希望这一构想将有助于致力于确保卓越的人员之间的沟通；促进对当前确保卓越和控制成本的组织结构是否在所需活动中造成冗余、竞争或差距的分析；拓宽对某些活动可能和/或适当范围的认识，例如纳入主动预防性护理和提供特殊的高风险项目；并协助确定需要进行研发的领域。
