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Volume 56, Number 6
November/December 2011

  • INTERVIEW
    Interview with Sandra Bruce, FACHE, President and CEO, Resurrection Health Care and Provena Health
    Stephen J. O'Connor
  • TRENDS
    Innovation or Stagnation? Crossing the Creativity Gap in Healthcare
    Ian R. Lazarus and Daniel Fell

  • REFORM
    End-of-Life Care: The Time for a Meaningful Discussion is Now
    William D. Petasnick
  • ARTICLES
    Leading for Quality in Healthcare: Development and Validation of a Competency Model
    Andrew Garman and Linda Scribner
    A Roadmap for Improving Healthcare Service Quality
    Denise M. Kennedy, Richard J. Caselli, and Leonard L. Berry
    Language Services in Hospitals: Discordance in Availability and Staff Use
    Brette A. Tschurtz, Richard G. Koss, Nancy J. Kupka, and Scott C. Williams

Executive Summary
Leading for Quality in Healthcare: Development and Validation of a Competency Model
Andrew Garman and Linda Scribner

Increased attention to healthcare quality and impending changes due to health reform are calling for healthcare leaders at all levels to strengthen their skills in leading quality improvement initiatives. To address this need, the National Association for Healthcare Quality spearheaded the development and validation of a competency model to support healthcare leaders in assessing their strengths and planning appropriate steps for development. Initial development took place over the course of several days of meetings by an advisory panel of quality professionals. The draft model was then validated via electronic survey of a national sample of 883 quality professionals. Follow-up analyses indicated that the model was content valid for each of the target samples and also distinguished differing levels of job scope and experience. The resulting model contains six domains spanning three organizational levels.

Executive Summary
A Roadmap for Improving Healthcare Service Quality
Denise M. Kennedy, Richard J. Caselli, and Leonard L. Berr

A data-driven, comprehensive model for improving service and creating longterm value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

Executive Summary
Language Services in Hospitals: Discordance in Availability and Staff Use
Brette A. Tschurtz, Richard G. Koss, Nancy J. Kupka, and Scott C. Williams

Despite efforts to advance effective patient–provider communication, many patients' language needs continue to be unmet or inappropriately addressed by healthcare providers (Wielawski 2010; Patek et al. 2009; Wilson-Stronks and Galvez 2007). This study presents a picture of the language resources currently provided by hospitals and those resources practitioners actually use. Questionnaire data were collected from 14 hospitals in Florida's Palm Beach, St. Lucie, and Martin counties on availability, staff awareness, and staff use of linguistic resources and services. Inconsistencies were identified between the language tools, services, and resources hospitals provide and those staff use. In addition, a large majority of staff respondents still rely upon someone accompanying the patient for communication with patients who have limited English proficiency, despite evidence that this practice contributes to miscommunication and serious medical errors (Flores et al. 2003; Flores 2005; HHS OMH 2001; Patek et al. 2009). Hospitals that use bilingual staff as interpreters often do not test the competency of these staff, nor do they assess the utilization or effectiveness of the tools and resources they provide. Hospitals can improve the cultural and linguistic care they provide if they (1) address the practice of using ad hoc interpreters, (2) effectively disseminate information to hospital staff regarding how and when to access available resources, and (3) collect patient population data and use it to plan for and evaluate the language services they provide to their patients.