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APS Bulletin • Volume 8, Number 2, 1998

Resource Reviews

John D. Loeser, MD, Department Editor

Quality Care

Reviewed by John D. Loeser, MD

M. Caroselli, St. Lucie Press, Boca Raton, FL, 1997, 289 pages, $39.95 (hardcover), ISBN 1-57444-043-8

This book consists of 11 vignettes that demonstrate quality care issues and their solutions with a concluding chapter that summarizes the critical points. The examples have been taken from a wide array of medical settings to indicate how institutions, large and small, attempt to solve problems related to internal quality issues and customer satisfaction.

The writing is lucid and enthusiastic. What is missing, of course, is documented quality control of the proposed quality controls. All of the examples cited in this book are said to have brought about the desired results. We do not read about any failed attempts to improve organizational activities. The costs of these activities to an institution are not documented. When the highly paid outside consultant delivers his or her advice and then moves on to the next institution, there is no one to say, "These recommendations did not achieve the desired results."

What are the options to improve personal efforts and organizational outcomes? How does one select from the many sources of advice those strategies that will work in one's own organization? Quoting the guru does not alleviate my doubts. All prophets are false, I fear.

On the other hand, large, impersonal healthcare organizations, impaired by the allocation of resources to managers who do not understand the fundamental bases of health care, frequently engage in poorly controlled and ineffective personnel strategies and substandard delivery of health care. Many important topics are addressed in this book, and those responsible for organizing and planning healthcare delivery should be cognizant of the problems that the author has addressed. It surely would be nice to apply the principles of outcomes-based medicine to quality control programs!

John Loeser is a professor of neurological surgery and anesthesiology at the University of Washington in Seattle.

Reviewer content represents the opinion of the reviewer, not APS.

Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu

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