RESUMEN
BACKGROUND: Health care has a number of historical barriers to capturing the voice of the customer and to incorporating customer wants into health care services, whether the customer is a patient, an insurer, or a community. Quality function deployment (QFD) is a set of tools and practices that can help overcome these barriers to form a process for the planning and design or redesign of products and services. The goal of the project was to increase referral volume and to improve a rehabilitation hospital's capacity to provide comprehensive medical and/or legal evaluations for people with complex and catastrophic injuries or illnesses. HIGH-LEVEL VIEW OF QFD AS A PROCESS: The steps in QFD are as follows: capture of the voice of the customer, quality deployment, functions deployment, failure mode deployment, new process deployment, and task deployment. The output of each step becomes the input to a matrix tool or table of the next step of the process. CASE STUDY EXAMPLE: In 3 1/2 months a nine-person project team at Continental Rehabilitation Hospital (San Diego) used QFD tools to capture the voice of the customer, use these data as the basis for a questionnaire on important qualities of service from the customer's perspective, obtain competitive data on how the organization was perceived to be meeting the demanded qualities, identify measurable dimensions and targets of these qualities, and incorporate the functions and tasks into the delivery of service which are necessary to meet the demanded qualities. DISCUSSION: The future of providing health care services will belong to organizations that can adapt to a rapidly changing environment and to demands for new products and services that are produced and delivered in new ways.
Asunto(s)
Satisfacción del Paciente , Atención Dirigida al Paciente/organización & administración , Centros de Rehabilitación/normas , Gestión de la Calidad Total/métodos , Arizona , California , Competencia Económica , Predicción , Hospitales con 100 a 299 Camas , Humanos , Evaluación de Necesidades/organización & administración , Nevada , Estudios de Casos Organizacionales , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Defensa del Paciente , Derivación y Consulta/organización & administración , Centros de Rehabilitación/organización & administración , Encuestas y CuestionariosRESUMEN
Underwater swimming has unique features of breathing apparatus (SCUBA), thermal protective gear, and fins. The energy cost of underwater swimming is determined by the drag while swimming and the net mechanical efficiency. These are influenced by the cross-sectional area of the diver and gear and the frequency of the leg kick. The speeds that divers can achieve are relatively low, thus the VO(2) increases linearly with values of VO(2)*d(-1) of 30-50 l*km(-1)for women and men, respectively. Diving experience had little effect on VO(2) for women; however, male divers with experience had lower VO(2) than beginners. The location and density of the gear can alter the diver's attitude in the water and increase the energy cost of swimming by 30 percent at slow speeds. The type of fin used has an effect on the depth and frequency of the kick, thus on drag and efficiency, with a range of VO(2) from 25 to 50 l*km(-1). A large flexible fin had the lowest energy cost and a large rigid fin the highest. Adding extra air tanks or a dry suit increased the cost of swimming by 25 percent. The energy cost of underwater swimming is influenced by gender, gear and its placement, fin type, and experience of the diver.
Asunto(s)
Buceo/fisiología , Consumo de Oxígeno , Natación/fisiología , Equipos y Suministros , Femenino , Humanos , MasculinoRESUMEN
In summary, previous attempts to explain the role of inheritance in autoimmune disorders through family studies have been hampered by the variable degree of phenotypic expression. Our evidence utilizing dogs in family studies is consistent with the concept that genetic factors play some role in determining disease susceptibility. Recognizing the complexity of the genetic components involved in these studies, we have proposed a hypothesis of two classes of genes, one that relates to immunoregulation and another that specifies pathologic lesions (and thus the clinical signs). This dual system of interacting genes provides a rational explanation for many of the observations previously encountered in both human and canine studies.