Objectives: Industrial management principles could be used to improve the quality and efficiency of health care. In this study, we have evaluated the effects of a process management approach to trauma patient care. The major objective was to reduce the waiting times and increase the efficiency of the hospital.

Methods: Urgent surgery care was analyzed as an overall process. The process development followed the Plan-Do-Check-Act (PDCA) cycle and was based on statistical analysis of certain performance metrics. Data were collected from hospital databases and by personnel interviews. To develop the process, the anesthesia induction was performed outside the operating room, better process guidance was developed, and patient flow was reorganized. The transition time for these changes was 1 year (2002 to 2003).

Results: Waiting times decreased by 20.5 percent (p<.05), nonoperative times in the operating room were reduced by 23.1 percent (p<.001), and efficiency was increased by 9.7 percent (p<.001) after reengineering of the care process. Overtime hours decreased by 30.9 percent.

Conclusions: Managing urgent surgical care as a process can improve the productivity and quality of care without a need to increase personnel resources. The focus should be on reducing waiting times and waste times.

Health care systems throughout the world are faced with continuously rising health care expenditure. In Germany, a fee per capita system will be introduced by 2003 to keep the budgets for hospital care within limits. As a result, numbers of hospital beds and hospitals will be cut in the coming years. On the other hand, more and more patients and health care providers are asking if they are really receiving an adequate value for their money in the treatment they receive. All this will have a strong impact on the anaesthesiologist's work and her/his perception of the different facets of quality.

Quality has various aspects for the anaesthesiologist. The patient as a customer should not incur any detrimental effects after a surgical procedure, and is accompanied by the anaesthesiologist throughout the perioperative setting. The surgeon needs optimal conditions to perform a procedure. The hospital must balance equally costs and income; this requires optimal operating room utilization. Finally, health insurance companies and the government are responsible for covering the cost of treatment according to the quality of the care delivered.

Quality assessment concerning structure, process and outcome has to take these demands into account. Continuous quality improvement in the spirit of Deming's ‘plan-do-check-act cycle’ has to be part of anaesthesiologist's everyday routine. In future, the traditional barriers between the specialities treating a patient will be disrupted when reimbursement for treatment is made according to quality and efficacy of treatment.

Motivational interviewing is a client centred behavioural therapy for addictive behaviours. It is an intervention designed to help all addicts, not just those ready to change. It is therefore suitable for use as an opportunistic intervention for clients whose main reason for contact may not be their addiction. A pilot randomized controlled trial of home-based motivational interviewing by a specially trained midwife to help pregnant smokers reduce their habit was performed in Glasgow from February 1997 to January 1998. Did motivational interviewing take place? All 171 counselling interviews from 48 intervention clients were audio-taped. Forty-nine interviews from 13 randomly selected clients were transcribed for content analysis. A rating scale established for feedback to trainee psychologists was used by three experienced analysts. Thirty-two interviews were scored independently to validate the rating scale in this setting. More than 75% of interviews showed satisfactory motivational interviewing. Therapist utterances were motivational, and client responses included many self-motivational statements. Few episodes of client resistance were recorded. Rating took 160 mins per half hour interview. This instrument provided a valid measure of intervention quality for a randomized controlled trial. It would not be practical to document process outside a research environment.