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The use of quality improvement processes can yield major benefits to an organisation. This article looks at why some companies are failing to capitalise on this technique and suggests a phased‐approach to getting it right.

Recounts how medieval English Jewry began when Jews were invited to immigrate by William I and ended with their expulsion by Edward I in 1290. The Jewish community was important and for most of its existence it was prosperous, owing to its particular social function – being the bankers, moneylenders and financiers of the time. Concentrates on a relatively little known aspect of the medieval Jewish community: the role played by its women. Jewish women played a significant part in business, not just as the wives or widows of businessmen, but as entrepreneurs on their own account. This was in sharp contrast to the position of women in wider English society. Using contemporary documents, the article examines the scale and nature of the business activities of Jewish women in medieval England, sketches the activities of some of these female entrepreneurs, and attempts to investigate the factors which enabled them to play such a prominent role.

Asserts that, too often companies have jumped headlong into implementing a quality programme without first doing their homework, and they then wonder why the so‐called improvement effort has failed. Contends they need to go back to basics. Looks at why quality efforts have not always produced the desired results. Asserts that a successful quality improvement process requires, a willing chief executive officer; an experienced capable guide and a reward system that makes sense. Emphasizes that the key ingredient is the leader willing to take the lead in cultural change and sponsor a participative, in‐house effort to redesign the reward system and make it supportive of the new team‐based culture being created.

Suggests that, rather than being a block to quality improvement, middle managers can be a driving force in making improvement happen. Argues for a systemic improvement approach which deals with improvement issues in distinct organisational strata, which places hourly‐paid workers and managers on different teams. Makes a case for middle managers as an indispensable link between the hourly‐paid improvement teams and the rest of the organisation.

Compares the organization improvement effort in two US companies, one which partially empowered its employees and one which fully empowered them, and concludes that although positive results are possible with partial empowerment they take longer to materialize and are often different from the company’s original objectives. The full empowerment model is superior in terms of achieving overall organization objectives, and is easier and cheaper to implement. Believes that we have dug ourselves into a partial empowerment rut, thereby frustrating our improvement efforts and consequently deriving only partial benefits.

Proclaims that in recent years there has been considerable research examining the benefits of social connectedness for a variety of outcomes, such as health and general well being. Argues, while bonding capital is beneficial to the self‐interest of the individual or small group, bridging capital is what is necessary to build a collective identity as a nation. Concludes that because people have varying access, with regard to formal organizations, their ability to use social capital for their benefit, and the benefit of their communities, may be of short‐term duration.

We present a legislative background and assessment of approaches to financing the US Department of Veterans Affairs (VA) healthcare services, and focus on issues related to beneficiaries eligible for both VA and Medicare benefits. We refer to a large, VA Medical Center (VAMC) hospital and healthcare complex as a case for comparison of financing approaches. Several legislative proposals had been made to grant the VA funding transfers from Medicare. To date, none has passed in the Congress. Our analysis shows that payments from Medicare would need to be adjusted for the specialized characteristics of VAMC patients, as well as for higher capital costs related to the federal VAMC mandate to maintain reserve capacity for national health emergencies, in order to appropriately apply Medicare payments.