With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plan-do-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored.
With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plando-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored.Mayo Clin Proc. 2007;82(6):735-739 CQI = continuous quality improvement; DPMO = defects per million opportunities; PDSA = plan-do-study-act; QI = quality improvement; TPS = Toyota Production System; VSM = value stream mapping I n the past 2 decades, innumerable advances have occurred in medicine and technology. However, the health care system continues to perform far below acceptable levels in the areas of ensuring patient safety and addressing patient needs.1 The publication To Err is Human from the Institute of Medicine galvanized health care system response and public demand for change when the US population learned that medical errors cause 44,000 to 98,000 deaths annually. 2 The abyss between what physicians know should be done for patients and what is actually done accounts for more than $9 billion per year in lost productivity and nearly $2 billion per year in hospital costs. 3 Despite our complex medical environment, physicians rely primarily on paper tools, memory, and hard work to improve the care given to patients. However, creation of reliable and sustained improvement in health care is difficult with use of traditional methods. Improvement often requires deliberate redesign of processes based on knowledge of human factors (how people interact with products and processes) and tools known to assist improvement. The clear ethical imperative to enhance the quality and safety of care and meet external accreditation requirements and consumer expectations requires physicians to address qualityof-care issues systematically. 4,5The goals of this review are to provide clinicians with sufficient information to understand the basics of quality improvement (QI), highlight the basics of major improvement methodologies, provide a starting point for improvement projects, and stimulate further inquiry into QI methodologies currently being used in health care. DEFINING AND APPLYING THE CONCEPTS OF QUALITYThe US Agency for Healthcare Research and Quality defines quality health care as "doing the right thing, at the right time, in the right way, for the right person-and having the best possible results." 6 Quality was first studied as an industrial process in 1931 by Shewhart.7 Shewhart's concepts include identifying customer needs, reducing ...
Seven learners, including 2 preventive medicine fellows, 2 family medicine residents, 1 internal medicine resident, and 2 master's-level nursing students participated in an experiential 4-week quality improvement rotation at a major academic medical center. Together they worked on a quality improvement project that resulted in enhanced medication reconciliation in a preventive medicine clinic. Learner knowledge measured on the QI Knowledge Application Tool increased from an average of 2.33 before the start of the rotation to 3.43 (P = .043) by the end of the rotation. At the conclusion, all learners said they were confident or very confident that they could make a change to improve health care in a local setting. Although this pilot supports the feasibility and potential benefits of interdisciplinary quality improvement education, further research is necessary to explore strategies to implement the same on a larger scale, and to examine the impact on patient outcomes.
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