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  1. Health care practitioners are increasingly expected to demonstrate that they deliver high-quality, high-value care.

  2. Quality improvement in health care traces its roots to industrial safety improvement.

  3. The use of systematic, well-specified methods to define and address problems, first described in industry, is applicable to quality improvement in health care.

  4. Multiple methodologies are used to undertake quality improvement projects in health care. Three commonly used methodologies are FOCUS-PDSA (Find, Organize, Clarify, Understand, Select, Plan, Do, Study, and Act), Six Sigma, and Lean.

  5. Quality improvement methodologies all have analogous steps: problem definition, measurement, analysis, implementation, and controlling the process in question.

  6. Human factors engineering, important in quality improvement, includes physical ergonomics, cognitive ergonomics, and organizational ergonomics.

  7. There are parallels between quality improvement operations and research. Researchers use many of the same strategies as people conducting quality improvement work, and researchers’ expertise can be leveraged in problem definition, measurement, analysis, and implementation phases of quality improvement projects.

  8. The distinction between quality improvement operations and research is sometimes unclear. People conducting quality improvement work should consider consultation with their institutional review board to determine whether a proposed quality improvement project might be considered research.


Since the publication of the Institute of Medicine monograph To Err Is Human in 2000, there has been a dramatic increase in the public’s concern about the quality of patient care and the extent of errors that occur during the provision of that care.1 Further, this enlightened concept of quality includes ensuring that the care is both beneficial and cost-effective. Increased scrutiny of health care quality has placed unprecedented demands on all health care providers to demonstrate the safety and value of the care they deliver.

Until recently, the autonomy of the individual practitioner to provide care in a manner in which the practitioner deemed best was paramount. In the hospital setting, the quality of care was ensured by preemployment credentialing with nonrigorous periodic renewal and supplemented by episodic case conferences; the primary reliance for quality rested in the individual professionalism of each practitioner. This approach no longer suffices. Practice groups, regardless of specialty, are being asked to identify potential sources of error both within their practices and across the entire health care system. Currently, hospital chief executives and medical officers expect that groups will establish procedures and protocols to minimize risk and to collaborate with other professional groups within a health system to achieve coordinated care. For example, it is expected that anesthesiologists will collaborate with surgeons and nurses to cross-check and confirm correctness at certain critical points in a patient’s care (eg, time-out before incision or checking transplant organ compatibility). As part of the continued support of collaborative, high-quality, cost-effective care, they are expected to document the approaches used to evaluate and improve the quality and safety of the care provided.

These concerns about patient safety are driven at many ...

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