The Ongoing Quality Improvement Journey

Next Stop, High Reliability

Quality improvement in health care has a long history that includes such epic figures as Ignaz Semmelweis, the 19th-century obstetrician who introduced hand washing to medical care, and Florence Nightingale, the English nurse who determined that poor living conditions were a leading cause of the deaths of soldiers at army hospitals. Systematic and sustained improvement in clinical quality in particular has a more brief and less heroic trajectory.

Over the past 50 years, a variety of approaches have been tried, with only limited success. More recently, some health care organizations began to adopt the lessons of high-reliability science, which studies organizations such as those in the commercial aviation industry, which manage great hazard extremely well. This study reviews the evolution of quality improvement in U.S. health care and proposes a framework that hospitals and other organizations can use to move toward high reliability.

(This research was not funded by the Robert Wood Johnson Foundation, but has been provided as an additional resource from this special issue of Health Affairs.)

April Issue of Health Affairs Focuses on Patient Safety and Health Care Quality

  1. 1. The Ongoing Quality Improvement Journey
  2. 2. A Road Map for Improving the Performance of Performance Measures
  3. 3. The Trade-Off Among Quality, Quantity, and Cost
  4. 4. Global Trigger Tool' Shows that Adverse Events in Hospitals May be Ten Times Greater Than Previously Measured
  5. 5. Preventing Bloodstream Infections
  6. 6. Measuring the Performance of Individual Physicians by Collecting Data from Multiple Health Plans
  7. 7. Measuring Health Care Performance Now, Not Tomorrow
  8. 8. Despite Improved Quality of Care in the Veterans Affairs Health System, Racial Disparity Persists for Important Clinical Outcomes
  9. 9. The Importance of Transitional Care in Achieving Health Reform
  10. 10. An Early Status Report on the Beacon Communities' Plans for Transformation Via Health Information Technology
  11. 11. A Comparative Study of 11 Local Health Department Organizational Networks
  12. 12. Public Health Performance
  13. 13. A Self-Assessment Process for Accreditation Preparedness
  14. 14. Public Health Delivery Systems
  15. 15. Regionalization in Local Public Health Systems
  16. 16. Public Health Services and Systems Research
  17. 17. A Shot in the Rear, Not a Shot in the Dark
  18. 18. What Predicts Local Public Health Agency Performance Improvement?
  19. 19. Growth of a Scientific Community of Practice
  20. 20. Evolution of Coauthorship in Public Health Services and Systems Research
  21. 21. Resources that May Matter
  22. 22. Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths
  23. 23. Public Health Financial Management Competencies
  24. 24. Decision Science
  25. 25. Public Health Financial Management Needs
  26. 26. Data-Driven Management Strategies in Public Health Collaboratives
  27. 27. Using Geographic Information Systems to Match Local Health Needs with Public Health Services and Programs
  28. 28. Public Health Systems and Services Research
  29. 29. Local Public Health Capacities to Address the Needs of Culturally and Linguistically Diverse Populations
  30. 30. A Needs Assessment for Data and Methods in Public Health Systems Research
  31. 31. Mapping the Multidisciplinary Field of Public Health Services and Systems Research

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