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