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.)