Healthcare improvement, also known as quality improvement, is vital to the sustainability of our health system. Not only are healthcare costs escalating out of control, but the pressure on hospital beds, leads to "Code Red" for most of winter in many hospitals around the country.
If we are to make significant improvements to our health system, then every person needs to see quality as a core responsibility of their role, from the cleaners, kitchen staff and technicians through to the surgeons and managers.
Quality is everyone's responsibility
This is personal! Most people want the best healthcare possible for themselves,their family and loved ones. For that to occur, each one of us needs to prioritise quality in everything we do. By learning some basic skills, working more effectively as a team, applying quality improvement methods, reviewing, and refining, together we can make a real difference to the quality of service and care we will all receive.
Quality improvement icons like W. Edwards Deming, Walter Shewhart, and J.M. Juran introduced the concepts of quality improvement to industry and the manufacturing sector during the 20th century. Over time other sectors grasped the importance of applying the general laws and truths of quality improvement through the scientific method, thereby reducing problems and wastage while significantly improving productivity and competitiveness.
Safety critical sectors such as aviation, space programmes, shipping, armed forces and engineering have further advanced quality improvement methodology and applied the key principles with impressive results. While some areas of health have made large improvements in the last 50 years, (such as post-surgical infection rates, maternal and neonatal mortality), some would suggest that overall, health has lagged behind and it is only in the last 10 years that quality improvement has gained much traction. While the reasons for this are complex, two factors that cannot be ignored are the medico-legal implications of acknowledging mistakes and the impact of clinician autonomy, variability and resistance to standardisation.
Two key reports that have stimulated significant improvement in healthcare are: To Err is Human (1999), and Crossing the Quality Chasm: A New Healthcare System for the 21st Century (2001), both from the Institute for Medicine. The first one highlighted the reality that we all can make mistakes, but do we have the systems in place to reduce these? The second report caused shockwaves through the USA as the ''chasm" between best care and usual care was emphasised and called for urgent fundamental change to redesign the American health care system and close the quality gap.
An illustrated look at quality improvement in health care
Dr Mike Evans presents a brief history of quality improvement, then touches on system design, the Model for Improvement, and the familiar challenge, "What can you do by next Tuesday?"
(Dr Mike Evans, 2014)