Quality management in health care
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A previously published analysis of an interesting dataset consisting of time intervals between medication errors is replicated and some errors in the original analysis are discussed. The dataset is then analyzed using well-known methods from the field of statistical process control. The results and conclusions of the analysis are not consistent with those of the original analysis. The need for future collaborations between health care and quality management professionals are discussed.
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Qual Manag Health Care · Apr 2008
Comparative StudyHow work context shapes physician approach to safety and error.
A study was undertaken to examine how different hospital clinical settings compare in their capacity for physicians to attend to safety and employ a learning approach to error. Multiple qualitative methods were used to examine medical residency teams in the emergency department, surgery department, and the medical intensive care unit. The focus was on how physicians responded to errors that occurred and safety-related issues, and what features of the surrounding work context were associated with those responses. ⋯ Surgery's capacity to deal with error and safety issues was adversely affected by the emphasis on hierarchy among surgeons, the high permeability of surgeons across hospital work settings, emphasis on individual blame when mistakes occurred, and workload. These findings highlight the necessity for health care organizations to conduct regular assessments of their clinical environments to help identify the workplace factors that shape clinician approach to safety and error. It also calls into question the singular, uniform approaches to enhancing quality and safety within health care organizations.
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Health care delivery systems are widely studying and implementing physician pay for performance (P4P) initiatives to improve quality and control costs. However, the increasing focus on quality-driven financial incentives has some troubling implications for medical professionalism. This article examines the P4P concept in light of a notion of medical fiduciary professionalism that dates back to the 18th-century Scottish physician John Gregory. Gregory's principles serve as a framework to assess the appropriateness of P4P initiatives in disseminating the principles of high-quality care without damage to professionalism, the patient-physician relationship, and access to care for all patients.
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Qual Manag Health Care · Jul 2007
The National Institute for Health and Clinical Excellence: an interview with Gillian Leng, MD.
Within Great Britain's National Health Service, the National Institute for Health and Clinical Excellence (NICE) is the agency charged with the task of developing and disseminating guidelines to be followed by all National Health Service providers and provider organizations. Dr Gillian Leng is the Director of Implementation Systems and a member of the Board of Directors of NICE. ⋯ Prior to joining NICE, Dr Leng, a board-certified internist, conducted a practice in internal medicine. Dr Leng was interviewed by QMHC at the London offices of NICE in October 2006.
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Qual Manag Health Care · Jul 2007
Current pulse: can a production system reduce medical errors in health care?
One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. ⋯ Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.