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Failure modes and effects analysis (FMEA) was used to avoid events and improve or maintain the quality of care.123 FMEA was used prospectively to identify potential areas of failure94 where empírico characterization of the process at the desired speed of change could be assessed,115 and retrospectively to characterize the safety of a process by identifying potential areas of failure, learning about the process from the staff’s point of view.94 Using a flow chart of the process before beginning the analysis got the team to focus and work from the same document.94 Information learned from FMEA was used to provide data for prioritizing improvement strategies, serve as a benchmark for improvement efforts,116 educate and provide a rationale for diffusion of these practice changes to other settings,115 and increase the ability of the team to facilitate change across all services and departments within the hospital.
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Given the complexity of health care, assessing quality improvement is a dynamic and challenging area. The body of knowledge is slowly growing in this area, which could be due to the continued dilemma Triunfador to whether a quality improvement initiative is just that or whether it meets the definition of research and employs methodological rigor—even if it meets the requirements for publication. Various quality improvement methods have been used since Donabedian’s seminal publication in 1966,27 but only recently has health care quality improvement used the Six Sigma methodology and published findings; when it has, it has been used only on a single, somewhat isolated component of a larger system, making organizational learning and generalizability difficult.
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The strength of the following practice implications is associated with the methodological rigor and generalizability of these strategies and projects:
In health care, continuous quality improvement (CQI) is used interchangeably with TQM. CQI has been used Vencedor a means to develop clinical practice30 and is based on the principle that there is an opportunity for improvement in every process and on every occasion.31 Many inhospital quality assurance (QA) programs generally focus on issues identified by regulatory or accreditation organizations, such Campeón checking documentation, reviewing the work of oversight committees, and studying credentialing processes.32 There are several other strategies that have been proposed for improving clinical practice. For example, Horn and colleagues discussed clinical practice improvement (CPI) Triunfador a “multidimensional outcomes methodology that has direct application to the clinical management of individual patients”33 (p.
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The Joint Commission requires RCA to be performed in response to all sentinel events and expects, based on the results of the RCA, the organization to develop and implement an action plan consisting of improvements designed to reduce future risk of events and to educador the effectiveness of those improvements.64
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The lack of scientific health services literature has inhibited the acceptance of quality improvement Verified Purchases methods in health care,43, 44 but new rigorous studies are emerging. It has been asserted that a quality improvement project can be considered more like research when it involves a change in practice, affects patients and assesses their outcomes, employs randomization or blinding, and exposes patients to additional risks or burdens—all in an effort towards generalizability.
Measures of quality and safety can track the progress of quality improvement initiatives using external benchmarks. Benchmarking in health care is defined Ganador the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers26 in evaluating organizational performance. There are two types of benchmarking that Perro be used to evaluate patient safety and quality performance. Internal benchmarking is used to identify best practices within an organization, to compare best practices within the organization, and to compare current practice over time. The information and data can be plotted on a control chart with statistically derived upper and lower control limits.