Curing Health Care: New Strategies for Quality Improvement

Berwick, Donald M.; Godfrey, Blanton A.; Roessner, J. David

doi:10.1097/01445442-199109000-00018

Cited by 204 publications

(146 citation statements)

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“…Many believe that lack of physician involvement represents the single most important obstacle to the success of clinical QI (Berwick, Godfrey, and Roessner 1990;Board 1992;Health Care Advisory Board 1992;McLaughlin and Kaluzny 1994;Blumenthal and Edwards 1995;Shortell 1995). Physicians play a central role in clinical resource allocation decisions and possess the clinical expertise needed to differentiate appropriate from inappropriate variation in care processes.…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

142

106

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Objective. To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. Data Sources. Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. Study Design. Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. Data Collection/Abstraction Methods. Moreover, as much as one-third of some hospital procedures expose patients to risks without improving their health; one-third of drugs prescribed are not indicated; and one-third of laboratory tests showing abnormal results do not get followed up by clinicians (Dubois and Brook 1988;Brook et al. 1990;Leape 1994; Institute of Medicine 2000).Many believe that quality improvement (QI) represents a promising strategy for improving hospital quality of care. QI is a systemic approach to planning and implementing continuous improvement in performance. QI emphasizes continuous examination and improvement of work processes by teams of organizational members trained in basic statistical techniques and problem solving tools and empowered to make decisions based on their analysis of the data. The systemic focus of QI complements a growing recognition in the field that the quality of the care delivered by clinicians depends substantially on the performance capability of the organizational systems in which they work. While individual clinician competence remains important, many increasingly see the capability of organizational systems to prevent errors, coordinate care among settings and practitioners, and ensure that relevant, accurate information is available when needed as critical elements in providing high quality care (Institute of Medicine 2000). Reflecting the growing emphasis on organizational systems of care, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the Peer Review Organizations of the Centers for Medicare and Medicaid have all encouraged hospitals to use QI methods.Although QI holds promise for improving quality of care, hospitals that adopt QI often struggle with its implementation (Shortell, Bennett, and Byck 1998). By implementation, we refer to the transition period, following a decision to adopt a new idea or practice, when intended users put that new idea or practice into use--for example, when clinical and nonclinical staff begin applying QI principles and practices to improve clinical care processes ( et al. 2004). In addition, the systemic nature of many quality problems implies that the effectiveness of a QI initiative may depend on its implementation across many conditions, disciplines, and departme...

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Section: Discussionmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

142

106

View full text Add to dashboard Cite

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“…Whatever the explanation, the consequences of these findings may be significant for hospitals and their quality improvement efforts. Many believe that lack of physician involvement represents the single most important obstacle to the success of hospital quality improvement (Berwick, Godfrey, & Roessner, 1990;Blumenthal & Edwards, 1995;Board, 1992;Health Care Advisory Board, 1992;McLaughlin & Kaluzny, 1994;Shortell, 1995). Physicians play a central role in clinical resource allocation decisions and possess the clinical expertise needed to differentiate appropriate from inappropriate variation in care processes.…”

Section: Discussionmentioning

confidence: 99%

“…We view this dimension as necessary for the learning component of QI insofar as it emphasizes organization-wide commitment and involvement and because most, if not all, vital work processes span many individuals, disciplines, and departments (Berwick, Godfrey, & Roessner, 1990;James, 1989). Learning generally requires that clinical professionals and hospital staff from different specialties, functions, or units work together in order to document how patient care processes work in its entirety and identify the key process factors that play a causal role in process performance.…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, an emphasis on data presentation and feedback in QI implies that standards of performance are identifiable and that benchmarking to such standards will shape the approach to patient care and allow the organization to monitor performance and impose appropriate accountability for performance. As with scope of QI implementation, intensity of QI is likely to impact organizational performance when it becomes an integral part of the daily work life of organizational members as opposed to an intermittent or circumscribed activity (Berwick, Godfrey, & Roessner, 1990;Deming, 1986;Ishikawa, 1985). The more intense or developed the QI effort, the greater the organization's capability to systematically improve quality.…”

Section: Introductionmentioning

confidence: 99%

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Quality improvement and hospital financial performance

2006

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SummaryThe objective of this study was to examine the association between the scope and intensity of Quality improvement (QI) implementation in hospitals and organizational performance. A sample of 1,784 community hospitals was used to assess relationships between QI implementation approach and two hospital-level performance indicators: cash flow and cost per case. Two-stage instrumental variables estimation, in which predicted values (instruments) of eight QI intensity and scope variables plus control (exogenous) variables were used to estimate hospital-level performance indicators. Our results suggest that QI has a measurable impact on global measures of organizational performance and that both control and leaning approaches to QI matter in these settings. Hospitals that implement QI effectively can reasonably expect to improve their financial and cost performance, or at least not place the hospital at risk for investing in quality improvement. These outcomes are specific to QI strategies that emphasize both control and learning.

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“…4,9 Practices in the Continuous Quality Improvement (CQI) arm received practice facilitation based on the Model for Improvement. [27][28][29][30][31] The CQI facilitators provided a structure and process for quality improvement using CQI tools that focused on sequential Plan-Do-Study-Act (PDSA) 27 cycles guided by quality measurement data. Implementation of a system for obtaining reliable quality measures was a timeconsuming first step, and the length of the intervention was allowed to vary (up to 18 months; mean, 15 months and 9.7 meetings), depending on practice needs.…”

Section: Studymentioning

confidence: 99%