"Leaders must make quality a core strategy of the organization. That's probably the most important barrier that must be addressed — a mindset change from "quality is the job of the quality department" to "quality is a core operational responsibility for every executive, every person." ~ James Reinertsen
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 as Dr Reinertsen has pointed out (quoted above) 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.
Let's get started
In the following sections, you will find a range of resources to help you, your team and organisation on your quality journey. Help make it even better by contacting us and recommending key resources, reports, stories and ideas.
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.
For an overview of healthcare improvement, view the following links and webpages.
- Basics of Quality Improvement in Healthcare - (2007) useful article by Verkay et al published by Mayo Clinic Proceedings [Abstract] [Full article, 5 pages, pdf]
- What is ‘‘quality improvement’’ and how can it transform healthcare? (2007) - editorial written by Paul B Batalden and Frank Davidoff. Published by Quality & Safety in Healthcare journal [Abstract] [3 page pdf]
- USAID Healthcare Improvement Project - this website has been established as a global knowledge resource for healthcare improvement and includes a searchable knowledgebase portal and numerous examples of quality improvement stories and improvement methods.
Healthcare & quality improvement centres
The following links will take you to websites for some of the key international and national groups focusing on quality and healthcare improvement. Let us know of others to include.
- Institute for Healthcare Improvement – the Institute for Healthcare Improvement (IHI) is a non-profit organisation and leading international centre of excellence. Led by CEO Dr Don Berwick, (recently nominated for Administrator of the Centers for Medicare & Medicaid Services, USA), their website contains an impressive array of programmes, resources, tools and examples of healthcare improvement from around the world.
- The World Health Organization: Observatory on Health Care for Chronic Conditions – large range of resources, reports, studies and information relevant to improving chronic care.
- The MacColl Institute for Healthcare Innovation - Improving Chronic Illness Care is a national programme of The Robert Wood Johnson Foundation, with special interest in guidelines, specialty expertise and information systems for chronic care.
Improving healthcare accessibility
NZ Telehealth Resource Centre
The New Zealand Telehealth Resource Centre provides resources and advice to clinicians and practices who are considering or planning to implement a telehealth service. The services are provided entirely free of charge. The aim is to encourage the uptake of telehealth by health professionals across the country. It includes case studies of where telehealth is already providing benefits. Site visits, workshops and demonstrations are also offered by the resource centre team.
“Telehealth is changing the way we deliver healthcare and is a good example of how the sector is harnessing IT to provide better services to patients closer to home,” says Dr Coleman. “It means people living in rural or remote areas can access the same specialist care as those living in urban areas without having to travel great distances. Equally, telehealth is useful in busy urban environments or where a patient is not easily able to travel." (Source: Beehive.govt.nz – New online telehealth resource to encourage uptake). To learn more visit The NZ Telehealth Resource Centre homepage.
- Institute for Healthcare Improvement - TV Channel (IHI-TV): Excellent source of videoed presentations you can view 24/7