Quality of Health Care From Evidence to Implementation

by Joel Rodriguez-Saldana (Editor)

The pursuit of quality has been a human endeavor since ancient times, which accelerated in the 20th Century in the industry through the vision and contributions of Shewart, Juran and Deming, who created the basis of disruptive innovations in science and technology, and contributed to the advance of industrial leadership in Japan. Quality became an essential component of industry, and has evolved with the emergence of new leaders like Feigenbaum, Crosby and Oakland. Garvin described that quality is measured from multiple perspectives, including manufacturers, payers and consumers. Albeit the practice of medicine has been considered an art beyond the scope of measurement or improvement, efforts to improve the quality of health care have also occurred. In the last three decades, a vibrant movement to improve the quality of health care has sprung up, under the leadership of the United States, Europe, Japan and Australia. The first milestones in the pursuit of quality of health care were individual efforts that faced adversity and discredit. Ernest A. Codman led to the measurement of the outcomes of healthcare and became the basis of the first and current regulating agencies. Documented deficiencies by the Flexner report in 1910 led to improvements in the quality of medical education and the pre-eminence of a biomedical scientific model. The modern area of quality of health care was heralded under the leadership of Avedis Donabedian who described its three components: structure, process and outcomes. Over the years, it was recognized that the most important stakeholders in the assessment of quality of healthcare are patients and their families. In the words of Peter Drucker, “customers are the reasons we get to stay in business”, and medicine is no exception. Since 1980, the leaders, the amount of information and the initiatives to improve quality of healthcare increased exponentially. This history hit a critical turning point in 1999 with the Institute of Medicine “To Err is Human” report that documented the disadvantages of health care with other high risk industries and the priorities to increase patient safety and quality. New leaders of quality of health care include Donald Berwick, Thomas Bodenheimer, Peter Pronovost, Atul Gawande, Michael Porter, Clayton Christensen, and Richard Grol and their contributions are recognized. In the last decade, application of industrial strategies to improve quality, including Lean and Six Sigma has been tested in healthcare, with positive but still limited results. Current priorities and challenges include patient centeredness and safety, quality assurance, innovation, and sustainable, long term implementation. “Quality of Health Care: History, Evidence and Implementation” describes the evolution of quality in health care and its roots in industry. Beyond the importance of technical excellence and the advances achieved in the delivery of health services, quality of health care is deeply influenced by the social determinants of health, by the performance of health systems, by patients’ adherence and clinical inertia. Quality of health care is about people, patient centeredness, the use of scientific evidence and the capacity to produce outcomes. “Quality of Health Care, from Evidence to Implementation,” describes the evolution of quality in health care, its roots in industry, and the various components directly and indirectly involved. This book delivers a comprehensive view, and an inviting approach to integrate its components and the challenges of measurement and innovative strategies of implementation, individual and social support.

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