Question

Dr. Atul Gawande is one of the champions of quality and patient safety today. He is a surgeon, a researcher and a prolific speaker and author. He contends that in order to “heal medicine”, we need to go, as an industry, from “being cowboys to pit crews”.

Q: Explain what he means by this, and how can the CQI methods and tools that you have been learning can contribute to the changes that we need to make in health care?

Answer 1

answer-

the statement in order to “heal medicine”, we need to go, as an industry, from “being cowboys to pit crews” discuss that Physicians have traditionally been trained to be autonomous, independent, and self–sufficient like cowboys who are independent and trained in healthcare organization but to give quality care to patients we need people who can understand teamwork like pit crews. they work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design.

in healthcare quality and patients safety is very important which can be improved with the use of CQI tools and methods. Because errors are caused by system or process failures, it is important to adopt various process-improvement techniques to identify inefficiencies, ineffective care, and preventable errors to then influence changes associated with systems ( McNally MK, Page MA, Sunderland VB ,1997). tools for quality improvement—including failure modes and effects analysis, Plan-Do-Study-Act, Six Sigma, Lean, and root-cause analysis—that have been used to improve the quality and safety of health care.

In health care, continuous quality improvement (CQI) is used interchangeably with TQM. CQI has been used as a means to develop clinical practice and is based on the principle that there is an opportunity for improvement in every process and on every occasion .( Berwick DM ,1998).

Quality improvement projects and studies aimed at making positive changes in health care processes to effecting favorable outcomes can use the Plan-Do-Study-Act (PDSA) model. This is a method that has been widely used by the Institute for Healthcare Improvement for rapid cycle improvement. One of the unique features of this model is the cyclical nature of impacting and assessing change, most effectively accomplished through small and frequent PDSAs rather than big and slow ones, before changes are made systemwide .(Berwick DM ,1998).

Errors will inevitably occur, and the times when errors occur cannot be predicted. Failure modes and effects analysis (FMEA) is an evaluation technique used to identify and eliminate known and/or potential failures, problems, and errors from a system, design, process, and/or service before they actually occur. ( Spath PL, Hickey P. ,2003).

reference-

McNally MK, Page MA, Sunderland VB. Failure mode and effects analysis in improving a drug distribution system. Am J Health Syst Pharm. 1997;54:17–7

Berwick DM. Developing and testing changes in delivery of care. Ann Intern Med. 1998;128:651–6

Spath PL, Hickey P. Home study programme: using failure mode and effects analysis to improve patient safety. AORN J. 2003;78:16–21.