Committee on Health Care for Underserved Women, ACOG. The uninsured. Obstet Gynecol 2004;104:1471–1473.
John P. Keats Joseph C. Gambone
Quality is the degree to which health services for the individual and populations increase the likelihood of desired health outcomes, consistent with current professional knowledge.
Each physician assumes a significant responsibility for safety and excellent care in their own practice environment.
Adverse outcomes and near misses allow the organization to examine its processes of care with an eye to continuous improvement.
In an assessment of the factors leading up to serious adverse events in hospitals, communication problems were the most frequently identified root cause, occurring in almost three-fourths of cases.
No one should be hesitant to raise questions and concerns when an unsafe situation is observed.
Drills and rehearsals for emergency situations improve outcomes and enhance safety.
Hand washing using appropriate technique before and after every patient encounter should be considered mandatory.
In the operating room, a preoperative verification process, a marking of the surgical site, and the performance of a time-out should be routine.
Medication safety is a high priority for quality improvement initiatives. Avoiding abbreviations that may lead to medication error increases patient safety.
Disruptive behavior in the hospital setting can have adverse effects on patient safety and overall quality of care.
Professional organizations endorse active disclosure to the patient when adverse events occur, including those caused by error.
Effective communication with office personnel and with patients is an essential element for creating a culture of safety in the office setting.
What Is Quality Care?
It has been more than a decade since the Institute of Medicine (IOM) published two seminal works in the fields of patient safety and medical care quality: To Err Is Human and Crossing the Quality Chasm (1,2). Despite the heightened awareness and increased public focus on the crucial issues raised by these publications, there is limited evidence of significant progress toward making this country’s health care both safer and better (3). One reason for this absence of momentum may be the very gradual incorporation of an emphasis on the principles of patient safety during medical school and residency. Leaders in the patient safety movement have called for the redesign of education for health care professionals in order to equip these individuals with the essential knowledge, skill, and attitude required to function safely and effectively in the health care delivery environment of the 21st century. Although this imperative affects all health professions, it is particularly compelling in medical education because physicians’ actions and decisions indicate parameters for the care that most other health care professionals provide (4).
The IOM defined quality as “the degree to which health services for the individual and populations increase the likelihood of desired health outcomes . . . consistent with current professional knowledge” (5). Of note in this assertion is the recognition that health care quality is important and applicable to entire groups of people, as well as to every single patient. Implicit is the obligation to be sensitive to the ﬂexible meaning of “desired health outcomes,” because desired outcomes may differ from the perspective of hospitals, physicians, patients, and their families. Adherence to the definition includes rigorous application of accepted standards of information and treatment to any clinical problem, a process now referred to as evidence-based medical practice (6).
Another construct to define and achieve higher quality health care can be derived from the “Five Rights” of medication administration: right patient, right drug, right dose, right time, and right route (7). The Five Rights of medical quality could be thought of as doing the right thing for the right patient at the right time; doing it right the first time; and doing it right for every patient (8).
The concepts embodied in these two statements are elegantly incorporated into the IOM’s six “Aims for Improvement” that are articulated in Crossing the Quality Chasm and listed in Table 3.1 (The Six Aims) (2). It is notable that “Safe” is listed first. Safety has always been considered “first among equals” in the hierarchy of physicians’ responsibilities. This was initially understood as an admonition to individual medical practitioners. However, it is now recognized that fulfilling this promise of safety requires conscientious evaluation and careful renovation of the systems that deliver medical care.