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1. 5 – QualityImprovement
Eugenie S.Heitmiller,
ElizabethA.Martinez,
PeterJ.Pronovost
KeyPoints
1. Qualityisa characteristicof the systeminwhichcare isdelivered,andeverysystemisperfectly
designedtoachieve the resultsthatitachieves.If we wanttoimprove the qualityof care that we
provide,we needtoreorganize the waythatwe work.
2. The growingdemandforimprovedqualityandsafetyinhealthcare frompatients,providers,
insurers,regulators,accreditors,andpurchaserscallsforanesthesiologiststoevaluatethe qualityof
care that theyprovide.
3. Improvingqualityof care entailsmeasuringperformance.However,healthcare providershave
limitedabilitytoobtainfeedbackregardingperformanceintheirdailywork,inpartbecause of a lackof
informationsystemsandlackof agreementonhow to measure qualityof care.
4. The goal of measurementistolearnandimprove.The measurementsystemmustfitintoan
improvementsystem;caregiversmusthave the willtoworkcooperativelytoimprove,theymusthave
ideasor hypothesesaboutchangesinthe currentsystemof care,and the team musthave a model for
testingchangesandimplementingthose thatresultinimprovements.
5. Previouseffortstomeasure performance have focusedpredominantlyonoutcome measures,
includingin-hospital mortality rates.Althoughimportant,hospital mortalityalone providesan
incomplete pictureinthatitdoesnot provide insightintoall domainsof quality.A balancedsetof
structures(howcare is organized),processes(whatwe do),andoutcome measures(results we achieve)
isneededtoobtaina more accurate picture of the qualityof care.
6. Future effortstoimprove qualityof care inthe fieldof anesthesiologyshouldfocusonthe
developmentof valid,reliable,andpractical measuresof quality.
7. Developingaqualitymeasure requiresseveral steps:prioritize the clinical areatoevaluate;select
the type of measure;write definitionsanddesignspecifications;developdatacollectiontools;pilot-test
data collectiontoolsandevaluatethe validity,reliability,andfeasibilityof measures;developscoring
and analyticspecifications;andcollectbaselinedata.

2. 8. One of the greatestopportunitiestoimprove qualityof care and patientoutcomesprobablywill
not come fromdiscovering newtherapiesbutfromdiscoveringhow tobetterdelivertherapiesthatare
knownto be effective.
9. Strategiesthathave beenusedsuccessfullyinthe aviationindustrytoimprove performance
include interventionstoreduce complexityandthe creationof redundanciesinthe systemtoensure
that critical processesoccur.These strategieshave notbeenfullyevaluatedinthe practice of
anesthesia.
10. Healthcare providerscanorganize theirpatientsafetyandqualityimprovementeffortsaround
three keyareas:translatingevidence intopractice,identifyingandmitigatinghazards,andimproving
culture andcommunication.Althougheachof these areasrequiresdifferenttools,theyall helphealth
care organizationstoevaluate progressinpatientsafetyandquality.