Quality Improvement
Chairs: Associates in Process Improvement: Lloyd Provost, MS, Clifford L. Norman, MA, Ron Moen, MA, Jerry Langley, MS, Thomas Nolan, PhD, Kevin Nolan, MAIntermountain Health Care: Brent James, MD, MStat
You got into health care because you wanted to help people. But you’re only human. Sometimes you make mistakes — and those mistakes can cause harm.
In fact, if you’re a patient in a hospital, your risk of dying from a medical error is greater than your chance of dying while driving, mountain climbing, or bungee jumping. According to a paper published in JAMA, mistakes kill 180,000 people in the US every year.[1] That’s the equivalent of three jumbo jets crashing every two days.
And then there are other problems that don’t kill people, but still hurt them. Delays. Ineffective treatments. High costs. Lack of respect for patients. Racial and economic inequality.
Clearly, it’s not enough simply to try harder. We need to do things a new way — a better way. Borrowing from the worlds of aviation and manufacturing, great thinkers have developed powerful methods to guide improvement in health care. And an army of people on the front lines — nurses, doctors, pharmacists, and members of other health-related professions — have used those methods to make a difference.
[1] Leape LL. Error in medicine. JAMA. 1994;272:1851-1857.
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Quality Improvement Faculty
Related Courses/Lessons
QI 101: Fundamentals of Improvement
QI 102: The Model for Improvement: Your Engine for Change
QI 103: Measuring for Improvement
You may want to familiarize yourself with the terminology of quality improvement or refer to the quality improvement bibliography to begin your journey.
June 24, 2009: Donald Berwick, MD, MPP, president and CEO, IHI - Would you do a better job if your pay were linked to patient outcomes? Don Berwick explores pay for performance.
September 15, 2008: Stuart Altman, PhD, Professor of National Health Policy, Brandeis University - With a public beset by health care woes — the number of uninsured Americans is rising, primary care doctors are few and far between — a change is coming in US health care policy. But what will that change look like within the next five years? And what will it mean for you as you embark on a career in health care?
April 27, 2009: David B. Nash, MD, MBA, Founding Dean, Jefferson School of Population Health, Thomas Jefferson University - Interested in having quality improvement and patient safety in the curriculum at your school? Wish you knew how you could help make it happen? Listen in.
January 27, 2009: Patrick Lee, MD, Volunteer Clinical Mentor, Partners In Health, Hospitalist Physician, Newton-Wellesley Hospital, Clinical Instructor in Medicine, Harvard Medical School - Interested in improving the quality of care in a developing country but not sure how to get started? Curious about how effective, lasting improvements are made in rural, resource-poor settings? Then listen to this call and hear the story of how Dr. Patrick Lee and his teammates helped make dramatic improvements at a hospital in Kirehe, Rwanda.
May 15, 2009: Parker Palmer, sociologist, Paul Batalden, Dartmouth Medical School professor, David Leach, former CEO of the Accreditation Council for Graduate Medical Education - When you spot a patient who’s not getting the best possible care, what do you do? How do you speak up? Join the discussion.
Lucian Leape, MD, Adjunct Professor of Health Policy, Harvard School of Public Health - Millions of people suffer every year from mistakes in health care. Lucian Leape, MD, explains why those mistakes happen — and how to prevent them.
A child is mistakenly vaccinated for hepatitis A, rather than B. Despite forthright disclosure and no evident harm to the child, the father becomes incredibly angry at the providers.
What can we learn from a successful improvement project in rural Rwanda? Discussion questions included.
A healthy 57 year old man underwent a liver donation procedure. He began to manifest some tachycardia late on the second postoperative day. Early on the third post-operative day, he began to hiccup, complained of being nauseated and was pronounced dead later that day.
Patients aren’t showing up for their appointments at the community health center. The results? Delays, overcrowding, and mounting frustration for everyone. Can this clinic be saved?
The term “patient navigator” is often used interchangeably with other terms such as “nurse navigator” and “care coordinator,” depending on how the role is defined by the organization. Utilizing this role, AnMed Health Cancer Center and Clemson University’s School of Nursing sought out a plan to improve patient-centered cancer care. (Presented at the 2008 20th Annual National Forum in Nashville, TN)
Noah Zanville, a student at Indiana University School of Nursing, shares his experience at the 20th Annual National Forum on Quality Improvement in Healthcare in Nashville, TN and explains why other students should consider attending in the future.
Employees at Clemson University's St. Francis Health System conducted a project which aimed to increase process reliability relative to identifying, screening, and monitoring infants at high risk for hypoglycemia by RNs while eliminating unnecessary newborn blood glucose screening and monitoring. (Presented at the 2008 IHI 20th Annual National Forum in Nashville, TN)
“By and large, hospitals that want to educate health professionals about quality, safety, and teamwork have to start from scratch with each new graduate they hire,” says Linda Cronenwett, PhD, RN, FAAN, Dean and Professor at the University of North Carolina, Chapel Hill School of Nursing (Chapel Hill, North Carolina, USA). She is involved in a national initiative to change that reality.
In 2004 Dr. Brian Koll was searching for a method to speed culture change at his institution, Beth Israel Hospital in New York. This story profiles efforts at the hospital to introduce quality improvement to the next generation of health professionals.
This study interviewed medical students and residents in an academic medical center, and categorized the factors that influenced their learning from errors. The authors concluded that facilities could help by addressing variability in faculty response and by disseminating clear, accessible algorithms to guide behavior when errors occur. The survey also revealed the need for a teaching and learning focus on emotionally charged situations, learning from errors and near misses, and a balance between individual and systems responsibility.
Have you ever left the doctor’s office in a rush without asking all of the questions you had? This brief article summarizes a few organizations’ method of guiding patients through their care. The article also explains how this approach to care provides benefits to patients and health care organizations.
This article describes a study where 77 medical, physician assistant, nurse practitioner, and health services management students were provided training in quality improvement, community-oriented primary care, and teamwork. These students were then formed into 13 interdisciplinary teams to apply their knowledge in underserved areas ("service learning") under a community and faculty preceptor.
A selected bibliography of essential books and articles about quality improvement in health care, categorized by major topics in the field.
A group of health professions students from seven countries participated in the International Forum on Quality and Safety in Health Care, held April 2008 in Paris. Each day the students met to reflect on key topics discussed in the sessions they attended. This article provides a summary of some take-home lessons on topics such as improvement methodologies, effective teamwork and communication, and involving students early in quality improvement.
This article describes the influx of new energy and ideas that often accompany students who enter health care organizations. As these students learn quality improvement principles they can often greatly help organizations improve their quality.
The article describes the Pennsylvania Local Interdisciplinary Team which was created to develop and implement an innovative model for the education of students from multiple backgrounds in quality improvement. The lead poisoning prevention project is presented as an example of the work of an interdisciplinary student team in a community setting in Philadelphia.
This article describes an interdisciplinary course in continuous improvement developed by the Schools of Medicine and Nursing at Case Western Reserve University and the Program in Health Administration at Cleveland State University, which focuses on learning through experience. The course accommodates a large number of students, and has created new partnerships with Cleveland area health care organizations.
This Institute of Medicine report examines the education of public health professionals, an essential component of the public health workforce. Report recommendations include establishing partnerships between schools of public health and other academic disciplines, local and state health departments and community organizations; adding public health training to medical and nursing school curricula; and increasing federal funding for public health research.
This article describes the Institute for Healthcare Improvement's (IHI) Interdisciplinary Professional Education Collaborative which began in August of 1994. The goal was to teach and train medical students in quality improvement theory, as a means to improve health care as they joined the medical workforce.
What makes a good health care leader? Does leading Quality Improvement activity require a specific skill set? This activity will help you identify some of the desirable characteristics of a leader and provide answers to some of these questions.
Sometimes we see or sense that things are not right in the care for patients and their families. What’s a thoughtful, morally alert student to do?
What would you do after a wrong-site surgery?
Often, clinicians develop health care delivery systems and procedures without taking into account the “voice of the patient.” The purpose of this exercise is to increase awareness of our health care experiences as patients, or as the family members or caregivers of patients.
In 2005, Mayo School of Graduate Medication Education implemented a program to train all its resident and fellows — more than 1,500 students on three campuses — in quality improvement and safety.
In April 2009, we asked students and faculty to explore their schools' curricula to find out whether quality improvement and patient safety are included -- and if so, where.
This presentation was given by Linda Headrick, MD, Senior Associate Dean, Education and Faculty Development, University of Missouri School of Medicine (Columbia, Missouri, USA), to the Council of Academic Societies of the Association of American Medical Colleges in March 2004. Educational goals, methods, content, and assessment for teaching quality improvement as part of medical education are described.
Watch Parker Palmer's "A Movement Model of Social Change" plenary speech at the 10th Annual National Forum on Quality Improvement in Health Care (December 1998).
When you make a mistake that affects a patient, what should you say? Should you apologize, or will that put you at greater risk of being sued? Lucian Leape, MD, Adjunct Professor of Health Policy at the Harvard School of Public Health, describes how to talk with patients and families after a mistake has occurred.
Keynote plenary sessions and 10 other sessions from the 2009 International Forum in Berlin, Germany are available to view online, for free, for your continued learning.
What’s the single biggest challenge the US health care system will face within the next five to ten years? We put the question to a doctor, a nurse, a professor, a student, a hospital CEO, and a patient.
A patient suffers horrible burns. An operation takes twice as long as it should. A child dies from internal bleeding. All because a doctor, a nurse, or another care provider made a mistake. In this video, prominent clinicians describe the errors that still haunt them today — and point out ways those errors could have been prevented.
A baby falls gravely ill after a botched blood transfusion. A student nearly commits a medication error. A patient dies after a clumsy surgery. In this video, current and former clinicians (including IHI’s CEO Don Berwick) describe the errors that still haunt them today — and point out ways those errors could have been prevented.
What's the most pressing problem you could work on today? According to Dr. Patrick Lee, it's the problem of global health disparities. Here's what you can do to help.
Linda Kenney went into the hospital for an ankle replacement. She came out with a host of complications resulting from a mistake that no one was willing to admit. Until Rick Van Pelt, her anesthesiologist, stepped forward. In Part One of this video case study, you’ll find out what happened in the immediate aftermath of the surgery — and learn about common barriers to the open disclosure of errors in health care.
Linda Kenney went into the hospital for an ankle replacement. She came out with a host of complications resulting from a mistake that no one was willing to admit. Until Rick Van Pelt, her anesthesiologist, stepped forward. In Part Two of this video case study, you’ll watch Kenney and Van Pelt describe their first meeting after the surgery — an awkward but pivotal experience for both. You’ll also see how they banded together to help other patients and clinicians.
Linda Kenney went into the hospital for an ankle replacement. She came out with a host of complications resulting from a mistake that no one was willing to admit. Until Rick Van Pelt, her anesthesiologist, stepped forward. In Part Three of this video case study, Kathy Duncan, RN, and Don Berwick, MD, analyze the case.
Not every program offers coursework in safety and improvement. But with a little effort, you can get the training you need. Nursing student Montana Schultz suggests a few ideas to get you started.
Millions of people suffer every year from mistakes in health care. Lucian Leape, MD, explains why those mistakes happen — and how to prevent them.
The mission of the Institute for Improving Medical Education is to identify opportunities to foster innovations in medical education (medical school, residency and continuing medical education) to better align the knowledge, skills, and professionalism of medical students, residents, and practicing physicians with the needs and expectations of the public.
Achieving Competence Today (ACT) is a teaching resource for health care educators. ACT develops and provides resources for the ACGME Systems-Based Practice and Practice-Based Learning and Improvement, and for the AACN Essentials of Graduate Nursing Practice competencies. Educators have several options for finding and downloading high-quality curriculum materials.
The Association of American Medical Colleges (AAMC) and the medical schools, teaching hospitals, academic and professional societies, faculty, residents, and students it represents are committed to improving the health of Americans through medical education, research, and high-quality patient care. Numerous resources and tools are available on the website, including a medical school educational Curriculum Directory, Resources for Future Physicians, the Job Center, and more.
The Institute for Healthcare Improvement's (IHI) Innovation Series white papers share with readers the problems IHI is working to address; the ideas, changes, and methods being developed and tested to help organizations make breakthrough improvements; and early results where they exist.
This website is a comprehensive resource for quality and safety education for nurses, providing a place to learn and share ideas about educational strategies that promote quality and safety competency development in nursing.
Quality and Safety Education for Nurses (QSEN) is a comprehensive resource for nursing educators. This website is a place to learn and share ideas about educational strategies that promote quality and safety competency development in nursing.
The Standards for Quality Improvement Reporting Excellence (SQUIRE) Guidelines help authors write excellent, usable articles about quality improvement in healthcare.
