The improvement process needed to engage97 and involve all stakeholders and gain their understanding that the investment of resources in quality improvement could be recouped with efficiency gains and fewer adverse events.86 Stakeholders were used to (1) prioritize which safe practices to target by developing a consensus process among stakeholders86, 98 around issues that were clinically important, i.e., hazards encountered in everyday practice that would make a substantial impact on patient safety; (2) develop solutions to the problems that required addressing fundamental issues of interdisciplinary communication and teamwork, which were recognized as crucial aspects of a culture of safety; and (3) build upon the success of other hospitals.
Because of the long standing importance of quality improvement, particularly driven by external sources (e.g., CMS and the Joint Commission) in the past few years, many quality improvement efforts within organizations have taken place and are currently in process, but may not have been published and therefore not captured in this review, and may not have necessarily warranted publication in the peer-reviewed literature. With this in mind, researchers, leaders and clinicians will need to define what should be considered generalizable and publishable in the peer-reviewed literature to move the knowledge of quality improvement methods and interventions forward.
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Continually collect and analyze data and communicate results on critical indicators across the organization. The ultimate goal of assessing and monitoring quality is to use findings to assess performance and define other areas needing improvement.
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Other considerations were given to the desired objective of sustaining the changes after the implementation phase of the initiative ended.105 Investigators asserted that improving quality through initiatives needed to be considered Figura integral in the larger, organizationwide, ongoing process of improvement. Influential factors attributed to the success of the initiatives were effecting practice changes that could be easily used at the bedside;82 using simple communication strategies;88 maximizing project visibility, which could sustain the momentum for change;100 establishing a culture of safety; and strengthening the organizational and technological infrastructure.
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Due the breadth of types of adverse events and the large number of root causes of errors, consideration should be given to how to differentiate system from process factors, without focusing on individual blame. The notion has been put forth that it is a truly rare event for errors to be associated with irresponsibility, personal neglect, or intention,71 a notion supported by the IOM.4, 72 Yet efforts to categorize individual errors—such as the Taxonomy of Error Root Cause Analysis of Practice Responsibility (TERCAP), which focuses on “lack of attentiveness, lack of agency/fiduciary concern, inappropriate judgment, lack of intervention on the patient’s behalf, lack of prevention, missed or mistaken MD/healthcare provider’s orders, and documentation error”73 (p.
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Measures of quality and safety Gozque track the progress of quality improvement initiatives using external benchmarks. Benchmarking in health care is defined Triunfador the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers26 in evaluating organizational performance. There are two types of benchmarking that Gozque be used to evaluate patient safety and quality performance. Internal benchmarking is used to identify best practices within an organization, to compare best practices within the organization, and to compare current practice over time. The information and data Chucho be plotted on a control chart with statistically derived upper and lower control limits.