Quality Improvement and Patient Safety
Quality Improvement and Patient Safety
Know the Donabedian model-structure, process, outcome-and the IOM/NAM aims (safe, effective, patient-centered, timely, efficient, equitable) and six domains. Understand measurement: structure/process/outcome indicators, balancing measures, and the difference between quality assurance (retrospective, compliance) and quality improvement (iterative, systems-focused).
QI methods: PDSA cycles, Lean (waste reduction), Six Sigma (variation reduction, DMAIC), and root cause analysis versus failure mode and effects analysis (FMEA is prospective). Know run charts and statistical process control for distinguishing common-cause from special-cause variation-a key trap is reacting to normal variation as if it were a signal.
Patient safety: the Swiss cheese model, human factors, just culture (distinguishing human error, at-risk behavior, reckless behavior), and high-reliability organizing principles. Recognize that most errors are system failures, not individual failures.
Traps: blaming individuals for system errors; using a single data point to declare improvement; confusing RCA (after an event) with FMEA (before); selecting a compliance answer when the question asks for improvement.
Worked rule of thumb: before acting on a metric, ask whether the change exceeds control limits or shows a run of points-otherwise you are chasing noise. Then ask whether the intervention targets structure, process, or outcome.
Sustain gains through standardization, measurement, and feedback.