As the article on the Antipodean Perspective on Quality says, Quality in Health Care is a relatively new phenomenon. Started in the 1980's, when studies showed huge discrepancies in health outcomes at different facilities, length of hospital stays, numbers of errors and adverse events which were far higher than expected and of course probably a major driver in this the expense that inefficiencies and adverse events brought, this came at the same time as health consumers became more vocal in their health care. Quality systems were brought in that originated in post war Japanese manufacturing industries and Total Quality Management follows that through as not being reactive as Quality Improvement was critiques as being but working proactively to improve systems and outcomes. There is always the question of human fallibility, but in Quality it is said that an adverse event usually has precursors of "near misses" and it is important that these are recognised and acted upon. It could be that the human fallibility in an adverse event could have been avoided if near miss episodes had been recognised, reported and followed up, also what systems have been in place that act as supports to prevent the human fallibility element?
Just some thoughts...
Great stuff Ali, and I can add to what you are saying, the Japanese quality management model goes back to a couple of American scholars (Deming and Shewhart). Deming held a presentation in 1950 in Japan and the Japanese liked his so-called Deming wheel so much that they created their own, called PDCA cycle, and that stands for plan, do, check and action. The added word cycle signifies that PDCA is an ongoing process and the Japanese were so good at it that they rolled the American car industry in the 1980, while the American car bosses had been asleep at the wheel (i.e. not listening to their own academics).
ReplyDeleteIn other words I would second what you are saying, because what this total Quality Management really means is "constantly learning from self and others", seems the perfect recipe to get ahead :-)
HI Alison
ReplyDeleteThanks for raising this issue. I am very interested in Quality issues, raised by my sister who was a Quality and Risk manager at a DHB for a number of years. I learnt a lot from her about the origins of quality and risk, purposes etc. I think unfortunately many nurses do not understand the importance of quality issues. We have a lot to learn from the airline industry who adopted quality and risk so well and have allowed it to infiltrate their culture. We still have a way to go I think