Victim or player: pediatric surgeons deal with quality improvement and the information age

Medicine as a profession is changing from a cottage industry to an information industry. Physicians and surgeons historically have measured quality of care in a retrospective fashion, reviewing complications in peer review forums, in morning report, or in regular morbidity and mortality conferences. Increasing pressure is placed on hospital systems and clinicians to show measurable improvements in outcomes of care and to remove waste. The retrospective system of quality assurance is being replaced by a prospective measurement of care processes called quality improvement (QI). The measurements are returned to clinicians to enable them to understand and manage the processes and improve patient care. QI has made dramatic improvements in several other industries, including aviation and communications. QI tools are intuitive to most physicians, are easily transferable to medicine, and can be used to remove waste and improve patient care, education, and management of resources. As demand increases for improved quality of care, pediatric surgeons can play a leadership role or have quality changes imposed on them without representation.