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Published on: February 16, 2011
Variability in clinical systems: applying modern quality control methods to health care
N J Banks1, R H Palmer, D M Berwick
1Center for Quality of Care Research and Education, Harvard University School of Public Health, Cambridge, MA, USA.
The Joint Commission Journal on Quality Improvement
|August 1, 1995
Summary
Quality management tools revealed design flaws in clinical systems, impacting timely patient care. Improving system design and information systems is crucial for reducing variability and enhancing healthcare quality.
Area of Science:
- Healthcare Management
- Clinical Operations
- Quality Improvement
Background:
- Timely completion of clinical care sequences is essential for quality healthcare.
- Ambulatory care settings present unique challenges for system performance measurement.
- Existing quality management concepts and tools were assessed for their utility in this context.
Purpose of the Study:
- To evaluate quality management concepts and tools for measuring system performance in ambulatory care.
- To identify process failures and design flaws within clinical care sequences.
- To provide recommendations for improving healthcare quality and reducing process variability.
Main Methods:
- Described clinical care procedures (complete blood count, mammogram, surgical consultation) across nine health maintenance organization centers.
- Assessed variability in intended versus actual processes and noted inconsistencies within and among centers.
- Tracked performance of key care sequences and quality characteristics using available, though often incomplete, data from computerized records and departmental files.
Main Results:
- Quality management techniques successfully identified process failures.
- Failures were frequently attributed to inherent design flaws within the clinical systems.
- Data acquisition for performance assessment was challenging and often incomplete.
Conclusions:
- Robust process designs are necessary to minimize variability in clinical care.
- Enhanced management information systems are recommended for effective process monitoring.
- Improvements in system design and information systems can lead to better quality of clinical care.
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