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Bristol, Shipman y la gobernanza clínica: las lecciones olvidadas de Shewhart
M A Mohammed1, K K Cheng, A Rouse
1Department of Surgery, University of Birmingham, Edgbaston, UK.
Lancet (London, England)
|March 29, 2001
Resumen
Las cartas de control de Walter Shewhart, un método para el control económico de la variación, distinguen entre causas comunes y especiales. Este enfoque es vital para mejorar la calidad y la gobernanza clínica, como se muestra en seis estudios de caso.
Área de la Ciencia:
- Gestión de la calidad Gestión de la calidad.
- Estadística Control de Procesos y Control de Estadísticas
- Mejora de la atención sanitaria.
Sus antecedentes:
- Las industrias manufactureras han mejorado significativamente la calidad de sus productos en el último siglo.
- El trabajo de Walter A. Shewhart sobre el control económico de la variación ha sido crucial para este éxito.
- Las tablas de control de Shewhart proporcionan un método gráfico para diferenciar entre causas comunes y especiales de variación.
Objetivo del estudio:
- Para demostrar el papel central del enfoque de la tabla de control de Shewhart en el logro de la gobernanza clínica.
- Para ilustrar la aplicación práctica del control estadístico de procesos en escenarios del mundo real.
- Para resaltar cómo la comprensión de la variación puede conducir a mejoras tangibles en la calidad y la seguridad.
Principales métodos:
- Aplicación de la metodología del cuadro de control de Shewhart.
- Análisis de seis diversos estudios de caso.
- Examen de la clasificación de la variación (causa común frente a causa especial).
Principales resultados:
- El cuadro de control guía eficazmente a los usuarios a las acciones de mejora adecuadas mediante la identificación de fuentes de variación.
- Los estudios de caso, incluidos incidentes de alto perfil como el exceso de muertes por cirugía cardíaca pediátrica en Bristol y las acciones de Harold Shipman, ilustran la utilidad del método.
- El enfoque demostró ser instrumental para traducir los principios de gobierno clínico en la realidad práctica.
Conclusiones:
- La metodología del cuadro de control de Shewhart es una herramienta poderosa para la mejora de la calidad en varios sectores, incluida la atención médica.
- Distinguir entre la variación de causa común y especial es esencial para la resolución efectiva de problemas y la mejora de procesos.
- La aplicación de los principios de control estadístico de procesos puede contribuir significativamente a lograr una gobernanza clínica sólida y la seguridad del paciente.
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