Historical Leaders in Quality Improvement - Research Paper Example

Running head: QUALITY IMPROVEMENT Historical Leaders in Quality Improvement Historical Leaders in Quality Improvement Introduction Quality is a continuing issue among healthcare providers, institutions, and organizations. The pioneering works on healthcare quality of Avedis Donabedian, Donald M. Berwick, and Robert Brook, to name a few, had greatly contributed on the assessment and improvement of healthcare quality. The corporatization and continuous government interventions on healthcare issues have changed and redefined the measures of healthcare quality. In particular, the industrialization of healthcare between 1980s and 1990s created a great impact on the delivery of healthcare services, affecting the manners on which risks are perceived, care is organized, and healthcare providers are supported (McLaughlin and Kaluzny, 2006). By recognizing and applying the organizational and production principles in the manufacturing sector, healthcare professionals can improve the delivery of healthcare services suited to the needs of the patient or organization. As such, fitting the curative environment to an individual’s or organization’s needs is important in beating the production goals. This approach can also be employed in the delivery of healthcare services to a single patient or population through a definite disease management program (McLaughlin and Kaluzny, 2006). Thus, reflecting on the lives of healthcare quality leaders is insightful. Florence Nightingale Florence Nightingale is known as a hospital reformer and a pioneer of nursing. She strived for innovations not only in nursing care, but in hospital administration as well. In 1854, along with well-trained women, Nightingale served the British military hospital during the Crimean War. She documented her observations on the victims and casualties of war by means of statistical applications, treatment, and analysis of mortality and injury cases. She used line diagrams to show the comparison of mortality cases between civilian and military personnel and presented such to government authorities through polar-area diagrams. From 1854 to 1856, in a British military hospital in Turkey, Nightingale led nursing efforts where she prioritized clothing and bedding supplies for the casualties of war and emphasized the need for a more sanitary clinical environment (Knudsen and Debon, 2003). She used to visit wards, even late at night, looking after the conditions of ill soldiers. This exemplary perseverance, dedication, and patience made her to earn the title “The Lady with the Lamp.” After six months, the mortality rate in the military camp fell from 60% to 2% (Knudsen and Debon, 2003). Through her efforts, military doctors and government authorities were finally convinced on the real essence of nursing and medication. In 1856, Nightingale became the general superintendent of the Female Nursing Establishment in Military Hospitals (Knudsen and Debon, 2003). After a year, by presenting her observations and statistical records concerning the conditions of military hospitals, she persuaded the government officials to establish the Royal Commission on the Health of the Army. From then on, she frequently sought as an advisor for sanitation and patient care for different healthcare programs. For instance, Elizabeth Blackwell founded a Woman’s Medical College in 1868 in consultation with Nightingale. Using the funds raise for her works in the Crimea, Nightingale instituted the Nightingale School and Home for Nurses which paved for the establishment of Liverpool system of district nursing in England. In 1907, Florence Nightingale received the Order of Merit from the King of England, making her as the first woman recipient of such honor (Knudsen and Debon, 2003). Ernest Amory Codman If Florence Nightingale struggled for the creation of a national healthcare system, Ernest Amory Codman aimed to bring the accountability on the quality of healthcare to individual level. Codman earned his degree in medicine from Harvard Medical School and gained expertise from Massachusetts General Hospital. While actively practicing his profession, he conceived the idea of “end result” and in 1910, shared it to Edward Martin in London. Inspired by the idea of Codman, Martin founded the American College of Surgeons (Mallon, 2000). Both Martin and Codman advocated the measurement of end results or clinical outcomes as the pillar of standards in medical and surgical competence. In the long run, Codman’s “end result” idea led to the development of a small-pocket card or “end result card” where case number, procedures, preoperative diagnosis, long- and short-term outcomes, and names of operating team members are recorded. Guided by his end results idea, Codman suggested that every patient should be made aware on the end results of medical procedure he received and physicians must be conscious on the end results of any treatments given to a patient. In so doing, patients can realize the quality and importance of medical services they received and physicians could learn from their shortcomings and further improve in the professional practice. When he entered in the military service during World War I, Codman employed his idea and made end result card for every injured soldier he treated (Mallon, 2000). He returned to Boston after the war and started his works in orthopedic surgery. Codman recorded the first case of bone sarcoma and wrote, in 1934, a classical book in orthopedic surgery. In 1996, the Joint Commission, in recognition of the pioneering works of Codman in the quality of medical practices, established the Codman Award (Mallon, 2000). This award intends to give honor, annually, to individuals and organization in the utilization of process-and-outcome measures to improve the delivery of healthcare services.  Avedis Donabedian Avedis Donabedian earned his medical degree from American University of Beirut in Lebanon. He was also a graduate of Harvard School of Public Health under its master in public health program. Donabedian became prominent in the systematization of knowledge, quality measures, and healthcare monitoring, from different healthcare organizations. His research works on structure-process-outcome assessment of healthcare quality was internationally recognized and became the fundamental basis of quality assessment at present. In 1961, after working as professor in different universities, Donabedian worked at the University of Michigan as a professor of public health economics in the School of Public Health (Donabedian and Bashshur, 2003). He introduced the principles of structure-process-outcome in his book, “Evaluating the Quality of Medical Care.” In it, he accentuated the direct influence of hospital structure which includes qualified physicians, staff, medical supplies, and equipment, and the delivery of medical services, such as surgical procedures and medical operations, to the quality of healthcare outcomes which involves mortality, complication, and length of confinement. Donabedians model became the standard in the assessment of healthcare programs. Donabedian became a member of prestigious healthcare organizations National Academy of Sciences, American College of Healthcare Executives (ACHE), and Institute of Medicine, IOM (Donabedian and Bashshur, 2003). He was also a recipient of numerous awards for his work like the first Richard B. Tobins Award from the American College of Utilization Review Physicians, the Baxter American Foundation Prize for Health Services Research, and the Sedgwick Memorial Medal for Distinguished Service by the APHA, respectively, in 1984, 1986, and 1999 (Donabedian and Bashshur, 2003). In 1989, the Avedis Donabedian Foundation was established in Barcelona, while in 2000, the University of Michigan instituted the Avedis Donabedian Distinguished University Professorship. Robert H. Brook Robert H. Brook obtained his degrees in medicine from Johns Hopkins Medical School and in doctorate in science from Johns Hopkins School of Hygiene and Public Health. He served as a professor at the University of California, Los Angeles (UCLA) under medicine and health services and holds an executive position at the Health Science Program of RAND Corporation (Dick and Steen, 1991). He is prominently known in quality assessment and assurance of medical care. Brook’s extensive works on the quality of healthcare and assessment of health status had incited the formulation of healthcare policies for the quality improvement of healthcare services. In addition, his medical studies had inspired the measures of determining the suitability of medical procedures and surgical operations for specific cases. Brook has dedicated his life and professional career to improving the delivery of healthcare services through quality evaluation. While working at the UCLA, Brook was actively involved in the training of physicians for healthcare services with emphasis on the community level (Dick and Steen, 1991). He is a member of major healthcare organizations like the American Association of Physicians, the National Academy of Sciences, Institute of Medicine (IOM), and the American Society for Clinical Investigation. Brook has received a number of awards from various award-giving bodies in medicine, including the Peter Reizenstein Prize, the Institute of Medicines Lienhard Award, and the Baxter Foundation Prize for excellence in health services research (Dick and Steen, 1991). He conducted revolutionary works in the development of instruments for the measurement of health status of individuals vulnerable to debilitating diseases, including the HIV patients, the elderly, and the special-needs children. Recently, Brook was appointed as the chair of coronary artery bypass panel, an arm of the Californias Office of Statewide Health Planning, for graft surgical outcomes. Donald M. Berwick Donald M. Berwick, an authority in healthcare quality and improvement, cofounded the Institute for Healthcare Improvement (IHI) in Massachusetts in 1991 in order to advocate the improvement of the healthcare quality (Huber, 2006). Berwick served as a professor of pediatrics and healthcare policy and health policy and management, respectively, in Harvard Medical School and Harvard School of Public Health. Berwick is a pediatric consultant at the Massachusetts General Hospital and an associate pediatrics at Childrens Hospital in Boston. He has published various articles and co-authored books on healthcare management, healthcare policy, technology assessment, and decision analysis. Berwick is an active member of editorial board in different professional journals, including the Journal of the American Medical Association. Berwick served a number of healthcare committees and handled executive positions in different healthcare organizations. In 2002, the former U.S. president, Bill Clinton, appointed Berwick as a member of the Advisory Commission on Consumer Protection and Quality in the Healthcare Industry (Huber, 2006). In 2004, Berwick was recognized as a fellow of the Royal College of Physicians in London and became as honorary Knight Commander of the Most Excellent Order of the British Empire. He received various awards, including DuPont award for excellence in childrens healthcare from Nemours, the William B. Graham Prize for Health Services Research, and the Earnest A. Codman Award (Huber, 2006). John E. Wennberg John E. Wennberg is known as a demographic health researcher who documented medical care with respect to geographic variations. He presented the correlations of demographic locations to healthcare cost, quality of patient care, and outcomes of medical treatments (Cannon and Tanner, 2005). Wennberg obtained his degree in medicine from McGill University and trained in nephrology and internal medicine, and studied public health at Johns Hopkins University. Through his major project, “The Dartmouth Atlas of Health Care,” he persuaded the U.S. congress in the establishment of the Agency for Health Care Policy and Research, which is now known as the Agency for Healthcare Research and Quality (AHRQ). In 1970s, along with Alan Gittelson, Wennberg proposed the methodology of small-area analysis intended for healthcare utilization based geographical locations (Cannon and Tanner, 2005). Wennberg looked into the possible reason on the variation of medical practices based on geographic area. He argued that better patient outcomes are not necessarily related to more healthcare services or healthcare spending. He was a recipient of various awards, including the Picker Institute Award for Career Achievement in Patient-Centered Care, the Baxter Foundations Health Services Research Prize, and the Joint Commissions Ernest Amory Codman Award. In 2007, Wennberg was recognized as the most influential health policy researcher by “Health Affairs” journal through his outstanding works in applying outcome measures to improve the quality of healthcare. Conclusion The quality of healthcare pertains to the degree of which healthcare services, consistent with the current professional knowledge, is delivered to the general public and attained the desired health outcomes. Reflecting on the lives of historical leaders in healthcare, in improving the quality of healthcare, quality management has a crucial role in addressing issues in the delivery of healthcare services, including medical errors and patient safety. In addition, the evaluation of performance, technological applications, and communication strategies are essential to the implementation of quality healthcare practices. References Cannon, M. F. and Tanner, M. (2005). Healthy competition: Whats holding back health care and how to free it. Washington, D.C.: Cato Institute. Dick, R. S. and Steen, E. B. (1991). The computer-based patient record: An essential technology for health care. Institute of Medicine (U.S.). Washington, D.C.: National Academy Press. Donabedian, A. and Bashshur, R. (2003). An introduction to quality assurance in health care. Oxford ; Toronto: Oxford University Press. Huber, D. (2006). Leadership and nursing care management. Philadelphia: Saunders Elsevier. Knudsen, S. and Debon, N. (2003). Florence Nightingale. On my own biography. Minneapolis: Carolrhoda Books. Mallon, W. J. (2000). Ernest Amory Codman: The end result of a life in medicine. Philadelphia: Saunders. McLaughlin, C.P. and Kaluzny, A.D. (2006). Continuous quality improvement in healthcare: Theory, implementations, and applications, 3rd ed. Sudbury, MA: Jones and Bartlett. Read More