Continuous improvement as an ideal in health care

Article Abstract:

An analogy between the practice of medicine and two different managerial methods of assuring quality is drawn. There are two types of assembly lines: one run by a foreman, dedicated to the Theory of Bad Apples, who declares himself to be alert and watching for flaws. He informs his workers that others, perhaps more adept, are waiting for their jobs if they are not vigilant; the other line is controlled by a foreman who informs his team that 'we are in this together for the long haul, and that it is in our collective best interests to improve the quality of the work.' In the second style, the job of this foreman is to look for opportunities to improve quality, for skill that could shared, and to integrate knowledge gained from past mistakes into the quality in the future. Current medical practice all too often practices the 'bad apple' style of quality control--finding the problem and problem-makers. To determine the bad practitioners, there is overemphasis upon measurement and ability to detect incompetence rather than in finding opportunities and methods for improving. The Japanese have implemented a new concept of quality control, 'The Theory of Continuous Improvement.' They have found that usually the failure of a process lies not in the work ethic of the workers, but in poor job design, failure of leadership or unclear purpose. Real quality requires changes to the production environment based on data derived from the production cycle itself. Medical care is far from this ideal and from the Theory of Continuous Improvement. This theory applies both to large medical institutions and to small systems such as those in individual doctor's offices. American medicine needs to abandon the Theory of Bad Apples and embrace the Theory of Continuous Improvement.

Evaluation, Medical care, Physicians, Medical professions, column

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Payment by capitation and the quality of care

Article Abstract:

The debate continues on the issue of capitation payments, a method of allocating funds to the physician or health care team prior to dispensing health care. Capitation has become very common since 1987 and most often combines the arrangement of prepaying with the actual management of health care. If estimates for funds per patient are off target, some services may be performed below standard. The main focus is on this inherent risk and the individual decision for any given amount of care by physicians. Despite such heavy criticism, capitation itself has not done as poorly as feared by many opponents and may actually prompt change in the delivery of care.

Management, Planning, Medical care, Cost of, Health care costs, Managed care plans (Medical care), Capitated payment systems (Medical care)

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Errors today and errors tomorrow

Article Abstract:

Doctors and other healthcare professionals will never be able to reduce medical errors until they implement the many ideas that have been proposed for doing so. A few public demonstration projects might help to prove that such action is possible. According to the Institute of Medicine, 100 patients die every day in US hospitals because of medical errors.

Editorial, Prevention, Hospital patients, Medical errors, Death of

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