Improving the quality of health-care: Personal reflections on some opportunities and impediments

Peter D Phelan MD, FRACP, MRACMA
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Abstract There are considerable opportunities for improving quality of health-care but also significant impediments. Identifying, investigating and responding to adverse events in a way that will limit their chance of recurrence is probably the single greatest opportunity for quality improvement. However, this requires a shift from a culture of blame to one that recognises such events as almost always a system failure. A general rule, the shorter the duration of a hospital admission, the safer it will be, but regrettably this is not well understood by the community. The considerable variation in rates of many medical and surgical interventions between private and public patients and between patients living in different localities provides a great opportunity for determining what rates produce the best health outcomes. It is probable that reducing the health problems of the socioeconomically disadvantaged, a major quality issue, will require innovative approaches to delivery of their health-care.

提高保健质量:对一些机会和障碍的个人思考
提高卫生保健质量有相当大的机会,但也存在重大障碍。识别、调查和应对不良事件的方式将限制其复发的机会,这可能是质量改进的最大机会。然而,这需要从一种指责文化转变为一种承认此类事件几乎总是系统故障的文化。一般来说,住院时间越短,就越安全,但遗憾的是,社会对这一点没有很好的理解。私立医院和公立医院患者之间以及生活在不同地区的患者之间的许多医疗和手术干预率存在很大差异,这为确定何种比率能产生最佳的健康结果提供了很好的机会。减少社会经济上处于不利地位的人的健康问题,这是一个重大的质量问题,很可能需要采取创新的办法来提供保健服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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