The Joint Commission journal on quality improvement最新文献

{"title":"Evaluating Quality Indicators for Patients with Community-Acquired Pneumonia","authors":"David C. Rhew MD,&nbsp;Matthew Bidwell Goetz MD (Chief of Infectious Diseases),&nbsp;Paul G. Shekelle MD, PhD","doi":"10.1016/S1070-3241(01)27050-3","DOIUrl":"10.1016/S1070-3241(01)27050-3","url":null,"abstract":"<div><h3>Background</h3><p>Several organizations have published evidence-based quality indicators for community-acquired pneumonia (CAP). However, there is variability in the types of indicators presented between organizations and the level of supporting evidence for each of the indicators. A systematic review of the literature and relevant Internet Web sites was performed to identify quality indicators for CAP that have been proposed or recommended by organizations, and each of the indicators was then critically appraised, using a well-defined set of criteria.</p></div><div><h3>Methodology</h3><p>The MEDLINE, EMBASE, Best Evidence, and Cochrane Systematic Review databases and Internet Web sites were searched for articles and guidelines published between January 1980 and May 2001 to identify quality indicators for CAP and relevant evidence. Experts in the area of health services research were contacted to identify additional sources. A well-defined set of criteria was applied to evaluate each of the quality indicators.</p></div><div><h3>Results</h3><p>The systematic review of the literature and Internet Web sites yielded 44 CAP-specific quality indicators. The critical appraisal of these indicators yielded 16 indicators that were supported by a study that identified an association between quality of care and the process of care or outcome measure, were applied to enough patients to be able to detect clinically meaningful differences, were clinically and/or economically relevant, were measurable in a clinical practice setting, and were precise in their specifications.</p></div><div><h3>Conclusions</h3><p>Many organizations recommend indicators for CAP. Indicators may serve as measures of clinical performance for clinicians and hospitals, may help in benchmarking, and may ultimately facilitate improvements in quality of care and cost reductions. However, CAP indicators often vary in their meaningfulness, scientific soundness, and interpretability of results. A set of five critical appraisal questions may assist in the evaluation of which quality indicators are most valid.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 11","pages":"Pages 575-590"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27050-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Following Physical Restraint Reduction Programs in Two Acute Care Hospitals","authors":"Lorraine C. Mion PhD, RN (Director),&nbsp;Joyce Fogel MD,&nbsp;Satinderpal Sandhu MD (Assistant Staff),&nbsp;Robert M. Palmer MD, MPH (Staff),&nbsp;Ann F. Minnick PhD, RN (Associate Dean and Professor),&nbsp;Teresa Cranston BSN, RN (Clinical Nurse Specialist),&nbsp;Francois Bethoux MD (Assistant Staff),&nbsp;Cindy Merkel MSN, RN (Clinical Nurse Specialist),&nbsp;Cathy S. Berkman PhD, MSW (Associate Professor),&nbsp;Rosanne Leipzig MD, PhD","doi":"10.1016/S1070-3241(01)27052-7","DOIUrl":"10.1016/S1070-3241(01)27052-7","url":null,"abstract":"<div><h3>Background</h3><p>Physical restraint rates can be reduced safely in long term care settings, but the strategies used to prevent wandering, falls, and patient aggression have not been tested for their effectiveness in preventing therapy disruption. A restraint reduction program (RRP) consisting of four core components (administrative, educational, consultative, and feedback) was implemented in 1998–1999 in 14<!--> <!-->units at two acute care hospitals in geographically distant cities.</p></div><div><h3>Methods</h3><p>The RRP was targeted at units with prevalence rates of ≥ 4% for non-intensive care units (non-ICUs) and ≥ 25% for ICUs, as well as two additional units. The RRP was implemented by an interdisciplinary team consisting of geriatricians and nurse specialists.</p></div><div><h3>Results</h3><p>Of the 16,605 admissions to the RRP units, 2,772 cases received RRP consultations. Only six units (four of seven general units and two of six ICUs) demonstrated a relative reduction of ≥ 20% in the physical restraint use rate. No increase in secondary outcomes of patient falls and therapy disruptions (patient-initiated discontinuation or dislodgment of therapeutic devices) occurred, injury rates were low, and no deaths occurred as a direct result of either a fall or therapy disruption event.</p></div><div><h3>Discussion</h3><p>Given the minimal success in the ICU settings, further studies are needed to determine effective nonrestraint strategies for critical care patients. ICU clinicians need to be persuaded of the favorable risk-to-benefit ratio of alternatives to physical restraint before they will change their practice patterns.</p></div><div><h3>Summary</h3><p>Efforts to identify more effective interventions that match patient needs and to identify nonclinician factors that affect physical restraint use are needed.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 11","pages":"Pages 605-618"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27052-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey of 92 Quality Improvement Projects","authors":"Farrokh Alemi PhD (Associate Professor of Management),&nbsp;Farhad K. Safaie PE (Chief Executive Officer),&nbsp;Duncan Neuhauser PhD (Professor)","doi":"10.1016/S1070-3241(01)27053-9","DOIUrl":"10.1016/S1070-3241(01)27053-9","url":null,"abstract":"<div><h3>Background</h3><p>Studies focusing on the impact of improvement efforts on the organization have yielded mixed results, which has increased interest in comparing the processes of improvement used. Data for a convenience sample of 92 quality improvement (QI) projects in 32 organizations were gathered from interviews and self-reported surveys from 1998 to 2000. A self-administered questionnaire was developed to measure 70 characteristics of improvement projects.</p></div><div><h3>Results</h3><p>Most (80%) of the improvement projects were conducted by hospitals or clinics affiliated with hospitals. The projects took an average of 13 months from the team’s first meeting to the end of the pilot study. Project teams met 14 times (approximately once a month) and spent 1.5<!--> <!-->hours per meeting. Some projects did not measure the impact, others did not intend to have a specific impact, and still others measured but did not achieve the planned impact.</p></div><div><h3>Discussion</h3><p>Patients and employees may be benefiting from improvement projects, but organizations may not be leveraging these improvements to reduce cost of delivery or increase market share. Considerable variation in the projects’ impact raises the question of the need to improve the improvement methods. Generalization from this study should be made with caution, as data were based on a self-selected convenience sample of organizations. Furthermore, respondents did not complete all items, and missing information may affect the conclusions. The data on current improvement practices that are provided in this study can serve as baseline data against which rapid improvement efforts can be judged.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 11","pages":"Pages 619-632"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27053-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and Deploying a Patient Safety Program in a Large Health Care Delivery System: You Can’t Fix What You Don’t Know About","authors":"James P. Bagian MD, PE (Director),&nbsp;Caryl Lee RN (NCPS program manager),&nbsp;John Gosbee MD (Director),&nbsp;Joseph DeRosier PE, CSP (NCPS program manager),&nbsp;Erik Stalhandske MPP, MHSA (NCPS program manager),&nbsp;Noel Eldridge MS (NCPS executive assistant),&nbsp;Rodney Williams JD (NCPS program manager),&nbsp;Mary Burkhardt MS, RPh (NCPS program manager)","doi":"10.1016/S1070-3241(01)27046-1","DOIUrl":"10.1016/S1070-3241(01)27046-1","url":null,"abstract":"<div><h3>Background</h3><p>The Veterans Administration (VA) identified patient safety as a high-priority issue in 1997 and implemented the Patient Safety Improvement (PSI) initiative throughout its entire health care system. In spring 1998 the External Panel on Patient Safety System Design recommended alternative methods to enhance reporting and thereby improve patient safety.</p></div><div><h3>Redesigning the PSI initiative</h3><p>The VA began redesigning the PSI initiative in late 1998. The dedicated National Center for Patient Safety (NCPS) was established. Using the panel’s recommendations as a jumping-off point, NCPS began to identify known and suspected obstacles to implementation (such as possible punitive consequences and additional workload). NCPS adopted a prioritization scoring method, the Safety Assessment Code (SAC) Matrix, for close calls and adverse events, which requires assessing the event’s actual or potential severity and the probability of occurrence. The SAC Matrix specifies actions that must be taken for given scores. Use of the SAC score permits a consistent handling of reports throughout the VA system and a rational selection of cases to be considered. A system for performing a root cause analysis (RCA) was developed to guide caregivers at the frontline. This system includes a computer-aided tool, a flipbook containing a series of six questions, and reporting of the findings back to the reporter. The final step requires that the facility’s chief executive officer “concur” or “nonconcur” on each recommended corrective action. The RCA team outlines how the effectiveness of the corrective action will be evaluated to verify that the action has had the intended effect, and it ascertains that there were no unintended negative consequences.</p></div><div><h3>Implementation</h3><p>Based on successful implementation in two pilots, full-scale national rollout to the 173 facilities began in April 2000 and was concluded by the end of August 2000. NCPS supplied 3 days of training for individuals at each facility. The training included didactic components, an introduction to human factors engineering concepts, and small- and large-group simulation exercises. Facility leaders were reminded of the necessity to reinforce the point that assignment to an RCA team was considered an important duty.</p></div><div><h3>Discussion</h3><p>It is essential to design and implement a system that takes into account the concerns of the frontline personnel and is aimed at being a tool for learning and not accountability. The system must have as its primary focus the dissemination of positive actions that reduce or eliminate vulnerabilities that have been identified, not a counting exercise of the number of reports.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 10","pages":"Pages 522-532"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27046-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Organizational Costs of Preventable Medical Errors","authors":"William B. Weeks MD, MBA,&nbsp;Julia Waldron RN, MS,&nbsp;Tina Foster MD, MPH,&nbsp;Peter D. Mills PhD,&nbsp;Erik Stalhandske MPP, MHSA (Program Manager)","doi":"10.1016/S1070-3241(01)27047-3","DOIUrl":"10.1016/S1070-3241(01)27047-3","url":null,"abstract":"<div><h3>Background</h3><p>Preventable medical errors are associated with additional costs that tend to be borne by patients, but little is known about organizational costs associated with such errors. Two composite case studies (a fall and a delay in diagnosis) were used to identify the organizational costs of preventable medical errors.</p></div><div><h3>Analysis</h3><p>Legal, marketing, and organizational costs—direct, indirect, and long term—were associated with each of the preventable medical errors. A model was generated to examine the theoretical relationship between the costs and four determinants of corporate performance—price, wages, cost of capital, and efficiency.</p></div><div><h3>Discussion</h3><p>Organizations may also have a financial incentive to improve patient safety, for beyond patient and societal costs, preventable medical errors appear to account for significant legal, marketing, and operational costs for the organizations that deliver health care. Some of these costs are not so much the cost of the error but the costs of organizational responses to the error. Three broad areas of inquiry could be used to test the model and improve our understanding of the organizational costs of errors: market response to patient safety interventions, before/after studies of interventions, and case-control studies.</p></div><div><h3>Summary and conclusion</h3><p>Health care leaders have a moral imperative to implement systems that reduce medical errors and improve patient safety. An understanding of the costs associated with medical errors may help leaders understand the importance of patient safety from a financial perspective, develop measures to evaluate the impact of patient safety initiatives, and efficiently allocate resources to address this important health concern.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 10","pages":"Pages 533-539"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27047-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Patient Care Notebook: Quality Improvement on a Rehabilitation Unit","authors":"Hilary Siebens MD (Unit Medical Director and Lecturer),&nbsp;Heather Weston OTR (Practice Leader),&nbsp;Darlene Parry PTA (Physical Therapy Assistant),&nbsp;Elaine Cooke RN, OCN, CRRN (Practice Leader, Nursing),&nbsp;Ricardo Knight PT, MD (Staff Physiatrist),&nbsp;Erika Rosato RN, OCN (Unit Program Director)","doi":"10.1016/S1070-3241(01)27049-7","DOIUrl":"10.1016/S1070-3241(01)27049-7","url":null,"abstract":"<div><h3>Background</h3><p>Shortened lengths of stay in acute and rehabilitation hospitals, continuing financial pressures on all postacute care services, and increasing out-of-pocket health care costs for patients and families challenge rehabilitation hospitals’ patient education and discharge planning processes. Spaulding Rehabilitation Hospital (Boston) introduced a patient care notebook in a 15-bed satellite unit and pilot tested its contribution to the patient education and discharge planning process.</p></div><div><h3>Developing the notebook</h3><p>The three-ring binder notebook included sections on medical appointments and phone numbers, understanding illness and medical care, coping with illness, physical activities, recommendations for the home, and community resources, with both standard and patient-specific information.</p></div><div><h3>Results</h3><p>Most of the patients and caregivers who received the notebooks found them to be helpful, and most staff indicated that the notebook improved the teaching process. Telephone calls to the unit after home discharges decreased from 28 calls for 11 discharges to 6 calls for 21 discharges after the notebook began to be used regularly.</p></div><div><h3>Discussion</h3><p>Staff felt that the process of using the notebook helped focus attention on teaching during the entire course of a patient’s hospitalization rather than just a day or two before discharge. The patient care notebook process is being introduced to the entire hospital and to all patients, regardless of discharge location and the patient’s literacy or proficiency with English.</p></div><div><h3>Conclusion</h3><p>In using the notebook, the QI team, and the entire unit staff, learned about the complexities of QI, patient education, and discharge planning. The notebook process was implemented throughout the hospital a little more than a year after the completion of the pilot project.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 10","pages":"Pages 555-567"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27049-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Continuous Improvement Process for Health Providers of Victims of Domestic Violence","authors":"Evelyn Swenson-Britt RN, MS, CS,&nbsp;Joe E. Thornton MD,&nbsp;Sue K. Hoppe PhD,&nbsp;Margaret H. Brackley PhD, RN, CS","doi":"10.1016/S1070-3241(01)27048-5","DOIUrl":"10.1016/S1070-3241(01)27048-5","url":null,"abstract":"<div><h3>Background</h3><p>Health care providers can play an important role in the prevention of domestic violence through established processes of identification, safety assessment, validation, documentation, and referral. In 1998 the Safe Family Project, funded by University Health System (UHS), affiliated with University of Texas Health Science Center at San Antonio, provided for a clinical review of existing services for victims of domestic violence. A subsequent review of the health system’s policy and clinical practice supported the need for resources and training and for an improved care process for victims of domestic violence.</p></div><div><h3>The continuous improvement process (CIP) model</h3><p>UHS adapted the Shewhart cycle of activities popularly referred to as PDSA (plan change, do change, study results, act on results), a systematic, process-focused approach to achieving continuous and measurable improvement, as its CIP model, and it formed a process improvement team. This process led to translation of research findings into best practice guidelines for treatment of domestic violence and staff education.</p></div><div><h3>Results</h3><p>Significant improvements were made in the overall qualitative chart reviews, although the diagnostic coding (using ICD-9 codes and e-codes) did improve. The CIP can be replicated in other settings to improve the care of victims of domestic violence.</p></div><div><h3>Discussion</h3><p>The CIP effort is being extended to outpatient facilities, and managers have requested that the training manual be replicated and placed throughout UHS as a resource manual. Other activities are intended to improve prevention of domestic violence and intervention when it occurs.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 10","pages":"Pages 540-554"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27048-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The End of the Beginning: Complexity and Craftsmanship and the Era of Sustained Work on Patient Safety","authors":"Richard I. Cook MD","doi":"10.1016/S1070-3241(01)27044-8","DOIUrl":"10.1016/S1070-3241(01)27044-8","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 10","pages":"Pages 507-508"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27044-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Safety and Computerized Medication Ordering at Brigham and Women’s Hospital","authors":"Gilad J. Kuperman MD, PhD,&nbsp;Jonathan M. Teich MD, PhD,&nbsp;Tejal K. Gandhi MD, MPH,&nbsp;David W. Bates MD, MSc","doi":"10.1016/S1070-3241(01)27045-X","DOIUrl":"10.1016/S1070-3241(01)27045-X","url":null,"abstract":"<div><h3>Background</h3><p>Medications are important therapeutic tools in health care, yet creating safe medication processes is challenging for many reasons. Computerized physician order entry (CPOE), one important way that technology can be used to improve the medication process, has been in place at Brigham and Women’s Hospital (BWH; Boston) since 1993.</p></div><div><h3>CPOE at BWH</h3><p>The CPOE application, designed and developed internally by the BWH information systems team, allows physicians and other clinicians to enter all patient orders into the computer. Physicians enter 85% of orders, with the remainder entered electronically by other clinicians.</p></div><div><h3>CPOE and safe medication use</h3><p>The CPOE application at BWH includes several features designed to improve medication safety—structural features (for example, required fields, use of pick lists), enhanced workflow features (order sets, standard scales for insulin and potassium), alerts and reminders (drug–drug and drug–allergy interaction checking), and adjunct features (the pharmacy system, access to online reference information).</p></div><div><h3>Results at BWH</h3><p>Studies of the impact of CPOE on physician decision making and patient safety at BWH include assessment of CPOE’s impact on the serious medication error and the preventable adverse drug event rate, the impact of computer guidelines on the use of vancomycin, the impact of guidelines on the use of heparin in patients at bed rest, and the impact of dosing suggestions on excessive dosing.</p></div><div><h3>Conclusion</h3><p>CPOE and several forms of clinical decision support targeted at increasing patient safety have substantially decreased the frequency of serious medication errors and have had an even bigger impact on the overall medication error rate.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 10","pages":"Pages 509-521"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27045-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a Healthy Health Care Workplace Produce Higher-Quality Care?","authors":"John M. Eisenberg MD (Director),&nbsp;Candice C. Bowman PhD, RN,&nbsp;Nancy E. Foster (Coordinator for Quality Initiatives)","doi":"10.1016/S1070-3241(01)27039-4","DOIUrl":"10.1016/S1070-3241(01)27039-4","url":null,"abstract":"<div><h3>Background</h3><p>The multiagency Quality Interagency Coordination Task Force (QuIC) coordinates activities and plans for quality measurement and improvement across all the U.S. federal agencies involved in health care. One of its working groups focuses on the health care workforce and ways to improve the quality of care that it provides. In October 1999 four government agencies, under the aegis of the QuIC, convened a conference to examine how health care workplace quality influences the quality of care. A healthy workplace is one in which workers will be able to deliver higher-quality care and in which worker health and patients’ high-quality care are mutually supportive. In October 2000 a follow-up conference was held to focus on a specific aspect of health care quality— patient safety.</p></div><div><h3>What we still need to know</h3><p>Although enough is known to justify some initiatives to improve the quality of the health care workplace, participants in both meetings agreed that the evidence to prove these associations is weak and that there has been too little research to evaluate the impact of interventions intended to improve quality through improvements in the health care workplace. New evidence-based information is needed to test the theory of the nature of the relationship between working conditions and care quality.</p></div><div><h3>Conclusion</h3><p>The tradition of evidence-based decision making needs to be applied to health care management as it has in medicine and nursing, to show how staffing, environment, organization, and culture can each can affect the quality of care.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 9","pages":"Pages 444-457"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27039-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}