Report of a continuous quality improvement program in a tertiary-care medical center.

OBJECTIVE/DESIGN: Changes in the health system in Israel have led to an increasingly competitive environment, decentralization, and economic constraints. We evaluated the use of a continuous quality improvement (CQI) program.

SETTING

Three medical departments and three administrative wings in a 700-bed, tertiary-care, teaching hospital in Jerusalem.

INTERVENTION

The program was planned as a short-term pilot project for long-term extension throughout the institution. The objectives were improved institutional efficiency and provision for change. The program was implemented through departmental improvement teams under a hospital management team and a steering committee, guided by an outside consultant firm.

RESULTS

The Orthopedics Department experienced a 3-day reduction in patient length of stay (P<.008). The Emergency Room experienced a significant reduction in time to discharge through reduced waiting times for consulting physicians (P<.007) and for blood tests (P<.001). The Office of Patient Admissions streamlined procedures for admission and discharge, accomplished physical restructuring, and installed a telephone hot line. In Medical Records, a significant improvement in records availability was realized. In Outpatient Clinics, reductions in waiting times were realized, but were not statistically significant. The Supply Division showed savings on monthly orders and increased efficiency, with 95% of orders completed promptly and accurately.

CONCLUSIONS

Several factors were identified as essential to the success of the program, including staff cooperation and commitment. We conclude that the CQI program was a useful tool to help our tertiary-care medical center adjust to changes in the Israeli healthcare system. It also served as a valid vehicle for maintaining and furthering optimal quality of care.