Joint Commission, Oakbrook Terrace, Illinois, USA.
Health Aff (Millwood). 2011 Apr;30(4):559-68. doi: 10.1377/hlthaff.2011.0076.
Quality improvement in health care has a long history that includes such epic figures as Ignaz Semmelweis, the nineteenth-century obstetrician who introduced hand washing to medical care, and Florence Nightingale, the English nurse who determined that poor living conditions were a leading cause of the deaths of soldiers at army hospitals. Systematic and sustained improvement in clinical quality in particular has a more brief and less heroic trajectory. Over the past fifty years, a variety of approaches have been tried, with only limited success. More recently, some health care organizations began to adopt the lessons of high-reliability science, which studies organizations such as those in the commercial aviation industry, which manage great hazard extremely well. We review the evolution of quality improvement in US health care and propose a framework that hospitals and other organizations can use to move toward high reliability.
医疗保健质量改进有着悠久的历史，其中包括伊格纳兹·塞梅尔魏斯（Ignaz Semmelweis）等医学领域的传奇人物，他在 19 世纪将洗手引入医疗保健领域；还有英国护士弗洛伦斯·南丁格尔（Florence Nightingale），她发现士兵在陆军医院死亡的主要原因是恶劣的生活条件。特别是临床质量的系统和持续改进具有更简短、不那么英勇的轨迹。在过去的 50 年里，已经尝试了各种方法，但只有有限的成功。最近，一些医疗机构开始采用高可靠性科学的经验教训，这些经验教训来自商业航空等行业组织，这些组织能够很好地管理巨大的风险。我们回顾了美国医疗保健质量改进的发展，并提出了一个框架，医院和其他组织可以使用该框架向高可靠性迈进。
