Varkey P, Kollengode A
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
J Postgrad Med. 2011 Jul-Sep;57(3):237-41. doi: 10.4103/0022-3859.85222.
Healthcare in India has been undergoing rapid changes in the last decade. As demand outpaces supply, quality improvement (QI) initiatives and tools can be beneficial to enhance safe, effective, efficient, equitable and timely care. Healthcare quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. This article discusses the framework for QI and reviews the Plan-Do-Study-Act (PDSA), Lean and Six Sigma methodologies, and briefly discusses key patient safety and quality measurement concepts. The PDSA cycle assists in testing the ideas through small tests of change or "pilots". Six Sigma aims at reducing variations in processes, and the Lean methodology predominantly focuses on enhancing process efficiency and eliminating non-value added steps in the process. It is likely that such structured problem solving approaches will provide an objective and systematic method of enhancing quality in healthcare institutions across India. As increasing attention being is paid on enhancing the quality of life through the Quality Council of India and accreditation of hospitals in India through the International Organization for standardization and National Accreditation Board for hospitals and healthcare providers, a focus on QI by institutional leaders and healthcare providers is key to enhancing the safety and quality of healthcare in India. Central to this also will be leadership buy-in, identification of a core faculty or team that will be the initiators of change, a respect for the need for faculty training and education in QI, measurement of issues to identify key priorities to focus on, and enhanced information systems where resources permit the same.
在过去十年中，印度的医疗保健行业一直在经历快速变革。由于需求超过供给，质量改进（QI）举措和工具可能有助于提供安全、有效、高效、公平且及时的医疗服务。医疗保健质量是指针对个人和人群的医疗服务在多大程度上提高了实现预期健康结果的可能性，并与当前的专业知识相一致。本文讨论了质量改进的框架，回顾了计划-执行-研究-行动（PDSA）、精益和六西格玛方法，并简要讨论了关键的患者安全和质量测量概念。PDSA循环有助于通过小规模的变革测试或“试点”来检验想法。六西格玛旨在减少流程中的变异，而精益方法主要侧重于提高流程效率并消除流程中的非增值步骤。这种结构化的问题解决方法可能会为提高印度各地医疗机构的质量提供一种客观且系统的方法。随着印度质量理事会越来越关注通过提高生活质量以及通过国际标准化组织和印度医院及医疗服务提供者国家认证委员会对印度医院进行认证，机构领导者和医疗服务提供者对质量改进的关注是提高印度医疗保健安全性和质量的关键。对此至关重要的还将包括领导层的支持、确定将成为变革发起者的核心教员或团队、尊重对教员进行质量改进培训和教育的需求、衡量问题以确定需要关注的关键优先事项，以及在资源允许的情况下加强信息系统。
