Department of Obstetrics and Gynecology, Division of Gynecologic Oncology Surgery, Mayo Clinic, Rochester, MN, United States of America.
Department of Obstetrics and Gynecology, Quality Office, Mayo Clinic, Rochester, MN, United States of America.
Gynecol Oncol. 2019 Mar;152(3):486-491. doi: 10.1016/j.ygyno.2018.10.046.
Quality improvement in healthcare has accelerated over the past two decades, including in gynecologic oncology. Improvements have been made on a practice, institution, system and national scale, and efforts have focused on improving safety, efficiency, and cost of care. Gynecologic oncology practitioners ought to engage in this work to improve patient outcomes, comply with federal regulation, and continue to meet required educational requirements of training programs. In gynecologic oncology there are already many examples of successful quality improvement initiatives that have resulted in improved patient care, including the implementation of enhanced recovery after surgery programs, reduction in blood transfusion, and increases in guideline adherent cancer care. Quality improvement methodology is born out of industrial engineering and includes Six Sigma and Lean; both are frameworks for implementing quality improvement as a process and can be adopted in healthcare settings to achieve the desired outcomes. Six Sigma is a system that aims to have a 99.9997% defect free process, and uses the DMAIC (Define-Measure-Analyze-Improve-Control) framework to guide stakeholders in their work. Lean is a concept aimed at reducing waste in process. Regardless of methodology used, the most important aspect of successful quality improvement is the use of change-management theory to achieve stakeholder buy-in and institutional participation. The physician champion is a key element to this. Finally, once a project has been completed, successfully or not, it is important to disseminate the experience. This will allow for adoption and replication in other institutions. It also can serve as a mechanism for academic recognition and advancement. Quality improvement is an important and growing field in medicine, and has an important role in the future of gynecologic oncology.
在过去的二十年中，医疗保健领域的质量改进工作进展迅速，妇科肿瘤学也不例外。改进工作已经在实践、机构、系统和国家层面上展开，重点是提高安全性、效率和护理成本。妇科肿瘤学从业者应该参与这项工作，以改善患者的治疗效果，遵守联邦法规，并继续满足培训项目的教育要求。在妇科肿瘤学领域，已经有许多成功的质量改进举措，这些举措已经改善了患者的护理，包括实施手术后强化康复方案、减少输血和增加符合指南的癌症护理。质量改进方法源于工业工程，包括六西格玛和精益；两者都是将质量改进作为一个过程来实施的框架，可以在医疗保健环境中采用，以实现预期的结果。六西格玛是一种旨在实现 99.9997%无缺陷过程的系统，它使用 DMAIC（定义-测量-分析-改进-控制）框架来指导利益相关者的工作。精益是一种旨在减少流程浪费的理念。无论采用何种方法，成功实施质量改进的最重要方面是使用变更管理理论来获得利益相关者的认可和机构的参与。医生倡导者是这方面的关键要素。最后，一旦项目完成，无论成功与否，都要重要的是传播经验。这将允许在其他机构中采用和复制。它还可以作为学术认可和进步的机制。质量改进是医学领域一个重要且不断发展的领域，在妇科肿瘤学的未来发展中具有重要作用。
