Division of Neonatology, Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
J Perinatol. 2019 Jul;39(7):1000-1007. doi: 10.1038/s41372-019-0382-1. Epub 2019 May 9.
To solve complex problems in healthcare, providers need the will to make change, well thought-out or evidence-based ideas, and a quality improvement methodology for executing those ideas. This review will focus on specific elements of execution. A previous review by Picarillo (1) discussed the Model for Improvement, process maps, Pareto charts, Ishikawa diagrams, and driver diagrams. Here, Lean/Six Sigma (LSS) is introduced as an additional methodology for quality improvement (QI), including a selected discussion of some associated LSS tools. Specifically, the Failure Modes and Effects Analysis (FMEA) will be reviewed in more detail. This is a tool to proactively identify possible errors in processes of care, prioritize those which may have the biggest impact if they reached the patient, and develop action plans to address them. Finally, Planned Experimentation is presented as a mechanism to organize your testing strategy for ideas for change. Having an understanding of the concepts in this review and that by Picarillo (1) will provide a sound foundation in the methodology and tools needed to address quality problems in healthcare.
为了解决医疗保健中的复杂问题，提供者需要有改变的意愿、经过深思熟虑或基于证据的想法，以及执行这些想法的质量改进方法。本回顾将重点关注执行的具体要素。Picarillo（1）之前的一篇综述讨论了改进模型、流程图、帕累托图、石川图和驱动图。在这里，引入了精益/六西格玛（LSS）作为质量改进（QI）的另一种方法，包括对一些相关的 LSS 工具的选择讨论。具体来说，将更详细地审查失效模式和影响分析（FMEA）。这是一种主动识别护理过程中可能出现的错误的工具，对可能对患者产生最大影响的错误进行优先级排序，并制定行动计划来解决这些问题。最后，提出了计划实验作为一种机制，用于组织您对变革想法的测试策略。了解本综述中的概念以及 Picarillo（1）的概念将为解决医疗保健中的质量问题所需的方法和工具提供坚实的基础。
