Plsek P E
Paul E. Plsek & Associates, Inc., Roswell, GA 30075, USA.
Am J Infect Control. 1997 Apr;25(2):85-95. doi: 10.1016/s0196-6553(97)90033-x.
The paradigm of modern quality management is in wide use in health care. Although much of the initial effort in health care has focused on improving service, administrative, and support processes, many organizations are also using these concepts to improve clinical care. The analysis of data on clinical outcomes has undoubtedly led to many local improvements, but such analysis is inevitably limited by three issues: small samples, lack of detailed knowledge of what others are doing, and paradigm paralysis. These issues can be partially overcome when multiple health care organizations work together on focused clinical quality improvement efforts. Through the use of multiorganizational collaborative groups, literature reviews, expert panels, best-practice conferences, multiorganizational databases, and bench-marking groups, organizations can effectively pool data and learn from the many natural experiments constantly underway in the health care community. This article outlines the key concepts behind such collaborative improvement efforts and describes pioneering work in the application of these techniques in health care. A better understanding and wider use of collaborative improvement efforts may lead to dramatic breakthroughs in clinical outcomes in the coming years.
现代质量管理范式在医疗保健领域得到了广泛应用。尽管医疗保健领域最初的许多努力都集中在改善服务、行政和支持流程上，但许多组织也在利用这些概念来改善临床护理。对临床结果数据的分析无疑带来了许多局部改进，但这种分析不可避免地受到三个问题的限制：样本量小、对其他机构做法缺乏详细了解以及范式僵化。当多个医疗保健组织共同致力于有针对性的临床质量改进工作时，这些问题可以得到部分克服。通过使用多组织协作小组、文献综述、专家小组、最佳实践会议、多组织数据库和基准测试小组，各组织可以有效地汇总数据，并从医疗保健社区中不断进行的众多自然实验中学习。本文概述了此类协作改进工作背后的关键概念，并描述了这些技术在医疗保健领域应用的开创性工作。对协作改进工作的更好理解和更广泛应用可能会在未来几年带来临床结果的重大突破。
