Abstract：
CONTEXT:The phrase "Science of Improvement" or "Improvement Science" is commonly used today by a range of people and professions to mean different things, creating confusion to those trying to learn about improvement. In this article, we briefly define the concepts of improvement and science, and review the history of the consideration of "improvement" as a science. METHODS:We trace key concepts and ideas in improvement to their philosophical and theoretical foundation with a focus on Deming's System of Profound Knowledge. We suggest that Deming's system has a firm association with many contemporary and historic philosophic and scientific debates and concepts. With reference to these debates and concepts, we identify 7 propositions that provide the scientific and philosophical foundation for the science of improvement. FINDINGS:A standard view of the science of improvement does not presently exist that is grounded in the philosophical and theoretical basis of the field. The 7 propositions outlined here demonstrate the value of examining the underpinnings of improvement. This is needed to both advance the field and minimize confusion about what the phrase "science of improvement" represents. We argue that advanced scientists of improvement are those who like Deming and Shewhart can integrate ideas, concepts, and models between scientific disciplines for the purpose of developing more robust improvement models, tools, and techniques with a focus on application and problem solving in real world contexts. CONCLUSIONS:The epistemological foundations and theoretical basis of the science of improvement and its reasoning methods need to be critically examined to ensure its continued development and relevance. If improvement efforts and projects in health care are to be characterized under the canon of science, then health care professionals engaged in quality improvement work would benefit from a standard set of core principles, a standard lexicon, and an understanding of the evolution of the science of improvement.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Perla RJ,Provost LP,Parry GJdoi
10.1097/QMH.0b013e31829a6a15subject
Has Abstractpub_date
2013-07-01 00:00:00pages
170-86issue
3eissn
1063-8628issn
1550-5154pii
00019514-201307000-00002journal_volume
22pub_type
历史文章,杂志文章abstract：OBJECTIVES:To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing ...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0000000000000116
更新日期：2017-01-01 00:00:00
abstract：:The American patient and consumer groups are increasing pressure on physicians and health care organizations to improve and document the quality of care that they deliver. A leading cause of inadequate care is the significant variations in medical practice that cannot be explained by patient differences, which persist...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-199908010-00003
更新日期：1999-10-01 00:00:00
abstract：:Each department in a hospital is given the responsibility of managing its own day-to-day work. For the hospital as a whole to change, the individual departments must undergo a similar change. As each department aligns itself with the purposes of the whole organization, synergy is created and the hospital gradually, in...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:The mission of nonprofit health care clinics is particularly challenging to fulfill given the large number of uninsured and underinsured people they serve. In addition, these clinics feel pressure to provide services in an efficient manner to prevent patient no-shows and encourage the continua...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0000000000000215
更新日期：2019-07-01 00:00:00
abstract：:To improve processes in hospitals, a case study was conducted at a German university hospital, which consists of more than 30 clinics and institutes on a large campus. The case study focused on the analysis of the patient flow and of machine utilization in the radiology department. Radiological devices are spread over...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0b013e3181bee127
更新日期：2009-10-01 00:00:00
abstract：:The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health c...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0000000000000181
更新日期：2018-07-01 00:00:00
abstract：:With costs and competitive pressures increasing, pharmaceutical sponsors and contract research organizations are examining the drug development process. Investigators who conduct clinical studies significantly impact research quality and, thereby, costs. This article reviews current investigator selection methods and ...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-199907030-00004
更新日期：1999-04-01 00:00:00
abstract：:Like many organizations, Continental Rehabilitation Hospital of San Diego designs and communicates templates and targets for desired changes in behaviors and tracks results. It recognizes and celebrates successes and struggles with its failures. A recent case example demonstrates the importance of generating immediate...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-199706010-00007
更新日期：1997-10-01 00:00:00
abstract：:The patient-centered medical home model of primary care requires increased collaboration in care delivery. Recent studies suggest that such a collaborative model of care is aided by physician leaders who practice an inclusive approach to leadership; however, they do not empirically demonstrate what such strategies loo...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0b013e31825e876a
更新日期：2012-07-01 00:00:00
abstract：:Accountability in health care has taken on new dimensions with the drive to base contracting and provider of care selection upon data driven "report cards." The measurement and development of reportable outcomes are driving providers to move their organizations from a focus not only on "caring" but to one highly cogni...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-200009010-00005
更新日期：2000-10-01 00:00:00
abstract：PURPOSE:Medical home care has been identified as a model for improving primary care delivery and population-specific quality and safety outcomes. Questions remain how this model affects older adult quality. This systematic review addresses 2 important questions: Are quality and safety outcomes associated with medical h...
journal_title：Quality management in health care
pub_type： 杂志文章,评审
doi：10.1097/QMH.0000000000000041
更新日期：2014-10-01 00:00:00
abstract：:The Agency for Health Care Policy and Research pain guidelines and implementation theories were used in this improvement initiative to ensure that evidence-based pain management reached every provider and patient in a large tertiary care hospital. Implementation strategies, products, and outcome measures are described...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-199907020-00004
更新日期：1999-01-01 00:00:00
abstract：BACKGROUND:The obesity epidemic threatens to shorten life expectancy and reduce the quality of life for large segments of the population. The purpose of this study was to develop a decision rule for referral to a weight-loss program on the basis of the relationship between body mass index (BMI) and self-rated overall h...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/01.QMH.0000281061.15108.f8
更新日期：2007-07-01 00:00:00
abstract：:In a previous article (M. K. Hart, Qual Manag Health Care. 2003;12(1):5-19), the authors presented risk-adjusted control charts applicable for attributes data. The present article discusses a similar class of control charts applicable for variables data that are often skewed. The key feature of these charts is their a...
journal_title：Quality management in health care
pub_type： 评论,杂志文章
doi：10.1097/00019514-200404000-00003
更新日期：2004-04-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Inability to obtain timely medications is a patient safety concern that can lead to delayed or incomplete treatment of illness. While there are many patient and system factors contributing to postdischarge medication nonadherence, availability and insurance-related barriers are preventable. P...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0000000000000264
更新日期：2020-10-01 00:00:00
abstract：:This article proposes a new class of control charts that may be used for monitoring and improving the quality of care. Unlike conventional control charts that rely on observed performance data, these charts use risk-adjusted data in addition to the observed data. The resulting time-ordered charts are capable of reduci...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-200301000-00004
更新日期：2003-01-01 00:00:00
abstract：:To see the world systematically through the practice of systems thinking means to see the relationship in the phenomena we experience. The systems view is not just another way of improving an object, a process, or even services. It should not be viewed as a method that is focused only on "quality." The intrinsic value...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-199807010-00004
更新日期：1998-10-01 00:00:00
abstract：:Part II of this three-part tutorial focuses on the logistics of data collection. The author presents a checklist of things to consider when planning the details of a data collection effort; touches on the topics of bias and stratification; discusses examples of popular data collection methods; and points out some comm...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：
更新日期：1994-07-01 00:00:00
abstract：BACKGROUND:Although often used in health care settings as a method for continuous quality improvement, experience with the breakthrough collaborative in nonclinical health care settings is limited. In this article, we report pilot data from a social services collaborative conducted in 2007 to 2009 in Sweden, with speci...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0b013e3181c58e20
更新日期：2009-10-01 00:00:00
abstract：:The p chart is widely used in health care and other service organizations as well as in manufacturing to monitor the proportion of observations with some particular characteristic for comparing several sources of data or for tracking a single source of data over time. The conventional approach is to use 3sigma limits ...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/01.QMH.0000267449.32629.b1
更新日期：2007-04-01 00:00:00
abstract：:In this article, we report on the implementation of a computerized scheduling tool to optimize staffing for patient transport at the Mayo Clinic. The tool was developed and implemented in Microsoft Excel and Visual Basic for Applications and includes an easy-to-use interface. The tool allows transport management to co...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0b013e318231a84f
更新日期：2011-10-01 00:00:00
abstract：:"Quality" of care has become one of the main foci of the American health care system during the last 20 years. As costs escalated in all areas of health care, the purchasers and consumers of health care have begun to demand accountability for the products they purchase. The initial focus of the system was "quality of ...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-200407000-00005
更新日期：2004-07-01 00:00:00
abstract：:Quality indicators and a quality-monitoring system developed for use in the regulatory survey process offer a quality improvement tool for nursing home staff. The systematic use of resident assessment data can aid in the identification of quality of care problems and the determination of the nature of those problems. ...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-199604030-00008
更新日期：1996-04-01 00:00:00
abstract：:Recently, many have begun to explore the possibility of using analytical methods associated with continuous quality improvement in the efforts to improve health care. Central to this paradigm is the proposition that such analytical methods can be used to identify and react to variations in the processes and outcomes o...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：
更新日期：1992-10-01 00:00:00
abstract：:Many hospitals are unable to successfully implement evidence-based practices. For example, implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as a "change implementation failure." A prospective...
journal_title：Quality management in health care
pub_type： 杂志文章,多中心研究
doi：10.1097/QMH.0000000000000017
更新日期：2014-01-01 00:00:00
abstract：:The gastroenterology unit at the Höglands Hospital in Eksjö is responsible for the care of all 466 patients with inflammatory bowel disease (IBD) in a geographic area including approximately 115,000 inhabitants. In 2000, the frustration over an inadequate traditional outpatient clinic inspired us to redesign our outpa...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/00019514-200701000-00006
更新日期：2007-01-01 00:00:00
abstract：:Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational ...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0b013e31824d18ff
更新日期：2012-04-01 00:00:00
abstract：BACKGROUND:Hospitals establish surgical assessment units to promote efficiency and improve patient experience. Surgical assessment units are believed to reduce unnecessary admissions. We evaluated a hospital's on-call surgery service without this facility to determine benefits of implementation. METHODS:All emergency ...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0000000000000236
更新日期：2020-01-01 00:00:00
abstract：:As a group, physicians strive for quality but often resist quality measurement. Cost, inconvenience, lack of time, mistrust of quality measures, and a fear of what assessment may find are all factors contributing to this resistance. However, quality, in both rich and poor counties, continues to be poor at worse and va...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：
更新日期：2006-04-01 00:00:00
abstract：BACKGROUND:Metformin is recommended as initial therapy for most patients with type 2 diabetes mellitus. Its most serious adverse effect, lactic acidosis, is a rare entity with a high mortality rate. Despite well-publicized contraindications, metformin is inappropriately prescribed to many hospitalized patients. OBJECT...
journal_title：Quality management in health care
pub_type： 杂志文章
doi：10.1097/QMH.0b013e31826d1ef9
更新日期：2012-10-01 00:00:00
