Future hospital journal最新文献

Healthcare systems worldwide face the challenge of recognising and improving safety, timeliness, quality and productivity. The authors describe how the COM-B model, developed by Michie et al in 2011 to explain and change criminal behaviour, is useful in identifying what skills and capabilities healthcare providers require to improve their systems. These skills include the intellectual capability to understand, design and improve healthcare processes; the opportunity to do this in their daily work; the motivation to do this - in particular recognising the reasons not to change; and finally unlearning the behaviours based on historical system beliefs that are now invalid. Individual self-awareness and organisational leadership are required to give staff the time and resources to reflect, experiment and learn.

The challenge for all healthcare organisations is to develop and implement an approach that will enable improvements to the quality of healthcare to happen. This case study describes some of the thinking, design and learning from Imperial College Healthcare NHS Trust, on the early steps of our journey to create a culture of continuous improvement across the organisation.

Although quality improvement (QI) is frequently advocated as a way of addressing the problems with healthcare, evidence of its effectiveness has remained very mixed. The reasons for this are varied but the growing literature highlights particular challenges. Fidelity in the application of QI methods is often variable. QI work is often pursued through time-limited, small-scale projects, led by professionals who may lack the expertise, power or resources to instigate the changes required. There is insufficient attention to rigorous evaluation of improvement and to sharing the lessons of successes and failures. Too many QI interventions are seen as 'magic bullets' that will produce improvement in any situation, regardless of context. Too much improvement work is undertaken in isolation at a local level, failing to pool resources and develop collective solutions, and introducing new hazards in the process. This article considers these challenges and proposes four key ways in which QI might itself be improved.

Doctors have a central role in managing patients across a multitude of clinical environments, which places them in the ideal position to identify systemic issues. Traditional medical training focuses on the knowledge and technical skills required; rarely are doctors trained in leadership, management or how to analyse and understand systems so as to design safer, better care. Quality improvement methodology is an approach that is known to enable improvement of the systems in which healthcare professionals work in order to provide safe, timely, evidence-based, equitable, efficient and patient-centred care. To address the current disparity, the Royal College of Physicians (RCP) has launched a Quality Improvement Hub, which will aim to support physicians to face the challenges of improving medical care, enabling them to navigate the tools with more confidence and share and implement the learning more swiftly.

The doctor's role involves helping patients to understand their condition, including the anticipated benefits and risks of proposed treatments or omissions to treat. In order to treat, doctors require consent from patients but the duty to advise is equally strong if conservative management is appropriate. The recent judgement in the case of Montgomery has set a precedent for patient autonomy. However, doctors are still required to judge what risks they should disclose in their reasonable assessment of that patient and their specific situation. The General Medical Council reflects a consensus that the empowered autonomous patient is more likely to be satisfied with their clinical outcome than the passive victim of medical paternalism. Doctors, regardless of specialty, must counsel their patients adequately, paying particular attention to identifying material risks that are likely to be significant to their case.