The difficulties with Quality Improvement in health and social care

By | 21st March 2011

The focus on industrial quality improvement (QI) and teamwork emerged in the 1940s in response to the need for high quality, low cost materials for World War II.  The quality improvement approach was subsequently popularised in the Japanese automobile manufacturing industry in the 1960s and 1970s.  Supported by influential organisations such as the Institute for Healthcare Improvement (IHI) and the Joint Commission for Accreditation of Healthcare Organizations (JCAHQ), quality improvement principles have been widely employed in the US over the past decade or so, among a growing variety of health and social care providers.  This expansion has also been witnessed in a number of other countries’ health and social care systems, including Australia, Canada, and the UK.  Arguably, the use of QI approaches within health and social care context can be problematic.  As QI approaches are rooted in private sector organisations whose aim it is to offer a relatively limited range of services and products, with a narrow range of variability in quality, at a competitive cost to consumers who can choose among many suppliers, they do not necessarily match the more variable processes of care delivery.  This is not to say that there are no activities in the health and social care which are amenable to QI processes.  Laundry services, laboratory specimen processing and catering, for example, can more easily be organised in more standardised, efficient and reliable fashion.  But providing care involves a range of complex professional, economic and organisational factors.  In addition, unlike consumers, patients are usually unique, with differing co-morbidities and social conditions, different values and personal support systems, all which challenge the ethos of QI.  
(Scott Reeves, Editor-in-Chief)
To read more see: Reeves S, Zwarenstein M, Espin S, Lewin S (2010) Interprofessional Teamwork for Health and Social Care. Blackwell-Wiley, London.