Continuously improving patient care: practical lessons and an assessment tool from the National ICU Study.
Pressure for hospitals to maintain quality while lowering cost or provide greater quality at a given level of cost is particularly critical in intensive care services for which it is increasingly difficult to match revenues with costs, given reimbursement limits. At the same time, twofold to threefold differences in intensive care unit risk-adjusted mortality have been reported. This article provides a model for thinking about continuous improvement of intensive care services, draws on the National ICU Study to identify fundamental organizational and managerial processes associated with better performance, and offers a validated assessment instrument to be used as a tool for continuous improvement.
Shortell
S M
SM
JL Kellogg Graduate School of Management, Northwestern University, Evanston, Illinois 60208-2007.
Zimmerman
J E
JE
Gillies
R R
RR
Duffy
J
J
Devers
K J
KJ
Rousseau
D M
DM
Knaus
W A
WA
D003142:Communication; D003220:Conflict, Psychological; D003266:Continuity of Patient Care / Q000592:standards; D006302:Health Services Research; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007857:Leadership; D008962:Models, Theoretical; D009745:Nursing, Supervisory / Q000592:standards; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D011340:Problem Solving; D011785:Quality Assurance, Health Care / Q000592:standards*; D015203:Reproducibility of Results