title: Hospitalwide quality improvement in Thailand.
abstract: BACKGROUND
  In 1999 King Chulalongkorn Memorial Hospital, a 1,500-bed teaching hospital in Thailand, started planning and implementing a hospitalwide quality improvement program, as required for accreditation. DEPLOYING THE NINE-STEP LADDER STRATEGY: The steps in the strategy were as follows: (1) ensure commitment and formulate mutual strategies; (2) develop teams, technical staff, and support; (3) pilot new improvement activities and expand existing quality programs; (4) improve core systems and functions; (5) expand to the whole organization; (6) perform self-assessment and internal survey, (7) complete the incomplete; (8) submit the request for accreditation; and (9) improve continuously for excellence. For example, for step 3, the hospital set up five pilot cross-functional quality lead teams: the infection control committee, emergency-care patient care team, medication system team, laboratory and x-ray services team, and operating room team.
  
  
  RESULTS
  The hospital was accredited by the Institute of Hospital Quality Improvement and Accreditation, Thailand. Improvements were shown in inpatient mortality, patient satisfaction, and reporting of patient risk incidents and the number of serious incidents.
  
  
  CONCLUSIONS
  Critical success factors in implementing a hospitalwide QI program were as follows: (1) role of leadership, (2) need for "quality strategists," (3) physician involvement and participation in QI teams, (4) vertical and horizontal communication, (5) performance drivers, (6) simplicity in continuous quality improvement, and (7) the value of a learning culture.
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. sjiruth@chula.ac.th
authors.forename: Jiruth
authors.initials: J
authors.lastname: Sriratanaban
authors.forename: Yuwaree
authors.initials: Y
authors.lastname: Wanavanichkul
mesh_terms: D000068:Accreditation; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013785:Thailand