title: Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform.
abstract: Improving quality and safety of hospital care is now firmly on the health-care agenda. Various agencies within different levels of government are pursuing initiatives targeting hospitals and health professionals that aim to identify, quantify and lessen medical error and suboptimal care. Although not denying the value of such 'top-down' initiatives, more attention may be needed towards 'bottom-up' reform led by practising physicians. This article discusses factors integral to delivery of safe, high-quality care grouped under six themes: clinical workforce, teamwork, patient participation in care decisions, indications for health-care interventions, clinical governance and information systems. Following this discussion, a 20-point action plan is proposed as an agenda for future reform capable of being led by physicians, together with some cautionary notes about relying too heavily on information technology, use of non-clinical quality personnel and quantitative evaluative approaches as primary strategies in improving quality.
authors.affiliation: Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. ian_scott@health.qld.gov.au
authors.forename: I A
authors.initials: IA
authors.lastname: Scott
authors.forename: P J
authors.initials: PJ
authors.lastname: Poole
authors.forename: S
authors.initials: S
authors.lastname: Jayathissa
mesh_terms: D054869:Clinical Audit; D005260:Female; D018166:Health Care Reform; D006739:Hospital Administration / Q000592:standards*; D006751:Hospital Information Systems; D006801:Humans; D007857:Leadership; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008505:Medical Staff, Hospital; D009520:New Zealand; D016134:Organizational Policy; D010348:Patient Care Team / Q000592:standards*; D010358:Patient Participation; D010819:Physician's Role; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D017751:Safety Management / Q000458:organization & administration*