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Mayo Clinic Medical Science Blog

Feb 3, 2015 · 2 Replies

“One Size Fits All” Doesn’t Apply to Quality Improvement

By Elizabeth Zimmermann Young @elizabethzimmermann

QualityIn an era of rising health care costs, and continuing efforts to improve value for patients nationwide, we have seen the rise of a number of quality improvement and reporting efforts. In his study, published today in the Journal of the American Medical Association, David Etzioni, M.D., and his team, illustrated that seeking a standardized solution is unlikely to provide a universal result.

The research team found no difference in postoperative outcomes over time between University HealthSystem Consortium hospitals with and without participation in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).

These findings demonstrate the complexity and limitations of mandating use of national outcomes reporting structures such as NSQIP as a sole driver for quality improvement. While participation in NSQIP can be interpreted as the demonstration of a resolve to improve, the lack of an observed improvement over time underscores that institutional resolve is an essential first step, but alone is insufficient to achieve high quality care. Multiple additional steps are required for practice transformation.

Quality improvement (QI) groups such as Mayo Clinic’s Quality Academy, Office of Value Creation and Surgical Quality Program are instrumental in training and working with health professionals on a number of these steps. We provide a structured and holistic QI training framework that includes accurate identification of quality gaps, development and dissemination of solutions within a given practice and methodologies for sustained application of the solutions over time.

The nature and application of quality improvement solutions may differ between practice settings or hospitals dependent on a number of factors such as local culture, leadership support, implementation planning and available resources. Thus a ‘one-size-fits all’ approach will likely fail to yield sustained improvement in outcomes. QI interventions that are tailored to local practice needs, use rigorous QI methodologies, supported by adequate resources and with monitoring over time, are most likely to improve outcomes and ensure high quality care for every patient, every day.

News release and video interview

Post contributed by the Quality Academy, Office of Value Creation and Surgical Quality Program. Read more about Mayo Clinic’s quality and safety initiatives and recognitions.

Tags: American College of Surgeons, improvement, kern center, NSQIP, quality, surgical outcomes, value, health care delivery, Science of health care delivery

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