Attempts to improve healthcare quality and performance started way back in the 19 th century during the time of obstetrician Ignaz Semmelweis, who introduced the concept of hand washing in medical care. This was later taken up by Florence Nightingale, an English nurse, who came up with the concept of germs and how poor living conditions contribute greatly to high mortality. In 1910, these hygienic principles were supplemented by Ernest Codman who campaigned for the improvement of standards in hospitals that emphasized the analysis of the end results of care. He wrote a definitive report touching on medical practices which helped to stimulate effort in improving clinical quality in the early 1900s. In 1913, his efforts were given impetus by the creation of the Hospital Standardization Program which was formed by the American College of Surgeons.
The historical events culminated to the creation of Medicare in 1965. Medicare helped to improve access to medical care. However, it did not wholly address the issue of raising standards of care of newly insured patients. However, in 1966, a conceptual framework for measuring standards of health care was mooted by Avedis Donabedian. His concept lay the groundwork for subsequent efforts which aimed at improving health care quality. In his concept, health care was to be gauged by analyzing the structures and end results of care. On the other hand, researchers were also utilizing new ways of collecting evidence with regard to the use of particular clinical practices to improve health care results. In 1948, the Randomized Clinical Trial (RCT) was mooted. This led to an increase in the number of articles published based on such trials which reached about 10,000 per year by the mid-1990s (Chassin and Loeb, 2011). The Cochrane Central Register of Controlled Trials has about 640,000 reports today. The evidence gathered not only give credence to clinical efficacy of a number of treatments and tests but also magnifies the problem of how to use knowledge to improve the quality of care for patients.
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| Six Sigma | Lean | HRO |
| This concept was first mooted in the early 1980s by Bill Smith. It was first used at General Electric to improve waste management in order to save money ( Sadeghi, 2013 ). | This concept was first introduced by James Womack, Daniel Jones and Daniel Roos in 1991 when comparing Japanese and American companies which regarded the Toyota Company to be the best due to its Toyota Production System (Dekier, 2012). | High Reliability Organization (HRO) principle was first mooted by the human factors movement during the Second World War, which aimed at improving human effectiveness and equipment design. This gave rise to the study of organizations whose errors could have catastrophic consequences in 1984. The principle deals with a number of organizations that are regarded as highly reliable (Karlene, 2003) |
| This system aims at implementing a process that systematically eliminates defects and efficiencies by utilizing a set of quality management methods. It makes use of experts and statistical data within an organization. Its main objective is the delivery of reliability, high performance, and value to the customer | This system follows five basic principles which include improving product value for customers, designing of a value stream map, creating a continuous value stream to reduce waste, meeting client's demand, and striving for excellence. | This system is based on the assumption that organizations can be successful if they continually reinvent themselves, improvise on their existing processes and structures, and where the decision making process moves from the highest to the lowest level. |
| It uses statistical data and experts to measure quality. It uses the DMAIC and DMADV techniques to improve a process related to a business and/or create a new process or product design respectively. | The main technique that this system uses is to constantly strive for excellence by making the system to continually evolve | The system uses a number of techniques to achieve its objectives, namely, the creation of checks and balances, the use of an appropriate rewards system, quality maintenance and improvement, command and control structure, and risk perception. |
| I learned that any organization can improve its performance by devising ways and means of improving their existing processes or creating new ones by adopting a number of quality management practices | I have that that any organization can improve its performance and quality by constantly striving to excel in all its processes through continuous evolution. | I have learned that for any organization to be highly reliable, it needs to evolve constantly by maintaining high standards, rewarding its personnel, able to be aware of impending risks, and creating a good organizational command structure that is able to offer effective control. |
References
Chassin, M & Loeb, J. (2011). The Ongoing Quality Improvement Journey: Next Stop, High Reliability. Health Affairs, 30, 4.
Dekier, L. (2012). The Origins and Evolution of Lean Management System . Journal of International Studies, 5, 1, 46-51.
Karlene H. (2003). HRO Has A Prominent History . The Official Journal of Anesthesia and Patient safety foundation , 18, 1
Sadeghi, S. (2013). Integrating quality and strategy in health care organizations . Burlington, Mass: Jones & Bartlett Learning.
