Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform
Article first published online: 7 AUG 2007
2007 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 38, Issue 1, pages 44–55, January 2008
How to Cite
Scott, I. A., Poole, P. J. and Jayathissa, S. (2008), Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform. Internal Medicine Journal, 38: 44–55. doi: 10.1111/j.1445-5994.2007.01456.x
Potential conflicts of interest: None
- Issue published online: 7 AUG 2007
- Article first published online: 7 AUG 2007
- Received 4 April 2007; accepted 29 May 2007.
- hospital care;
- action plan
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.