9
General Reactions

The following text summarizes general reactions offered by members of both the forum and the audience during the last session of the workshop.

INFORMATION CAPACITY

Paul Epner of Abbott Laboratories proposed the idea of making information about quality improvements ubiquitous. The capacities of the research system to manage information remain unknown. The system should encourage free exchange of ideas to improve creativity and augment the amount of research being conducted. O’Neill noted that the greatest skill shortage is leadership. Good leaders successfully pick and choose among tools. Epner added that in a more accessible system, people would be able to better identify tools from all that have been attempted.

TRAINING

Diane Rittenhouse of UCSF said that developing skills related to health policy and health services research to be taught to medical students requires a lot of effort. Medical students often are not knowledgeable about quality, cost, access, and variations in care, among other issues. Part of the problem is that there are no models for behaving or teaching in this way. The culture of medicine



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 57
The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary 9 General Reactions The following text summarizes general reactions offered by members of both the forum and the audience during the last session of the workshop. INFORMATION CAPACITY Paul Epner of Abbott Laboratories proposed the idea of making information about quality improvements ubiquitous. The capacities of the research system to manage information remain unknown. The system should encourage free exchange of ideas to improve creativity and augment the amount of research being conducted. O’Neill noted that the greatest skill shortage is leadership. Good leaders successfully pick and choose among tools. Epner added that in a more accessible system, people would be able to better identify tools from all that have been attempted. TRAINING Diane Rittenhouse of UCSF said that developing skills related to health policy and health services research to be taught to medical students requires a lot of effort. Medical students often are not knowledgeable about quality, cost, access, and variations in care, among other issues. Part of the problem is that there are no models for behaving or teaching in this way. The culture of medicine

OCR for page 57
The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary and medical education must change to support widespread reforms in how medicine is practiced. The patients will benefit from these changes. BRIDGING THEORY AND PRACTICE Dougherty commented on potential opportunities to blend the basic science (theoretical side) and applied science (practical side) of quality improvement research. The testing of theories about context and the nature of implementation in real-world settings can help build the basic science, Dougherty said. Shortell proposed a framework for considering context. The framework focuses on the alignment of four areas: an organization’s strategy, its culture, its technical components, and its structure. First, an intervention must fit in an organization’s overall strategy and be considered a strategic priority to be sustained. Second, support for the intervention must be supported by the organizational culture; otherwise, people will not be able to successfully spread the change throughout the organization. Third, technical components to support the intervention must be in place so that information can be gleaned to assess the change. Fourth, the organization’s structure must be able to support both formal and informal ways of learning to share information. Otherwise, improvements will be suboptimized, with improvements in one division or team, but not throughout the organization. The challenge for systemwide quality improvement is to align all four areas to achieve sustained change. SYSTEMS CHANGE Responding to a comment about the risk of attempting quality improvement at the system level when the basic science of quality improvement is not well understood, O’Neill said there are some truths to all organizations, one of which is binary communication. Binary communication allows for only yes or no answers, not maybe, and helps judge a system’s level of organization. Health and medical care has not done a good job of encouraging binary communication, O’Neill said. Better binary communication could decrease chaos in the system and would thus be able to identify leverage points for change. Characteristics of great organizations hold three virtues, O’Neill proposed. First, every person in the organization should be able to say that he is treated with dignity and respect. If a person is not as valuable or is less valuable than others, he should not be there.

OCR for page 57
The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary Second, every person should be able to say that he has been given everything needed to succeed in terms of training, education, tools, and information. Third, every person should be able to say that someone recognized his efforts. Great organizations are difficult to find, but if they could be identified, huge gains in the value of health and medical care could potentially be captured.