Designing and implementing a comprehensive quality and patient safety management model: A paradigm for perioperative improvement

OBJECTIVES:: The objectives of this article are to describe the design and implementation of a comprehensive perioperative quality and patient safety management model. This model used a systems approach to integrate (1) multiple data sources of defects, (2) a multidisciplinary team, (3) a quality improvement methodology successful in high-risk industries other than health care, (4) retrospective and near-real-time analyses of defects, and (5) proactive feedback to the team, reporters, and hospital risk managers. METHODS:: Two primary incident-reporting systems were selected. A multidisciplinary team of physicians, nurses, risk managers, and others was formed. A simple taxonomy was used to categorize defects. Lean Six Sigma methodologies were used to analyze the data. The team calculated a priority score for each defect and developed quality improvement projects for those with the highest priorities. RESULTS:: During this study, 532 perioperative defects were captured, with newly captured defects analyzed weekly in near real time. The team created 91 quality improvement projects targeting all defect categories, with 33% focused on patient safety. Many projects were not based on the incident-reporting systems but originated from the model's systems approach. Feedback loops proactively revised formats for capturing defects, added patient-specific safety data to individual's medical records, and informed the hospital's risk managers of ongoing quality improvement projects. CONCLUSIONS:: This comprehensive model used a systems approach to successfully integrate aggregate data from incident-reporting systems, empowered stakeholders from a multidisciplinary team, and Lean Six Sigma methodologies to develop sustainable quality improvement projects to mitigate defects and positively impact perioperative processes.