Quality management in the delivery of pediatric anesthesia care

Health care is plagued today by a serious quality gap between the care people should receive and the care they do receive. The existing model of healthcare delivery is complicated and contains many layers of processes that patients and families find bewildering. Society's perception that healthcare processes are overly complex, expensive, waste resources, and result in delays, is echoed in a 1996 Picker Survey in which patients reported that the healthcare system is a "nightmare to navigate." One company that successfully closed the gap between customer quality expectations and that delivered is Toyota. Toyota is committed to a customer-centric approach by broadening their understanding of the customer's needs and endeavoring to satisfy these needs to achieve maximum customer satisfaction. Toyota is also known for its reliable vehicles and for its use of people as an integral part of the quality process. Many credit Toyota's success to aspects of their production system such as the "Jidoka" principle (not letting a defect go from one machine to the next and detecting unacceptable quality during the production process rather than waiting until the end, when it may be hidden). This industrial model for quality control can provide us with the tools to achieve consistently high-quality, high-value patient care. Both CCHMC and the Department of Anesthesiology have taken a page from Toyota's production system. We have adopted these tools and a culture of continuous quality improvement. Embedded in our delivery of health care to pediatric patients are the "6 aims of improvement." These aims can lead us all to fundamentally better care by applying medical knowledge and technology consistently in ways that are safe, effective, patient-centered, timely, efficient, and equitable.