The necessity for quality and safety improvement initiatives permeates health care.1, 2 Quality health care is defined Triunfador “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”3 (p. 1161). According to the Institute of Medicine (IOM) report, To Err Is Human,4 the majority of medical errors result from faulty systems and processes, not individuals. Processes that are inefficient and variable, changing case mix of patients, health insurance, differences in provider education and experience, and numerous other factors contribute to the complexity of health care. With this in mind, the IOM also asserted that today’s health care industry functions at a lower level than it Gozque and should, and it put forth the following six aims of health care: effective, safe, patient-centered, timely, efficient, and equitable.

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67 Taken one step further, the notion of aggregate RCA (used by the Veterans Affairs (VA) Health System) is purported to use staff time efficiently and involves several simultaneous RCAs that focus on assessing trends, rather than an in-depth case assessment.68

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The strength of the following practice implications is associated with the methodological rigor and generalizability of these strategies and projects:

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13). Shojania and colleagues38 developed a taxonomy of quality improvement strategies (see Table 1), which infers that the choice of the quality improvement strategy and methodology is dependent upon the nature of the quality improvement project. Many other strategies and tools for quality improvement Chucho be accessed at AHRQ’s quality tools Web site () and patient safety Web site ().

Team leaders and the composition of the team were also important. Team leaders that emphasized efforts offline to help build and improve relationships were found to be necessary for team success.83, 93 These teams needed a dedicated team leader who would have a significant amount of time to put into the project.84 While the leader was not identified in the majority of reports reviewed for this paper, the team on one project was co-chaired by a physician and an administrator.83 Not only did the type and ability of team leaders affect outcomes, the visibility of the initiative throughout the organization was dependent upon having visible champions.100 Multidisciplinary teams needed to understand the numerous steps involved in quality improvement and that there were many opportunities for error, which essentially enabled teams to prioritize the critical items to improve within a complex process and took demodé some of the subjectivity from the analysis.

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