Taming the measurement monster.

The healthcare performance measurement landscape continues to evolve. Despite questions about the value of performance data, healthcare organizations are being challenged to meet the data demands of a growing number of mandatory and voluntary measurement projects. Standardization of measure specifications and definitions is months (if not years) away. For healthcare organizations, the measurement "monster" may seem impossible to tame. Although the measurement capabilities of healthcare organizations are being stretched, there are some solutions. First, senior executives must be actively involved in promoting a meaningful measurement system that is compatible with the organization's quality goals and meets regulatory, purchaser, and accreditation requirements. Next, efficiency improvements in the way of systemwide collaboration and expanded information technology support can help reduce the administrative burdens. There is no denying that the focus on measurement has advanced the quality of patient care. Healthcare organizations must create the systems necessary to sustain these gains and move forward toward ever better patient care.

Using failure mode and effects analysis to improve patient safety.

Failure mode and effects analysis (FMEA) (ie, prospective risk analysis) involves close examination of high-risk processes to identify needed improvements that will reduce the chance of unintended adverse events. This risk assessment process is used in other industries (ie, manufacturing, aviation) to evaluate system safety. Health care organizations now are using it to evaluate and improve the safety of patient care activities. The FMEA process promotes systematic thinking about the safety of patient care processes (ie, what could go wrong, what needs to be done to prevent failures.) The steps of the FMEA process are described and applied to a high-risk perioperative process.

"Can you hear me now?" Providers must give patients a voice in efforts to reduce medical errors.

Efforts to improve health care safety can succeed only if providers listen to and otherwise actively involve patients. Several hospitals have created strategies to educate both staff and consumers to create a true provider-patient partnership that reduces the chance for errors.

Practical guide for improving performance.

Research has established that health care is not error free. The question facing perioperative units, as well as all health care services, is how to minimize the human factors that impact quality and safety. This two-part series on performance improvement in perioperative services was intended to help answer this question. Achieving performance excellence starts with a supportive work culture. The human issues of teamwork, communication, and leadership are crucial to achieving performance excellence. Next, perioperative caregivers must accept that all people make mistakes so systems and processes can be designed to be more "forgiving" of errors. Last, a planned and systematic approach must be used to measure, analyze, and improve performance. Successful implementation of performance improvement calls for strong partnerships between physicians, managers, and staff members. Performance excellence requires that everyone work together to ensure that perioperative care is safe, effective, appropriate, customer focused, and efficient.