Abstract
Efforts to improve health care quality take place in an environment that is continually changing. Some of this change is in response to fluctuations in market conditions, some change occurs in response to scientific progress and some of the change may occur based on the health of the population. Managing this constant change is an essential function of the people and the organizations that make up health care systems. Within this environment of change-related activity is a subset of deliberate efforts to make positive changes in the delivery of care. Many of these designed changes come about by “just doing it”; someone decides that a change in clinical practice or organizational arrangement seems like a good idea and the change is made. Such innovation and adaptation is an intrinsic part of clinical and managerial practice [Baily,MA., Bottrell,M., Lynn,J.,Jennings,B., The Ethics of Using QI Methods to Improve Health Care Qualty and Safety. The Hastings Center Report, July-August 2006. p.8.]. Health care providers must generate general standards of practice to suit individual patients, relying on their clinical knowledge, their unique knowledge of each patient, and the characteristics and capabilities of the local context in which care is being delivered. When this innovation and adaptation is undertaken in a systematic, data-guided way it becomes quality improvement.
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