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8.1: Introduction

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    The symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different.

    —Florence Nightingale (1860, p. 12)


    This chapter will focus on quality management (QM) and the maintenance of safety within health care management. You will read about recent significant events related to quality management that have occurred in the United Kingdom and the United States, bringing international attention to patient safety issues. Finally, Lean, a QM strategy, and the plan-do-study-act cycle (PDSA) will be introduced to familiarize you with QM terms and techniques often used in the province of Saskatchewan.

    Quality management refers to “the philosophy of a health care culture that emphasizes patient satisfaction, innovation and employee involvement” (Folse, adapted by Wong, 2015, p. 392). Quality assurance (QA) refers to the regular monitoring and evaluation of services to ensure that they meet the established standards of practice. Quality improvement (QI) refers to the ongoing work required to support optimum health for patients, through continued review and revision of processes and procedures according to best practices, emphasizing patient satisfaction, innovation, and employee involvement (Folse, adapted by Wong, 2015).

    Figure 7.1 Rigorous Training Ensures Highest Quality
    Health Care and Outcomes for Patients

    [n.d.], “Infusion Protocol Display,” photo courtesy of the Saskatchewan Health Authority (formerly Regina Qu’Appelle Health Region) collection number 2003.8-1304, is licensed under a Creative Commons Attribution 4.0 International License.

    QI is a fundamental responsibility of all health care providers. Florence Nightingale, one of the first QI experts, changed the provision of health care throughout the world. Her vision of nursing in hospitals “foreshadowed what, more than a century later would be designated a Magnet hospital” (Shiller, 2013, p. 1).

    Learning Objectives

    1. Describe the key issues leading to the development of Magnet hospitals.
    2. Identify how Magnet hospitals changed health care in the United States.
    3. Describe the key issues leading to the publication of the Francis report in the UK.
    4. Describe the features of “a culture of safety.”
    5. Appraise the use of Lean in health care.
    6. Appraise the plan-do-study-act (PDSA) cycle as a basis for QI work.
    7. Identify your leadership imperative to create safe work environments and support QI work.