1. Doucette, Jeffrey N. DNP, RN, CEN, NEA-BC, FACHE

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Safety: More than a quality model

Q Does it matter what quality model I use; for example, Plan-Do-Check-Act (PDCA), Lean, or Six Sigma?

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The short answer is no. The most important aspect of a good quality model is that everyone in the organization knows what the model is and talks about quality in that language. There are many different approaches to organized quality programs that have been widely published, such as Six Sigma, Lean, PDCA, Baldrige, and so on. The bottom line? If everyone in your organization isn't on the same page and speaking the same language around quality, you're far less likely to meet your quality goals. Effective communication is the cornerstone of any solid quality program.


I came across a great study using "sensemaking" as a lens for evaluating nurse-physician communication to improve patient safety. Sensemaking is defined as "a process whereby situations...are talked into existence."1 Interactions between two or more people result in sensemaking when individual perceptions are transformed into works that all parties can comprehend, which then serve as a springboard for action. The author cited the aviation industry, in which there are high risks and hierarchical differences, as being similar to healthcare. I published an article in 2006 comparing airline industry safety practices with nursing and in my research found that, in many respects, healthcare is years behind the aviation industry in terms of standardized protocols and practices.2


Ask anyone who flies a commercial airline more than three times a year and they can likely recite the safety briefing with little variation from the Federal Aviation Administration mandated script. In contrast, give a group of nurses a common medication reaction scenario and ask them what the first critical step is in the process, and you'll get almost as many answers as you have people in the room. This lack of standardization in everything from communication to process continues to cost patients their lives each and every day in healthcare organizations all over the world. We have a lot to learn from the airline industry in this regard.


We can't forget the important role of technology in patient safety and quality. One study reported on the development of a technology-driven patient response call center to assist in delivering the right resources during a patient emergency.3 The authors described the five rights of patient response as "the right request, to the right person, for the right response, in the right amount of time, for the right outcome." Using the call center approach and a technology decision tree, the deployment of rapid response teams was customized to the patient's condition at the time of the call, right-sizing resources and improving patient outcomes.


I believe it's more important to marry the right mix of technical proficiency, "sensemaking" communication, and information technology than to choose a particular quality model. The best case scenario is that you have both a formalized program and effective internal communication to ensure a safe environment.




1. Manojlovich M. Nurse/physician communication through a sensemaking lens: shifting the paradigm to improve patient safety. Med Care. 2010;48(11):941-946. [Context Link]


2. Doucette JN. View from the cockpit: what the airline industry can teach us about patient safety. Nursing. 2006;36(11):50-53. [Context Link]


3. Prince SB, Herrin DM. The role of information technology in healthcare communications, efficiency, and patient safety: application and results. J Nurs Adm. 2007;37(4):184-187. [Context Link]