[MUSIC] Welcome back, everybody, in this lesson, we're going to talk about the history of quality improvement and patient safety. And we're going to cover the time period between 1854 and 1966. But first we want to start with the definitions of quality improvement and patient safety. And for quality improvement, we're going to to use the Institute of Medicine's definition. Which is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. In summary, really, quality and quality improvement focuses on doing the right things and doing them well for our patients. The definition we want to use for safety comes from the National Patient Safety Foundation. And it's the freedom from those conditions that can cause death, injury, illness, damage to or loss of equipment or property, or damage to the environment. So now we're going to talk about the major events in quality and patient safety from 1854 to 1966. In 1854, Florence Nightingale used evidence-based quality improvement to reduce preventable harm in the Crimean War. This is in fact the first known use of the term preventable harm, we're going to go into more about this in a separate lesson. In 1910, Dr. Ernest Codman, a physician from Harvard Medical School and the Massachusetts General Hospital, who's considered the founder of evidence-based medicine. Believed that understanding why treatments were unsuccessful was the foundation for improving the care of future patients. And he confounded the American College of Surgeons, and formed a Committee for Hospital Standardization, which is the first known effort to standardize care within hospitals. In 1917, the American College of Surgeons adopted Dr. Codman's end result system for its Hospital Standardization program, which established minimum standards for hospitals. These standards included organizing hospital medical staff. Limiting staff membership to well-educated, competent, and licensed physicians and surgeons. Having rules and regulations to ensure regular staff meetings and clinical review. And also around medical records, to ensure that each medical record included the history, laboratory data, and physical examination data. And finally, it established diagnostic and treatment facilities. For example, like the clinical laboratory and radiology departments. When they applied these minimum standards to hospitals, they found that only 13% of roughly the 600 hospitals in the United States at this time surveyed met these minimum standards. In 1951, the Joint Commission on Accreditation of Healthcare Organizations was formed. This was created by the American College of Physicians, the American Hospital Association, the American Medical Association, the Canadian Medical Association, and the American College of Surgeons. Its primary purpose was to provide voluntary accreditation. And in the 1950s, the Joint Commission published the Standards for Hospital Accreditation. And that's built on what we know today as the Joint Commission, and how they accredit hospitals. In 1965, Congress passed the Social Securities Amendment. And in those amendments included that hospitals accredited by the Joint Commission were deemed to be in compliance with most of the Medicare Conditions of Participation for hospitals to participate in the Medicare and Medicaids program. In 1966 Dr. Donabedian published Evaluating the Quality of Medical Care. This was a landmark publication defining the quality of healthcare services using three parts. He included structures, processes, and outcomes. He defines structures as all of the factors that affect the context in which care is delivered. For example, physical facilities, equipment, and human resources. Processes, he defined as the sum of all actions that make up healthcare. Examples of these include technical processes, how care is delivered, and intrapersonal processes. And finally, outcomes of care, he defined as all the effects of healthcare on patients or populations. The structure he put in place around structures, processes, and outcomes. He really defined as having what are the necessary structures that will lead to consistent processes, and what are the processes that will predict good outcomes. This is very much what we still use today to help guide how we organize our quality improvement. This summarizes the major events in quality improvement in patient safety from 1854 to 1966. In our next lesson, we'll cover 1967 to the present.
