Institutional quality and patient safety programs: An overview for the healthcare epidemiologist

In the 1980s, the SENIC study by the Centers for Disease Control and Prevention (CDC) demonstrated that hospitals that had infection control programs had better infection-specific patient outcomes than those that did not.11,12 The study, the results of which were rapidly embraced by The Joint Commission (then the Joint Commission on Accreditation of Healthcare Organizations), helped fuel the establishment of healthcare epidemiology programs in every US hospital. The landmark 2001 publication by the National Academy of Medicine, “Crossing the Quality Chasm,” highlighted deficiencies in healthcare quality and patient safety and emphasized the need for improved delivery of healthcare.13 The publication defined quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge,” and outlined 6 components of quality known by the acronym STEEEP: safety, timeliness, efficiency, equity, effectiveness and patient centeredness. In 2000, the National Academy of Medicine published, “To Err Is Human: Building a Safer Health System,”14 a report that called for healthcare organizations to develop a “culture of safety,” with personnel and processes focused on safe and reliable care. Culture A focus on changing the culture of healthcare has led to many insights about improving the quality of care for patients. Since the National Academy of Medicine issued its call for a “culture of safety,” the healthcare industry has drawn lessons from other high-risk sectors (eg, the aviation industry) on key concepts like just culture, high reliability, and systems safety.