Quality Improvement in Neurosurgery

ec li ni cs .c om Health care workers want to provide the best care they can, and patients demand it. Moreover, our society wishes this care to be safe, efficient, and economically sustainable. Achieving these goals is the subject of quality improvement (QI), an ever-growing collection of systems and studies targeted at improving patient outcomes and the processes that achieve them. The recognized need for QI in health care is not new, appearing at various key moments first described in Ernest Codman’s “End Result System,” later with the formation of the Joint Commission in 1952, and more recently the publication of To Err is Human by the Institute of Medicine in 1999. But the scope of quality studies is steadily growing, most recently with an increasingly sharp focus on health economics and the idea of value-based purchasing. Unlike many other disciplines in medicine, QI is intimately associated with governing and regulatory systems. Drivers of QI have long included physician-led systems like the American Medical Association and the AmericanCollege of Surgeons, but the US Federal Government is also highly invested, predominantly after the creation of Medicare and Medicaid in 1965 made it economically critical to do so. More recently, with the passage of the Affordable Care Act in 2010, the importance of QI has been repeatedly reiterated. In a 2012 report to Congress, the “Triple Aim” was outlined by the Department of Health and Human Services to define the goals for modern health care QI: