ital structure and culture are under review. As hospitals attend to these aspects of their organization, the internal continuous improvement program takes on a more prominent role in addressing issues of quality and consumer satisfaction
Although the theory, data collection methods, and analysis techniques of continuous improvement have grown considerably since the days of quality assurance, clinical problems in healthcare organizations are also increasingly complex. The potential contribution of epidemiologic designs, decision-making models and action science to the solving of clinical and organizational problems are all acknowledged in the literature.
Although research has been part of the hospital mission for a long time, the perspective of research is fairly limited, emphasizing logical positivism and the experimental model. In addition, to disciplines such as nursing and occupational and physical therapies, research is fairly new. Staff at all levels and from each discipline are struggling with many of the issues involved in a movement away from a quality assurance model to
continuous improvements and a movement away from a
traditional clinical trial, quantitative model of research to a model which includes environmental context.
Some terms must be clarified prior to a comparison of the two processes. First, continuous improvement (CI) describes activities that promote an emphasis on organizational processes and systems and provide a foundation for quality. At the crux of continuous improvement is the determination of why processes fail and the implementation of a remedy to reduce the number of failures.
According to Batalden and Stoltz (1993), continuous improvement in healthcare requires: (a) development of new knowledge, (b) creation of a leadership policy that fosters a shared sense of purpose and promotes organizational learning, (c) a mastery of tools and methods that accelerate improvement of work, an...