Introducing change (science into the operating room): quality improvement versus experimentation

Abstract

Introducing change is sometimes vital on an individual, departmental, and institutional level to improve the quality of care of patients undergoing cardiopulmonary bypass. This review discussed the following areas: cost of poor quality, variation, knowledge, Deming's red bead experiments and his conclusions, how do you try to improve, measurement, statistics, and quality improvement verses research. Successes and failures with regard to the introduction of change, and strategies to introduce change without creating conflict are discussed with reference to the hospital in which the author works.

Figure 1.

Cause and effect diagram (stem/leaf, fishbone, Ishikawa).

Figure 2.

Statistical control charts—these use process control data to monitor trends against pre-determined criteria.

Figure 3.

Dot frequency diagram—this is designed to partition the vari-ation in the original data among the factors in the study.

Figure 4.

Cube design for factorial analysis—a 3D representation of the effect of three variables A, B, and C on an outcome measure.

Figure 5.

Response plot—the effect of one or more factors on an out-come variable being studied.

Figure 6.

Minimum hematocrit vs. time. This demonstrated how the minimum hematocrit increased after the introduction of retrograde priming.