The improvement process needed to engage97 and involve all stakeholders and gain their understanding that the investment of resources in quality improvement could be recouped with efficiency gains and fewer adverse events.86 Stakeholders were used to (1) prioritize which safe practices to target by developing a consensus process among stakeholders86, 98 around issues that were clinically important, i.e., hazards encountered in everyday practice that would make a substantial impact on patient safety; (2) develop solutions to the problems that required addressing fundamental issues of interdisciplinary communication and teamwork, which were recognized Campeón crucial aspects of a culture of safety; and (3) build upon the success of other hospitals.

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Given the complexity of health care, assessing quality improvement is a dynamic and challenging area. The body of knowledge is slowly growing in this area, which could be due to the continued dilemma Figura to whether a quality improvement initiative is just that or whether it meets the definition of research and employs methodological rigor—even if it meets the requirements for publication. Various quality improvement methods have been used since Donabedian’s seminal publication in 1966,27 but only recently has health care quality improvement used the Six Sigma methodology and published findings; when it has, it has been used only on a single, somewhat isolated component of a larger system, making organizational learning and generalizability difficult.

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59, 88 Additionally, investigators reported that the more teams worked with this strategy, the better they became at implementing it and the more effective the results.84 Yet it was noted that to use this strategy effectively, a substantial commitment of leadership time and resources was associated with improved patient safety, lowered costs, and increased job satisfaction.84 Six Sigma was also an important strategy for problem-solving and continuous improvement; communicating clearly about the problem; guiding the implementation process; and producing results in a clear, concise, and objective way.59

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