Is it time to peek under the hood of system-level approaches to quality and safety?

•Two decades after the 1999 "to Err is Human" IOM Report, the profound and positive impact of system-level quality and paradigm was discussed.•An opportunity to unlock further quality and safety gains, through deep organizational learning from individual clinician (nurse, physician) perfor...

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Bibliographic Details
Published in:Nursing outlook 2020-03, Vol.68 (2), p.141-144
Main Authors: Yakusheva, Olga, Needleman, Jack, Bettencourt, Amanda P., Buerhaus, Peter I.
Format: Article
Language:English
Subjects:
Adult
Female
Guidelines as Topic
Humans
Male
Middle Aged
Nursing
Nursing Care - standards
Organizational Objectives
Patient Safety - standards
Quality of Health Care - organization & administration
United States
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Summary:•Two decades after the 1999 "to Err is Human" IOM Report, the profound and positive impact of system-level quality and paradigm was discussed.•An opportunity to unlock further quality and safety gains, through deep organizational learning from individual clinician (nurse, physician) performance, was highlighted.•Types of new insights (e.g., evidence-informed innovation, intersection of systems, and human factors) that can be garnered through deep qualitative learning were suggested.•A Big Data approach enabling objective and replicable measurement of clinician performance from electronic health records was presented.•Positive organizations can learn from clinician practice variability how to supplement existing quality and safety systems and achieve new gains in quality and safety outcomes.
ISSN:0029-6554
1528-3968
DOI:10.1016/j.outlook.2019.11.004