David C. Kibbe

Continuous quality improvement in the clinical setting: enhancing adoption.

Our ability to involve physicians in Continuous Improvement depends on our understanding of (1) professional norms and behaviors,(2) how organizational structures and systems affect physicians, and (3) basic adoption processes within health care organizations and by their professionals.

Getting from A to C: lifecycle lessons for e-health deployment.

The 35-year history of continuous development of hospital information systems and the current efforts to develop an electronic health record in outpatient settings suggest a lifecycle that must take place before electronic technology is adopted in the highly decentralised US healthcare system. This six-stage lifecycle, called the ABCs of change, involves Acceptance of the need for change, Alignment of the actors to fulfil that need, Breadboard development of the desired, integrated system, a Blueprint for the system to be commercialised, Configuration methods for adapting the system to individual provider and patient needs, and Capital sources for the desired change. This article shows how that six-stage model is relevant to understanding prior development attempts and how current efforts to bring electronic health records to small, primary-care practices follow it. We conclude that it is a useful model for insight and for future planning.

Computer software for health care CQI.

The transition from a qualilty assurance to continuous quality improvement (CQI) demands a basic change from centralized to decentralized information management. In CQI, front-line staff can use personal computer (PC) software skills to manage, analyze, and act on process related information. Information services departments play a key role in this transition by, among other things, selecting software that optimally supports the PC-based work carried out by CQI teams. A review of typical CQI team software requirements and of available PC software suggests that Microsoft Excel 4.0 is a nearly ideal software platform to support CQI teams.

Tutorial: using Microsoft Excel for health care CQI.

The transition from QA to CQI in health care calls for decentralized data collection and analysis in conjunction with the use of personal computers to support CQI team activities. In this article, we discuss recent advances in PC software and hardware technology that make possible revolutionary changes in health care quality data management. We also present detailed examples of how to use Microsoft Excel 4.0 as a single software platform to support commonly used CQI tools and analyses.