I'm Duncan Neuhauser, I'm a professor in the department of epidemiology and biostatistics at the medical school at Case Western Reserve University in Cleveland, Ohio, and now emeritus. For the last 50 years, I've been an observer and scholar related, looking at quality and cost in healthcare. And although I have studied in and taught at four of the best schools of management in the world, I had never heard of quality improvement in general, or certainly never heard of quality improvement applied to healthcare. It was only much later that this set of concepts came to my attention, also much later in the mid 1980s did they begin to be seriously applied to healthcare. So what was well known in management in the past, was not so well known in healthcare. The quality improvement ideas with Deming started in the U.S., they went, were picked up in Japan and ignored in the U.S., they became the basis for the transformation of Japanese industry, then, because the Japanese companies did so well, American companies began to pick them up and say, maybe we should use some of these ideas to improve the quality of our products. From there, the connection was made into healthcare in the United States, and these ideas were picked up and thought about in healthcare. The results are different than they would be in industry, but they still pick, use the basic ideas. Quality improvement in ideas evolved in the mid 1930s with Shoehart and Deming and others pooling together a set of ideas. Oddly enough, these ideas originally started at the Western Electric plant in, and the Hawthorne plant in the Chicago area. One end of the plant, Shoehart, was creating quality improvement thinking. The other end of the plant, the work was being done that created the ideas like the Hawthorne effect. These are two landmarks in our understanding of management thought here. Oddly enough, neither group seemed to know the existence of the other. Who picked up on the quality improvement thinking, were engineers. Who picked up on the idea of the Hawthorne effect and the other results of that study, were people in organizational behavior. In universities, these people exist in very different departments and places. And one of the arts in the modern quality improvement thinking, is to how to combine ideas from both these streams together. What's quality improvement? For me, quality improvement is three basic ideas. It is the first one is patient mindedness. If this were a course in industry, it would be called customer mindedness. But health professionals like patients better as a term, and it'll be that way. Customer mindedness, patient mindedness is, are we really thinking very hard about what the needs of patients are, and how well we're meeting those needs. For example, the mother who has recently been diagnosed with cancer and her burning question is, if I have cancer, will my daughter have cancer? How well does the healthcare system manage and meet those urgent personal needs of patients? The second one is statistical mindedness. How do we know we're making an improvement? How do we know we're really helping patients to make improvements over time? So measurement is very important in this. The third one is, if we really are, want to focus on our patient's needs, if we're really measuring how well we're doing or not doing. The third one is, we've got to change the organization to improve what we do. And that's organizational transformation. In this course, you are about to take, I think you will be hearing of all these ideas woven together in over the ten modules. This course has been going on for 20 years now. It's the oldest, longest standing, most enduring course on quality improvement in healthcare, I think, in the entire world. So you're coming across some teachers who've had as much experience as anyone in teaching and thinking about these set of ideas. An important part of the ideas are teamwork and working together. Early on, what the course, we created a logo for the course and I want to show it to you here, because it captures so much of what this course is all about. The logo, if you look at it, has the, the don't go there sign and with a, a shining number nine. It also has a picture of three chimneys. The three chimneys, in this case, stood for three different professional schools. One of them being nursing, one of them being medicine, and in our case the third one being dentistry or other health professions and the thought was these students in these schools learn separately, while in fact, they should learn together. So that they can both learn together and be a team together later on in the provision of care. So we had what we call was this learning were chimneys of excellence. We wanted to stamp out the chimneys of excellence and replace them by the sunshine of number nine. Number nine is one of Deming's points which is, emphasizing teamwork on that one and so the idea of nursing students, medical students, other students learning together to make things better. There's a real underlying transformation that was day one in this course, 20 years ago. And continues as an impassioned commitment to this day. So this is part of a revolution in thinking. Bringing with it a whole new set of words and terminology. The Quality Improvement, Plans-Do-Study-Act cycles, run charts, Seven Step Meeting process, for example. These are new ideas that you would not have found in the medical literature 20 or so years ago. I want to add another concept and idea that you'll be hear, hearing and reading about in this course. And that's the idea of personal improvement projects. The general idea has been around for a long time, and in fact, it's satirized in a Broadway musical called the Pajama Game. Personal improvement is to take the ideas of quality improvement and prove something in your own life. This set of ideas, along with the workbook, was created in parallel to this course. This personal improvement book, which will be included as part of the references in this course, is now used all over the world, has been translated to at least eight or nine different languages, and is a part of the professional education of a lot of, of students all around the world. So it's, it's an example of the impact that this course has had over the years. To say nothing of many students who've taken the course who've gone on to important positions in quality improvement in healthcare. The quality improvement thinking in the late 1980s was certainly new to the medical school that I was in and not, not a vision or an idea that existed. So, I and a few other like-minded people, like Shirley Moore, for example, got together to try and say, how can we introduce these ideas into a medical curriculum. At the same time Shirley helped us, she was also thinking about developing these ideas and putting them in place in the nursing curriculum. So we had to find interested people wherever we could. We found a number of students. Usually the students were irritated about something that wasn't right in the, in the school. And so what we wound up initially helping them to say what kind of tools could you use to help make things better. And so we worked with, individually with students and a few faculty joined in. And after a while we thought maybe we could take some of these ideas and actually turn them into a short course. We were also joined by Farrohk Alemi who at the time was at Cleveland State University so that this became a cooperative activity not only across professions, but across two different universities in the same community. From that, the course evolved. There was a key part of the course, was to work very hard, to make sure there were both nursing students, and medical, and other students all in the same room, at the same time, working together on improvement projects. And that's a very distinctive feature. We really are continuing to be convinced about the importance of all health professionals learning these ideas, sharing them, and in combination, making them powerful to change their life. I think one of the values for you of this course, is that, that you're going to learn a lot of things that can give very practical value to your life. Whether it's a personal improvement project, or it's how to run a meeting successfully, or to answer the question “how do we know we're making an improvement?” So, this is a course that is not abstract, this is a course that is practical and hands on. You should be able to say, I see the world differently and now I think I can do things to make things better. I think you're going to have a fine time doing this. You have the best of teachers involved in this activity, and a lot of experience. [MUSIC]
