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EDITORIALS: Mark A Kelley and James M Tucci Bridging the quality chasm BMJ 2001; 323: 61-62 [Full text]

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"To care is human"

Paul Buss   (17 July 2001)

Tools for Thinking About Complex (Health Care) Systems

John W Rodat   (31 August 2001)

"To care is human" 17 July 2001
Paul Buss, Consultant Paediatrcian Royal Gwent Hospital Send response to journal: Re: "To care is human"	Kelley and Tucci outline a number of simple, well thought out, aspects to improving the "quality of care experience" for patients following a further North American report. What is vital to a perception of improved quality in the NHS is reinforcement of the perception by patients that health care professionals at all levels actually "care" for them individually. This simple human quality can engender forgiveness for slight delays or minor discomforts and significantly aid the healing process. It is not a substitute for quality but it is a very significant addition. All the mechanistic changes necessary to ensure a robust clinical governance process in NHS Trusts must be seen to compliment the best human attributes of all staff that work within the NHS not demoralise them....to "care" is human.
Tools for Thinking About Complex (Health Care) Systems 31 August 2001
John W Rodat, President, Signalhealth, LLC Albany, NY Send response to journal: Re: Tools for Thinking About Complex (Health Care) Systems	I share Kelley's and Tucci's admiration of the diagnoses in "Bridging the Quality Chasm," and their frustration with the general nature of the prescriptions for change. It's worth noting however, that there is a discipline for thinking about complex system in an organized and systematic manner. Generally referred to as System Dynamics (SD), it was pioneered at MIT by Jay Forrester and it has been used in a wide variety of settings, including health care. Most importantly, SD has a rigor and a variety of simulation tools. These tools are used to generate local as well as global insights, test alternatives, and help build group concensus about what to and what not to do. Though SD has not yet been used extensively in health care, our experience is that it is a very powerful method for designing and pre- testing concrete solutions to the problems identified in "Crossing the Quality Chasm."