Pediatric Hospital Medicine

Foreword

T he journey to high-value consistent health care has been more than a half-century pursuit, but thanks to the Pediatric Hospital Medicine experts of Cleveland Clinic Children’s, this text enables all providers of inpatient pediatric care to provide the highest-value, state-of-the-art, care today. The journey started in 1970 when the Institute of Medicine (IOM) was created to provide evidence-based research and recommenda tions for public health and science policy. Among the initiatives the Institute has led, quality has been one of the most transformative for health care organizations and practicing providers. In 1998, the IOM categorized health care quality issues as underuse, misuse, or overuse, which started a dialogue about health care practice. In 2000, the IOM’s Committee on Quality of Health Care in America published “To Err Is Human: Building a Safer Health System,” which transformed thinking about health care errors, the culture of safety, and the role of processes in enabling individuals to do the right thing. Utilizing the methodol ogy for improvement developed by W. Edwards Deming (1900-1993), the Institute for Healthcare Improvement built on this published work, and the enhanced awareness regarding medical errors that it created, to advance the culture of health care improvement and evolution to high reliability (error-free performance and safety, in all activities, all of the time) in health care. Deming’s principles of management employ Plan-Do-Study-Act cycles to make small intentional changes, that are measurable, to move to a predetermined goal. In this journey of health care improvement, the need to standardize became apparent, and we now know that organizations that effectively manage in this way dem onstrate increases in the quality of care while simultaneously reducing cost, what has now been termed “value.” In 2012, the American Board of Internal Medicine Foundation com menced the Choosing Wisely ® campaign, which sought to decrease medical overuse via yearly recommendations to help standardize prac tice, thereby improving the “value” of care. Initially involving nine

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