Quality improvement efforts often fall short by not following through with measurement after implementing new guidelines or care processes, according to Raul Coimbra, MD, PhD, FACS, surgeon-in-chief at Riverside University Health System Medical Center in Moreno Valley, CA.

After seeing many quality improvement efforts throughout his career, Coimbra argues that a key measure should be how often clinicians actually do what they say they do.

Coimbra notes that often, hospitals implement new procedures or processes, and then intend to measure compliance. However, the measurement often falls short and may rely on only a clinician’s report.

Coimbra cautions that the result can be that quality leaders may see a rosy picture of compliance. In reality, what really may be happening with patients could be quite different.

“I believe quality improvement in medicine today should be based on consistency, because consistency decreases costs and improves quality,” Coimbra says. “It is consistency that will make us better and better, but we have to keep an eye on it every day to make sure we are doing the best we can for our patients.”

There may be some hospitals that rely too much on the morbidity and mortality (M&M) conference to assess performance and identify deviations, Coimbra suggests.

“The M&M conference is a very antiquated method of doing quality improvement. You go into this room, and the chairman of the department is like a god sitting in the front row. You present your information, and then you are criticized. They throw tomatoes at you. Hopefully, at the end, there will be some lessons learned,” Coimbra says. “That does not take quality improvement to the next level where you identify a problem, develop actions to correct the problem, and measure our performance six months from now.”

Coimbra also believes quality leaders should push for more measurement of what the physician does rather than just conditions associated with the patient. Coimbra suggests that physicians need to know what they are doing that affects those more commonly measured metrics.

“For me, it’s less important to know how many times my trauma patients develop a pneumonia in the ICU [intensive care unit] than it is to identify how often I go to the operating room and there is delay in making a decision, or how many times there is a delay in obtaining a subspecialty consult,” Coimbra shares. “I need to know how many times there is an error in reading a CT scan and we make the wrong clinical decisions, all of the things that are related to ourselves and how we deliver care.”


  • Raul Coimbra, MD, PhD, FACS, Surgeon-in-Chief, Riverside University Health System Medical Center, Moreno Valley, CA. Phone: (951) 486-4000.