According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Since publication of the Society for Healthcare Epidemiology of America position paper on Clostridium difficile infection in 1995, significant changes have occurred in the epidemiology and treatment of this infection. C. difficile remains the most important cause of healthcareassociated diarrhea and is increasingly important as a community pathogen. A more virulent strain of C. difficile has been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.

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Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)

Objectives This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit.

Methods  This qualitative synthesis of SBME research and scholarship was carried out in two stages. Firstly, we summarised the results of three SBME research reviews covering the years 1969–2003. Secondly, we performed a selective, critical review of SBME research and scholarship published during 2003–2009.

Results  The historical and contemporary research synthesis is reported to inform the medical education community about 12 features and best practices of SBME: (i) feedback; (ii) deliberate practice; (iii) curriculum integration; (iv) outcome measurement; (v) simulation fidelity; (vi) skill acquisition and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team training; (x) high-stakes testing; (xi) instructor training, and (xii) educational and professional context. Each of these is discussed in the light of available evidence. The scientific quality of contemporary SBME research is much improved compared with the historical record.

Conclusions  Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts.

Medical Education 2010: 44: 50–63

A critical review of simulation-based medical education research: 2003-2009

Evaluating the quality of medical care.

Purpose This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). Method This is a quantitative meta-analysis that spans 20 years, 1990 to 2010. A search strategy involving three literature databases, 12 search terms, and four inclusion criteria was used. Four authors independently retrieved and reviewed articles. Main outcome measures were extracted to calculate effect sizes.

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Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence

Contributions of Simulation-based Training to Teamwork

Divergent Trends in Emergency Department Presentations Amid the Novel Coronavirus Disease 2019 Pandemic in Chicago, Illinois.

• Objective: To review the general principles of perioperative care for the primary care physician. • Methods: Qualitative assessment of the literature. • Results: A thorough history and physical examination provides the foundation of the preoperative evaluation. Laboratory testing generally should be performed when indicated rather than as routine screening prior to surgery. The American College of Cardiology and the American Heart Association have published consensus guidelines to guide the clinician on assessing cardiac risk, the potential benefit of noninvasive testing (eg, exercise electrocardiography [ECG], exercise or dobutamine stress echocardiography, and stress myocardial perfusion imaging), and the benefit of various management options. The indications for coronary artery bypass grafting and percutaneous coronary intervention prior to noncardiac surgery are identical to those for patients in which these procedures would otherwise be indicated. β-Blocker therapy has been shown to reduce the risk of perioperative cardiac death or myocardial infarction in selected patients. In patients with high or intermediate clinical risk who have known or suspected coronary artery disease and who are undergoing high or intermediate risk procedures, the most cost-effective strategy for postoperative monitoring is to obtain a 12-lead ECG immediately after surgery and on the first 2 days postoperatively. • Conclusion: With knowledge of established risk factors obtained from a thorough history and physical examination and application of evidence-based guidelines, the physician can order appropriate testing and targeted interventions to maximize beneficial outcomes.

An Evidence-Based Approach to Perioperative Care: Update for the Primary Care Physician

INTRODUCTION
In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first three years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research.


METHODS
ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the peri-operative microsystem. The components were developed from available evidence, a detailed needs assessment of the hospitals, reviewing experiences from prior surgical and non-surgical QI Collaboratives, and interviews with QI experts. The components comprise 5 domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), hospital- and surgeon-level comparative performance reports (e.g., process, outcomes, costs), networking (e.g., forums to share QI experiences and best practices), and funding (e.g., for the overall program, pilot grants, and bonus payments for improvement).


RESULTS
Through implementation of the 21 novel ISQIC components, hospitals were equipped to use their data to successfully implement QI initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching were undertaken by the hospitals as they worked to implement solutions. Hospitals received funding for the program and were able to work together on statewide quality initiatives. Lessons learned at one hospital were shared with all participating hospitals through conferences, webinars, and toolkits to facilitate learning from each other with a common goal of making care better and safer for the surgical patient in Illinois. Over the first three years, surgical outcomes improved in Illinois.


DISCUSSION
The first three years of ISQIC improved care for surgical patients across Illinois and allowed hospitals to see the value of participating in a surgical QI learning collaborative without having to make the initial financial investment themselves. Given the strong support and buy-in from the hospitals, ISQIC has continued beyond the initial three years and continues to support QI across Illinois hospitals.

Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): Implementing 21 Components to Catalyze Statewide Improvement in Surgical Care.

We were pleased to read the letter from Drs Merchant and Federman as we had hoped that our study would prompt deeper thought and further discussion about interprofessional bedside rounds.1 Like Drs Merchant and Federman, we were disappointed that the intervention used on our study, patient-centred bedside rounds (PCBR), did not result in improved patients’ perceptions of shared decision making, activation or satisfaction with care. Merchant and Federman state that prior studies have shown that patients prefer their team conduct rounds at the bedside. We wish to point out that the studies cited …

https://qualitysafety.bmj.com/content/qhc/early/2016/02/28/bmjqs-2016-005371.full.pdf

Kevin J. O'Leary

Papers

Contributions of Simulation-based Training to Teamwork

Divergent Trends in Emergency Department Presentations Amid the Novel Coronavirus Disease 2019 Pandemic in Chicago, Illinois.

An Evidence-Based Approach to Perioperative Care: Update for the Primary Care Physician

Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): Implementing 21 Components to Catalyze Statewide Improvement in Surgical Care.

Response to the letter to the editor by Drs Merchant and Federman