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

SUMMARY Review date: 1969 to 2003, 34 years. Background and context: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Objectives: Review and synthesize existing evidence in educational science that addresses the question, ‘What are the features and uses of high-fidelity medical simulations that lead to most effective learning?’. Search strategy: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the ‘grey literature’ were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Inclusion and exclusion criteria: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data extraction: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Data synthesis: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Headline results: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following:

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Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

人教版高中英语新课程教材中,语言运用（Using Language）是每个单元必不可少的部分,提供了围绕单元中心话题的听、说、读、写的综合性练习,是单元中心话题的延续和升华.如何设计Using Language部分的教学,使自己的教学模式既不落俗套,又能真正体现新课程标准所倡导的教学理念,正是广大一线英语教师一直努力探索的问题.

打磨Using Language,倡导新理念

Objective:To evaluate the relationship between burnout and perceived major medical errors among American surgeons.Background:Despite efforts to improve patient safety, medical errors by physicians remain a common cause of morbidity and mortality.Methods:Members of the American College of Surgeons we

Burnout and medical errors among American surgeons.

Normal accidents. Living with high-risk technologies

Reducing mishaps from medical management is central to efforts to improve quality and lower costs in health care. Nearly 100 000 patients are estimated to die preventable deaths annually in hospitals in the United States, with many more incurring injuries at an annual cost of $9 billion. Underreporting of adverse events is estimated to range from 50%-96% annually.1–3 This annual toll exceeds the combined number of deaths and injuries from motor and air crashes, suicides, falls, poisonings, and drownings.4 Many stakeholders in health care have begun to work together to resolve the moral, scientific, legal, and practical dilemmas of medical mishaps. To achieve this goal, an environment fostering a rich reporting culture must be created to capture accurate and detailed data about nuances of care.

Outcomes in complex work depend on the integration of individual, team, technical, and organisational factors. 5 6 A continuum of cascade effects exists from apparently trivial incidents to near misses and full blown adverse events. 7 8 Consequently, the same patterns of causes of failure and their relations precede both adverse events and near misses. Only the presence or absence of recovery mechanisms determines the actual outcome.9 The National Research Council defines a safety “incident” as an event that, under slightly different circumstances, could have been an accident.10 Focusing on data for near misses may add noticeably more value to quality improvement than a sole focus on adverse events.

Schemes for reporting near misses, “close calls,” or sentinel (“warning”) events have been institutionalised in aviation,w1 w2 nuclear power technology,w3 w4 petrochemical processing, steelw5 production,w6 military operations, and air transportation.w7-w11 In health care, efforts are now being made to create incident reporting systems for medical near misses 8 11–15 to supplement the limited …

https://www.bmj.com/content/bmj/320/7237/759.full.pdf

Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems

Adverse drug events cause substantial morbidity and mortality, yet they remain underappreciated and misunderstood. The terminology to describe errors and patient harm associated with medications causes much confusion. This article uses the case study of a patient with multiple adverse drug events to clarify key terms, such as adverse event, adverse drug reaction, adverse drug event, medication error, and side effect. The case discussion illustrates clinical approaches to analyzing the causal connection between a suspect drug and an adverse event. Examples and rationale for meaningful documentation of adverse drug events are provided, along with an outline of the types of events that should be reported to regulatory agencies.

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Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting

analysis is based on the screening of various socio-technical professions, such as the aviation, nuclear power, chemical, and food industries; road transportation; and health care. The benchmark analysis aims to associate specific traits of these industries with their safety performance. We then describe 5 high-level organizational dimensions derived from the general literature on risk and safety (11–13), each of which is associated with a range of values: type of expected performance (from daily routine work to highly innovative, and standardized or repetitive), interface of health care providers with patients (from full autonomy to full supervision), type of regulations (from few recommendations to full specification of regulations at an international level), pressure for justice after an accident (from little judicial scrutiny to routine lawsuits against people and systems), and supervision and transparency by media and people in the street of the activity (from little concern to high demand for national supervision). We consider the value of a given dimension to become a barrier when it is present for all work situations that entail equal or less safety and it is absent for all work situations that entail greater safety. The barriers can be ranged along a safety axis by considering the average safety

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Five system barriers to achieving ultrasafe health care.

This review examined interventions to improve patient handovers from hospital to primary care. Among 36 trials, many interventions had positive effects on patient care, including medication reconci...

Improving Patient Handovers From Hospital to Primary Care: A Systematic Review

Hypothesis Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events (WSPEs) are devastating, unacceptable, and often result in litigation, but their frequency and root causes are unknown. Wrong-side/wrong-site, wrong-procedure, and wrong-patient events are likely more common than realized, with little evidence that current prevention practice is adequate. Design Analysis of several databases demonstrates that WSPEs occur across all specialties, with high numbers noted in orthopedic and dental surgery. Databases analyzed included: (1) the National Practitioner Data Bank (NPDB), (2) the Florida Code 15 mandatory reporting system, (3) the American Society of Anesthesiologists (ASA) Closed Claims Project database, and (4) a novel Web-based system for collecting WSPE cases (http://www.wrong-side.org). Results The NPDB recorded 5940 WSPEs (2217 wrong-side surgical procedures and 3723 wrong-treatment/wrong-procedure errors) in 13 years. Florida Code 15 occurrences of WSPEs number 494 since 1991, averaging 75 events per year since 2000. The ASA Closed Claims Project has recorded 54 cases of WSPEs. Analysis of WSPE cases, including WSPE cases submitted tohttp://www.wrong-side.org, suggest several common causes of WSPEs and recurrent systemic failures. Based on these findings, we estimate that there are 1300 to 2700 WSPEs annually in the United States. Despite a significant number of cases, reporting of WSPEs is virtually nonexistent, with reports in the lay press far more common than reports in the medical literature. Our research suggests clear factors that contribute to the occurrence of WSPEs, as well as ways to reduce them. Conclusions Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events, although rare, are more common than health care providers and patients appreciate. Prevention of WSPEs requires new and innovative technologies, reporting of case occurrence, and learning from successful safety initiatives (such as in transfusion medicine and other high-risk nonmedical industries), while reducing the shame associated with these events.

https://jamanetwork.com/journals/jamasurgery/articlepdf/398954/soa60001.pdf

Paul Barach

Papers

Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems

Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting

Five system barriers to achieving ultrasafe health care.

Improving Patient Handovers From Hospital to Primary Care: A Systematic Review

Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: Are they preventable?