Introduction

Professionals involved with trauma care, and medicine in general, are being asked to adopt new standards of accountability as a major societal responsibility. In addition to traditional accountability for the highest standards of care for each individual patient (trauma audit), there is an increasing need to demonstrate the efficacy and cost-effectiveness of medical practice in health systems and entire patient populations. This has led to the development of the field of performance improvement.

Performance improvement is the continuous evaluation of a system and the providers through structured review of the process ofcare as well as the outcomes. Performance improvement has evolved from previous quality assurance paradigms and represents a more scientific and evidence-based continuation of those standards. The goal of performance improvement is to ensure that trauma centers and trauma systems design processes to monitor, analyze, and improve performance systematically with the ultimate intent of improving patient outcomes. The primary focus has been shifted to the assessment of whole processes – not isolated individual components of care. A performance process may reside entirely within a department, but major processes will include several departments or disciplines. A process may be narrowly defined and formalized, or it may be fairly loose and informal. In order for performance improvement to occur, processes need to be (1) planned and designed, (2) monitored by means of ongoing data collection, (3) analyzed to determine process effectiveness, and (4) implemented with a commitment for sustained activity and improvement. Continuous monitoring, analysis, and sustained improvement are the key elements in ongoing performance improvement efforts (O'Leary, 1995).