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The Clinical Support Systems Program concept: what is it and where did it come from?

Studies in a number of countries have demonstrated an alarming number of adverse events in hospitals, many leading to permanent disability or death.1,2 A significant proportion of these adverse events were judged to be preventable. Concerns flowing from such reports have led to a great deal of attention to improving quality of care in hospitals. A variety of techniques have been used, but the most durable has been some variant of the recurring cycles of internal audit and system modification used initially in the Japanese motor car industry and adapted and popularized in health care by Donald Berwick and others.3 Commonly termed ‘Continuous Quality Improvement’ or ‘Continuous Practice Improvement’ (CPI), this technique has been applied widely, although incompletely, in the health-care sector. In hospitals, its systematic implementation has been impeded by the absence of designated funding and by incomplete understanding of methodologies. There has also been a lack of support systems to allow information to be gathered and analysed.