Introduction to Quality Improvement
The purpose of this introduction is to help anyone with an interest in improving care, understand and apply principles and practices of Quality Improvement (QI). The basics of QI will be explained, and outlined practical applications for improvement of care will be discussed.
Our goal is to help anyone understand;
• What are measures of quality?
• What are some different models of QI?
• What is the difference between QI and research?
• How can I apply the resources given to my own practice?
What is Quality Improvement?
Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. Quality in health care is a direct correlation between the level of improvement and the desired health outcomes.
How quality is defined, depends on an organization's underlying system of care. Therefore, to achieve a different level of performance and improve quality, an organization's current system needs to change.
A successful QI intervention should incorporate the following key principles:
• QI should focus on systems and processes
• QI should focus on specific patients and patient groups
• QI should have a focus on multidisciplinary change and acceptance
• QI should focus on the use of the data for continuous improvement assessment
QI Systems and Processes
To make improvements, an understanding of each individual organization’s systems and processes is essential.
QI is most effective if it is individualized to meet the needs of a specific health service delivery system.
Process mapping is a tool commonly used to better understand the processes within a specific practice. A process map provides a visual diagram of a sequence of events that result in a particular outcome. By outlining specific steps, a process map can identify deficiencies and opportunities for improvement within the organization.
By comparing a process map to pertinent clinical guidelines for a specific clinical outcome, an organization can find specific opportunities for improvement of delivered care. The goal of QI is to provide an efficient and productive pathway that allows multi-disciplinary teams to provide optimal health care outcomes.
In order for QI to be successful, there needs to be a focus on a multidisciplinary approach to interventions. By incorporating all stakeholders in a QI intervention, the team will continue to gain knowledge and perspectives from different individuals, which makes for lasting and more effective improvements. Staff commitment and buy-in are crucial to lasting results.
It is the responsibility of each individual to be an active and contributing member of the team. Each person on a team brings a unique perspective to the process. In addition to individual stakeholders, an effective infrastructure, which includes policies and procedures, tools, resources, goals, active communication, and designated leadership roles, is also fundamental to implementing lasting care improvements.
Analysis of data is the cornerstone of QI. Data allows for constant auditing and continuous improvement. Data can demonstrate effectively how current systems are working, what happens when changes are applied, and how well an intervention is working, long term.
Data allows for objective measures of care. These measures can be used to:
• Obtain baseline markers that can be used to compare outcomes
• Indicate whether interventions lead to improvements in care
• Removes emotional and subjective measures, and shows true “measurable” changes
• Allows for auditing and persistent monitoring of interventions to prevent ineffective solutions and sustain change
• Allows comparison of outcomes with other available comparative data (i.e. CPQCC Data Reports)
A health care organization already has considerable data from various sources, such as, clinical records, practice management systems, satisfaction surveys, external evaluations, etc. By focusing on existing data, an organization can easily identify opportunities for improvement, and monitor performance improvement over time.
An easy way to implement QI measures is to model them after standardized performance measures/guidelines for standards of care. By setting goals and specific measures for improvement, an organization can keep track of improvements in care by regularly assessing whether the interventions are moving in the intended direction.
Differentiating QI from PI and Research
Sometimes Quality Improvement (QI) and Performance Improvement (PI) are used interchangeably. The focus of QI is quality of care as a measured outcome. PI refers to changes in a system’s performance which is usually focused on infrastructure and administrative processes. Although they are different terms and processes, they are not mutually exclusive, since improvements in infrastructure and administration may positively impact delivery of quality care.
QI also cannot be confused for research. Research focuses on testing new methods and its intent is to create knowledge. QI focuses on improving current practices internally within the standard of care, and by definition the data is confidential. Where as, research is intended to be published and presented and needs IRB approval.
Implementing meaningful change within your organization through QI practices, does not have to be difficult. If you are a part of the CPQCC Network, you are already one step ahead of the game. By analyzing your yearly CPQCC reports, you can easily identify areas that may need improvement. The organization can then focus on specific outcome measures that they might want to improve on. You can also use one of the many QI Toolkits available through the CPQCC to target a specific outcome. Once a specific outcome measure that will be targeted is determined, compare your current policies and procedures with up to date guidelines and standards of care. If needed, make pertinent changes to your current practice to be in-line with current standards using a multi-disciplinary approach. Once interventions are started, continuously analyze your data to ensure that the expect change is being met. Set specific goals, and continuously collect and analyze data to ensure that the intended improvements in quality of care are long lasting.
If you would like to learn more about Quality Improvement, the Institute for Healthcare Improvement has useful resources and modules that explain the process of QI in greater detail.