Question

How can quality improvement be a daily task in patient care?

Why does continous quality improvement need to be associated with change?

Answer 1

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. The Institute of Medicine (IOM), which is a recognized leader and advisor on improving the Nation’s health care, defines quality in health care as a direct correlation between the level of improved health services and the desired health outcomes of individuals and populations.

Continuous quality improvement (CQI) is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients.

Quality health care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”.

Efforts to improve quality need to be measured to demonstrate “whether improvement efforts (1) lead to change in the primary end point in the desired direction, (2) contribute to unintended results in different parts of the system, and (3) require additional efforts to bring a process back into acceptable ranges”.

Quality improvement projects and studies aimed at making positive changes in health care processes to effecting favorable outcomes can use the Plan-Do-Study-Act (PDSA) model. This is a method that has been widely used by the Institute for Healthcare Improvement for rapid cycle improvement. One of the unique features of this model is the cyclical nature of impacting and assessing change, most effectively accomplished through small and frequent PDSAs rather than big and slow ones, before changes are made systemwide. The purpose of PDSA quality improvement efforts is to establish a functional or causal relationship between changes in processes (specifically behaviors and capabilities) and outcomes. The PDSA cycle starts with determining the nature and scope of the problem, what changes can and should be made, a plan for a specific change, who should be involved, what should be measured to understand the impact of change, and where the strategy will be targeted. Change is then implemented and data and information are collected. Results from the implementation study are assessed and interpreted by reviewing several key measurements that indicate success or failure. Lastly, action is taken on the results by implementing the change or beginning the process again.

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; i.e., how things work; what happens when changes are made, and how to sustain improvements during daily work. Contributions are made from each individual’s skill set and the team’s synthesis of ideas. Additional information, including tools and resources to assist an organization in developing and supporting a QI team within its organization, can be found in the Improvement Teams module.

Continuous Quality Improvement (CQI) is a philosophy that encourages all health care team members to continuously ask: “How are we doing?” and “Can we do it better?” More specifically, can we do it more efficiently? Can we be more effective? Can we do it faster? Can we do it in a more timely way? Continuous improvement begins with the culture of improvement for the patient, the practice, and the population in general.Besides creating this inquisitive CQI culture in an organization, the key to any CQI initiative is using a structured planning approach to evaluate the current practice processes and improve systems and processes to achieve the desired outcome and vision for the desired future state. Tools commonly used in CQI include strategies that enable team members to assess and improve health care delivery and services.

Applying CQI to a practice’s EHR implementation means that the health care team must understand what works and what does not work in the current state and how the EHR will change care delivery and QI aims. The CQI plan identifies the desired clinical or administrative outcome and the evaluation strategies that enable the team to determine if they are achieving that outcome. The team also intervenes, when needed, to adjust the CQI plan based on continuous monitoring of progress through an adaptive, real-time feedback loop.

Meaningful Use is an important means to achieving the triple aims of health care—improving the experience of patient care, improving population health, and reducing per capita costs of health care.

Attesting to Meaningful Use, although it is an important milestone for a practice, is not an end unto itself. Practices that can achieve Meaningful Use will be able to use their EHR to obtain a deep understanding of their patient population and uncover aspects of patient care that could be improved. Using a planned, strategic approach to CQI will help a practice move from reporting the requirements for Meaningful Use to improving patient care and meeting other practice goals. The literature shows a strong link between an explicit CQI strategy and high performance. Put together, CQI and Meaningful Use can move a practice from its current state to a more desirable future state. CQI begins with a clear vision of the transformed environment, identification of necessary changes to achieve that vision, and input from engaged team members who understand the needs for the practice. In short, the journey to the desired future state involves a transformation of people, process, and technology. Meaningful Use of health information and an explicit commitment to CQI can help a practice establish that clear vision and implement it successfully.