What is Quality Improvement?
Quality Improvement (QI) is not simply an end goal. QI is a continuous process that employs rapid cycles of improvement. The Donabedian model provides three dimensions for the quality of care. These dimensions are: 1) the structure, which represents the attributes of settings where care is delivered; 2) the process, or whether or not good medical practices are followed; and 3) the outcome, which is the impact of the care on health status.
When initiating the quality improvement process, the Institute of Medicine’s quality domains (listed below) can guide the process by identifying specific areas for improvement.
Duke University’s guidance on quality improvement incorporates several models used in QI, and provides a description of five models discussed below. The processes described in each model may be combined and used together.
FADE - There are 4 broad steps to the FADE QI model:
PDSA - The 4 steps in this model include:
Six Sigma (DMAIC - define, measure, analyze, improve, control) - an improvement system for existing processes falling below specification and looking for incremental improvement.
CQI: Continuous Quality Improvement -“It focuses on the ‘process’ rather than the individual, recognizes both internal and external ‘customers’ and promotes the need for objective data to analyze and improve processes.” CQI is an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems.
TQM: Total Quality Management - a set of management practices throughout the organization, geared to ensure the organization consistently meets or exceeds customer requirements.
An additional model to consider is Root Cause Analysis (RCA). According to an EPC Evidence Report, RCA is defined as “a retrospective approach to error analysis” that “requires rigorous application of established qualitative techniques.” The report also identifies 2 major steps involved in Root Cause Analysis:
The key difference between the quality improvement models suggested by Duke and RCA is that the first five models are prospective, while RCA assesses problems retrospectively. The Duke models focus on what steps can be taken now to improve quality in the future, while RCA identifies a quality problem and how to solve this problem to improve quality. In the process of quality improvement, regardless of which model is chosen, there are three questions that implementers should consider.
Selecting a quality improvement model to address these questions is not a strictly defined process. There is not a specific model that works best based on different types of situations or concerns. When selecting a model for quality improvement, the health care organization should choose one that fits best within its existing organizational structure and workflow.
How to Improve - Institute for Healthcare Improvement
Patient Safety - Quality Improvement - Duke University
Chapter 5. Root Cause Analysis- Agency for Healthcare Research and Quality
Removing the Fluff: The Quality in Quality Improvement - Nursing Economics
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