Developing & Implementing a QI Plan

Part 1: Introduction

Part 2: Structure and Leadership

Part 3: Fictional Case Study: Using Different QI Charts / Diagrams 

Part 4: Developing a QI Plan

Part 5: Implementing a QI Plan

Part 6: Related Resources

Part 2: Structure and Leadership 

For a QI effort to be successful, it requires support and buy-in from the organization leadership. Leadership play an important role in improving quality by setting priorities, providing structure to support the improvement effort, modeling core values, promoting a learning atmosphere, acting on recommendations, advocating for supportive policies, and allocating resources for improvement.

A Board of Directors can provide leadership in QI process by:

• Supporting and guiding implementation of QI activities;
• Reviewing, evaluating and approving the QI plan annually; and
• Providing/approving necessary resources to execute the QI plan.

It is important to determine what is needed to achieve your QI priorities: People, funding, equipment, space, training/development. Adequate resources should be allocated to staff time; ongoing training of employees and medical staff; technical assistance; materials or equipment; and technical support, such as management information system. Recently there has been a concerted effort for organizations to adopt Electronic Health Records (EHRs) and incentive programs, improving the information available to providers at the point of care. As organizations develop their QI plans they should consider the healthcare environment including national quality measurement and reporting systems. It will be important to develop strategies to organize and standardize QI measures and efforts across the health care organization.

Educate all levels of staff about the importance of QI and provide them with skills needed to be involved in QI activities. Following are some CQI tools and techniques (PDF - 47 pages) available to assist in the

QI process:

Flow Chart is used to identify the actual flow or sequence of events in a process. It can be used in early stage of a QI project to help team members gain a better understanding of how processes are actually happening. Once problems are identified, a second flow chart can be created to show how a process should be performed.

Figure 1. Flow Chart Example

Source: HIVQUAL Group Learning Guide. New York State Department of Health AIDS Institute. 

Brainstorming (PDF - 4 pages) is used to generate a large number of ideas for issues to tackle, possible causes, approaches to use, or actions to take through the interaction of a group of people. It is used in a group setting to bring out ideas to find possible solutions and causes for a problem/issue.

Figure 2. Brainstorming Example

Source: American Society for Quality

Affinity Diagram (PDF - 4 pages) is used to gather large number of ideas, issues or opinions and organize them into groupings based on their natural relationship. You can use this tool to group ideas generated by brainstorming with your team and to sift through large volume of data/information.

Figure 3. Affinity Diagram Example

Source: American Society for Quality

Cause and Effect/Fishbone Diagram/Ishikawa is used to identify and graphically display all possible causes of a certain effect. This tool help team members to think in a systematic way and understand a problem and all the factors /root causes associated with the problem/cause/effect.

Figure 4. Sample Fishbone diagram

Source: Quality Improvement: Guide for HIV/AIDS Clinical Care, AETC National Resource Center

Histogram is a bar chart used to recognize and analyze patterns in a large set of data that are not apparent simply by looking at a table of data, or by finding the average or median.

Figure 5. Histogram

Pareto Chart can be used to display categories of problems graphically so they can be properly prioritized. You can use this tool when communicating to others about your data. It can be used when analyzing data about the frequency of problems or causes in a process or when there are many problems or causes and you want to focus on the most significant problem.

Figure 6. Pareto chart

Source: HIVQUAL Group Learning Guide. New York State Department of Health AIDS Institute.

Run Chart is used to study observed data (a performance measure of a process) for trends and patterns over a specified period of time. This tool helps you to see changes in performance over time and understand variation in process performance. It can be used to report data to senior staff or team members.

Figure 7. Run Chart

Source: American Society for Quality

Control Chart is used to monitor, control, and improve process performance over time by studying variation and its source. This tool is used to study how a process changes over time. Data are plotted in time order. A control chart has a central line for the average, an upper line for the upper control limit (UCL) and a lower line for the lower control limit (LCL). This information can be used to identify opportunities to improve performance or measure the effectiveness of a change in a process, procedure, or system.

Figure 8. Control Chart

Source: American Society for Quality

Benchmarking (PDF - 6 pages) involves comparing characteristics of different entities for the purpose of understanding the performance of other similar organizations and improving one’s own performance.  Benchmarking enables entities to improve their position competitively by helping clarify consumer needs and modern technologies and/or processes necessary to meet those needs.

Figure 9. Bar Chart

Source: Comparing Harvard Pilgrim's CAHPS Results to National and Regional Benchmarks. Agency for Healthcare Research & Quality (AHRQ) (2008).  

StoryBoard is a useful communication tool for effectively presenting a team’s work to a variety of audiences.

Figure 10. Storyboard

Source: Michigan Story Boards (PDF - 5 pages)

Dashboard is a visual tool that highlights an organization’s performance in a number of designated areas of quality. It includes response actions and desired changes in system, education, and compliance/competency behaviors, etc.

Figure 11. Dashboard

Source: Managing Data for Performance Improvement: Dashboard for Monitoring Improvements in Comprehensive Care. Health Resources and Services Administration.