An effective QI program requires changes in an organization's culture and infrastructure to overcome its traditional barriers and works toward a common goal of quality. This occurs when all staff embraces the philosophy of QI and understands their roles in supporting an organization-wide focus on QI. Hierarchical roles that are important in clinical settings, and include licensure and appropriate supervision, are different from roles that support effective QI. Therefore, a paradigm shift is needed from their standard care-team roles to those that also include quality improvement.
Each of these foundational topics needs to be discussed within the management team before beginning a quality program and then periodically thereafter. Assessing leadership support of quality, staff engagement in the quality process, and the ability of an organization to manage change, provides the context for an effective QI program that may evolve over time. An organization may step back to reflect on these topics annually or, at minimum, conduct a biennial review.
The leader's role in promoting and developing QI begins with creating and sustaining a personal and organizational focus on the needs of internal and external customers. Through actions, a leader demonstrates a clear commitment to the organizational mission, values, goals, and expectations that promote quality and performance excellence. The customer-oriented mission, vision, values, and goals of an organization are best integrated into all aspects of management through effective leadership.
An organization that experiences success in the development and implementation of its QI program understands that the organization's chief officer or senior leader creates energy, synergy, and focused leadership for the QI program. Under his or her leadership, all other managers or leaders work together to:
Achieving high levels of performance requires that an organization's leaders develop a strategic quality plan to fulfill the mission of integrating QI into their organization. A strategic quality plan provides guidance for delivering safe and quality care. The plan is often updated annually by clinical, administrative, and executive leadership to ensure the organization is continuously making improvements to meet the needs of its patients and families. The strategic quality plan:
In addition to the vision and strategy, a leader needs to create and support an infrastructure that organizes and supports the work. Successful leaders found these actions helpful in creating their quality infrastructures:
For quality to be effectively managed, individuals and groups in an organization should have a clear understanding of their roles and responsibilities relative to QI. Each staff member has a role in ensuring that QI objectives set by the organization are met. Ideally, all contributions are equally valued on the QI team. Although the medical assistant may be supervised by the physician when providing patient care, the medical assistant's perspective and input within the context of the QI team are very important. Since individuals on the QI team work in fundamentally different ways when doing improvement work compared with actual patient-care delivery, it is important to formalize their roles within the committee. Common roles within a QI team include:
Depending on the focus of improvement, other individuals in an organization may bring valuable insight to the process. Any individual may be considered a candidate for a QI team if he or she is willing to be part of a team that is committed to improving quality. In a smaller organization, one person may engage in multiple roles.
While the role of the team in a QI program is significant, total quality commitment involves all levels of an organization's structure. An organization needs to build ongoing training opportunities for staff and teams into its QI framework to sustain and advance its QI efforts. Quality patient care services are achieved through positive interactions among departments that work together to build a dynamic mechanism for continuously improving processes and outcomes of health care services. Additional information, including tools and resources to assist an organization with developing and supporting a QI team, can be found in the Improvement Teams module.
Successful implementation of a QI program begins with an honest and objective assessment of an organization's current culture, and its commitment to improving the quality of its care and services. An organization may ask its staff to participate in the assessment process to determine their level of understanding about its existing QI processes. Understanding an organization's strengths and weaknesses around QI is a good starting point to assess its readiness for change. Questions that an organization may want to consider in determining its readiness are:
The questions above are provided as examples to demonstrate the assessment process; however, a team may list others specific to its organization. A key point is for an organization to understand that assessing readiness for change increases its ability to support its identified QI goals.
When assessing an organization's readiness to undertake organization-wide practice and culture changes for QI, consider traits fundamental to the success of QI, such as:
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