Quality Improvement in Healthcare
Quality improvement (QI) is an important initiative for implementation in healthcare organizations of all sizes. Since a number of questions have been raised about this type of program and its implications, this response considers each of those in order. Quality Improvement in Healthcare
The Purpose and Need for QI Programs
The essence of QI programs is to improve patient care across a broad spectrum of measures. The U.S. Department of Health and Human Services defines QI as a “systematic and continuous actions that lead to measurable improvement in health care services and health status of targeted patient groups” (HRSA 2014). QI considers how processes are performed now, and measures improvements by measuring the changes in the organizations efficience, patient outcomes, and patient satisfaction surveys (HRSA 2014). This means that to change these outcomes, the current process within the organization must change and improve. Fundamentally, this means viewing patient care as a process, and it implies keeping the focus on the patients, on teamwork, and on proper and effective use of data about process and patients (HRSA 2014).
The key reasons QI is essential for today’s healthcare organization include that it leads to improved patient outcomes (both in terms of process and health outcomes; that it leads to improved managerial and clinical efficiency; that it avoids costs associated with mistakes and errors and poor patient outcomes; that it results in a proactive process that fixes problems earlier rather than after they’ve become unmanageable; and that it improves communications and relationships with the community, its local organizations and government (HRSA 2014).
Perspectives on QI from Various Stakeholders
Stakeholders in a healthcare facility have different perspectives on the issue of QI. For example, the patient wants to get well as quickly as possible. The healthcare third-party payer wants the patient to use the fewest and least expensive resources while achieving or maintaining good health. The healthcare workers want to provide the best available care, regardless of price. The healthcare organization’s administration and budgetary officers may want to achieve those healthcare goals at minimum cost and using the fewest possible resources.
In addition to these obvious stakeholders, the federal government in the form of the QIO Program (for Medicare) and similar programs for the Veterans Administration have strong interest in improving healthcare while keeping costs under control. According to the CMS (2014), the goals of the Medicare QIO Program are to “improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries” (CMS 2014). Quality Improvement in Healthcare
Because QI programs invariably generate changes in how the organization operates, any significant resistance to change may impact the project from a variety of levels, including push-back from doctors, nurses, support staff, administrators, and so on. The HRSA illustrates the general QI process in figure 1.
Roles Involved in QI Initiatives
Because QI programs can involve all aspects of a healthcare organization, such a program can potentially involve all elements of the organization, from those involved in support functions (janitorial, maintenance, etc.), specialist support staff (IT staff, therapists, radiology and phlebotomist technicians), as well as all medical staff and all administrative staff. With the focus on process rather than any specific step, a far-reaching QI initiative involves all aspects of the organization.
Not all QI programs have to be that extensive, however. Scott and George (2014) described a process improvement project that focused on one specific issue, that of reducing patient callbacks about medical information. The purpose of this specific QI was very limited: improve patient communication to assure confidential information is securely relayed to the patient in a timely way. A key element in this particular QI is that it involved only one particular problem that had been identified by the heathcare facility. In other words, the organization didn’t try to fix everything all at once. This organization started with a complex messaging system in which all messages and patient information from diagnostic lab results, lab messages, prescription requests, provider message boxes, and patient questions funneled through a single callback nurse. Scott and George (2014) used a Plan-Do-Study-Act (PDSA) approach to address this problem. A change in how messages were processed removed the bottleneck of the callback nurse and provided a better way to call patients in a more timely way. Instead of a nurse, phone operators took care of routing messages among labs, providers, and other internal systems, leaving the nurse free solely to deal with messages to and from the patient (Scott & George 2014). Quality Improvement in Healthcare
Monitoring Needs for QI Initiatives
The importance of monitoring the process to be improved begins by assessing the current situation to determine what needs to be improved. Once the problem is defined, then the identification of the factors that contribute to or measure the results of that specific process or processes determines the elements that need to be monitored. Whatever elements are monitored, they should be monitored before the QI initiative is implemented, as it is being implemented, and after it has been in place for an appropriate level of time. Only with data such as that can the effectiveness of the improvement be assessed to determine if further changes are needed. While some elements may not be readily measurable with numbers, Yildiz and Demirons (2014) noted that the most common assessment tool for non-numerical results across a wide variety of healthcare facilities was expert judgment of effectiveness.
Roles of Accrediting and Regulatory Organizations in QI
A number of organizations focus on regulating and accrediting healthcare organizations with respect to patient services quality. For example, the Joint Commission has an established set of national patient safety goals for healthcare organizations of various types (ambulatory, hospital, home care, etc.) (Joint Commission 2014). The Joint Commission provides accreditation reviews for healthcare organizations, one portion of which pertains directly to patient services quality. The government also has key organizations, including the QIO Program for Medicare (CMS 2014), and the Health Resources Services Administration (HRSA 2014) that are deeply involved in monitoring healthcare organizations with QI initiatives. Quality Improvement in Healthcare
Resources and Organizations That Assist with QI Initiatives
Many resources are available to assist with QI initiatives. (All organizations mentioned here are noted in the References list with website information for further information.) In terms of professional organizations, the American Healthcare Quality Association (AHQA) is a not-for-profit professional organization with the goal of improving healthcare in the U.S. Membership in the AHQA provides access to experts, advice, and resources needed to implement QI initiatives, as well as current information on regulatory and legal initiatives concerning QI.
- AHQA. (2014). Quality improvement organizations. American Healthcare Quality Association. Web. http://www.ahqa.org
- CIHQ. (2014). CIHQ website. Center for Improvement in Healthcare Quality. Web. http://www.cihq.org/default.asp
- CMS. (2014). Quality improvement organizations. Centers for Medicare and Medicaid Services. Web. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html
- HRSA. (2014). Quality improvement. Health Resources and Services Administration, U.S. Department of Health and Human Services. Web. http://www.hrsa.gov/
- Joint Commission. (2014). National patient safety goals. The Joint Commission. Web. http://www.jointcommission.org/standards_information/npsgs.aspx
Quality Improvement in Healthcare