CONCISE REVIEW FOR CLINICIANS
Basics of Quality Improvement in Health Care

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With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plan-do-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored.

Section snippets

DEFINING AND APPLYING THE CONCEPTS OF QUALITY

The US Agency for Healthcare Research and Quality defines quality health care as “doing the right thing, at the right time, in the right way, for the right person—and having the best possible results.”6 Quality was first studied as an industrial process in 1931 by Shewhart.7 Shewhart's concepts include identifying customer needs, reducing variations in processes, and minimizing inspections. Influenced by Shewhart's work, Deming8 recognized quality as a primary driver for industrial success and

MEASURING QUALITY

Measurement of defects is integral to QI. A systematic measurement of quality demonstrates 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. Using samples of success as the numerator and total opportunities as the denominator, events can be graphed using a control chart to evaluate performance

IMPROVEMENT TOOLS

Historically, health care has focused on quality assurance (ie, a system for evaluating the delivery of services or the quality of products) and quality control (ie, a system for verifying and maintaining a desired level of quality). These methods used alone are not adequate to enhance outcomes. Checking for defects and recommending changes without recognizing the effects of these changes on other parts of the organization may improve one process but harm others. Consequently, the best

QI VS RESEARCH

Confusion often exists about whether a project is associated with QI or research.21, 22, 23, 24 Most QI projects include data collection in small samples, frequent changes in protocols and interventions, discarding poor ideas, and pursuing ideas that work. This constantly changing baseline makes it problematic to think of QI as traditional research. However, the concepts of QI projects and QI research are not mutually exclusive.

Clearly, the objective of most QI projects is to efficiently

CONCLUSION

During the past 2 decades, a increase in QI activities has been slow but steady across the health care sector, perhaps influenced by market and regulatory pressures that encourage health delivery plans, employer and consumer involvement, and public reporting of performance information. A structured approach to QI using established rules of engagement has demonstrated utility in many situations common to medical care, including standardization of care, enhancement of patient safety, management

Questions About QI in Health Care

  • 1.

    Which one of the following would be the most valid outcome measure for the effectiveness of hypertension treatment?

    • a.

      Number of antihypertensive prescriptions

    • b.

      Prevalence of heart disease in the population

    • c.

      Incidence of stroke in the population

    • d.

      Cost of hospitalizations for the population

    • e.

      Number of clinic visits related to hypertension per year

  • 2.

    Which one of the following is the correct definition of PDSA?

    • a.

      Plan-design-survey-action

    • b.

      Plan-do-study-act

    • c.

      Process-deployed-suggestions-action

    • d.

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    A question-and-answer section appears at the end of this article.

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