Continuous Quality Improvement
Continuous quality improvement (CQI) is a concept that came out of the business industry.
Rather than creating a culture of blame if things do not go well, the focus is on a team
approach to improvement that rewards the group when things get better.
CQI has been adapted for health care in several ways. One acronym for this
is FOCUS-PDCA work:
First, FOCUS on a particular issue.
- Find a process to improve
- Organize to improve a process
- Clarify what is known
- Understand variation
- Select a process improvement
Then, move through a process improvement plan, PDCA
- Plan: create a timeline of resources, activities, training and target dates.
Develop a data collection plan, the tools for measuring outcomes, and thresholds for
determining when targets have been met.
- Do: implement interventions and collect data.
- Check: analyze results of data and evaluate reasons for variation.
- Act: act on what is learned and determine next steps. If the intervention is successful,
work to make it part of standard operating procedure. If it is not successful,
analyze sources of failure, design new solutions and repeat the PDCA cycle.
Ref: 1)
American Hospital Corporation. FOCUS-PDCA Methodology, 1989.
2) Executive Learning, Inc. Continual Improvement Principles:
An Introduction to Concepts and Tools for Healthcare Leaders. Brentwood, TN, 1993.
Another focus for healthcare quality improvement is the Center to Improve
The Care of the Dying (CIDC) at Rand Health, and
The Institute for Healthcare Improvement's Collaborative to Improve Care at The End of Life
Resource:
Lynn J, Schuster, JL, Kabcenell A.
Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians
Oxford University Press, 2000.
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Development
Select section:
Change, Groups, Phase 1,
2, 3, 4
•
Change
In Individuals
In Organizations
Stages of Change
Awareness
Adoption
Implementation
Institutionalization
•
Small Group Structure / Function
Leadership
Group Formation
Group Function
•
Phase 1: Prepare to Plan
Potential of Planning Process
How Much is Enough?
Ensuring Impact
Form Initial Workgroup
Elaborate Initial Idea
Stakeholders, Customers
Need, Purpose of Program
Planning Questions
Planning Steps, Timeline
Resources Needed to Plan
Use of Consultants
Use of Retreats
Write Planning Proposal
Selling, Getting Approval
•
Phase 2: Plan the Program
Form Planning Workgroup
Review, Revise Process
Strategic Planning
What is Strategic Planning?
Models
Steps
How Much is Enough?
Resources
Review Stakeholders, Customers
Conduct Needs Assessment
Company
Competition
Customers
Conduct SWOT Analysis
Case Study - United Hospital Fund
Define the Program
Purpose, Values
Mission, Vision
Mission
Vision
Service Delivery Model
Goals, Objectives
Strategies, Tactics
Strategic Decision Points
Business Planning
Case Examples:
Cleveland Clinic
University of Virginia
Organizational Structure, Leadership
Financial Plan
Implementation Plan
Human Resources
Physical Resources
Informational Resources
Community Resources
Operations
Evaluation
Marketing Plan
Targets, Timing
Write Proposal
Suggested Proposal Outline
Sell Plan
•
Phase 3: Implement the Program
Staff Recruitment
Staff Training
High Functioning Team
Standards of Practice, Policies, Procedures
Clinical Evaluation
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Phase 4: Review Program, Revise Plan
Form Review Workgroup
Program Evaluation
Plan Evaluation
Continuous Quality Improvement
Utilization Review
Appropriateness of Hospitalization
Documentation
Pearls
Respond to Denials
Revise Plan, Further Development
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