Quality improvement: Difference between revisions

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Different approaches may be needed depending on the level of certainty in the clinical science behind a quality improvement project.<ref name="pmid25407138">{{cite journal| author=Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF et al.| title=Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science. | journal=Implement Sci | year= 2014 | volume= 9 | issue=  | pages= 165 | pmid=25407138 | doi=10.1186/s13012-014-0165-1 | pmc=4239371 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25407138  }} </ref>
Different approaches may be needed depending on the level of certainty in the clinical science behind a quality improvement project.<ref name="pmid25407138">{{cite journal| author=Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF et al.| title=Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science. | journal=Implement Sci | year= 2014 | volume= 9 | issue=  | pages= 165 | pmid=25407138 | doi=10.1186/s13012-014-0165-1 | pmc=4239371 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25407138  }} </ref>
==Work culture and quality improvement==
A cross-sectional study of 537 American hospitals found that clinical improvement was associated with  the following, ranked in descending order of impact<ref name="pmid22547471">{{cite journal| author=Bradley EH, Curry LA, Spatz ES, Herrin J, Cherlin EJ, Curtis JP et al.| title=Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. | journal=Ann Intern Med | year= 2012 | volume= 156 | issue= 9 | pages= 618-26 | pmid=22547471 | doi=10.7326/0003-4819-156-9-201205010-00003 | pmc=3386642 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22547471  }} </:
* 'having physician and nurse champions rather than nurse champions alone'
* 'fostering an organizational environment in which clinicians are encouraged to solve problems creatively'
* 'holding monthly meetings to review AMI cases between hospital clinicians and staff who transported patients to the hospital'
* 'having cardiologists always on site'
* 'not cross-training nurses from intensive care units for the cardiac catheterization laboratory'


==References==
==References==

Revision as of 22:10, 19 June 2018

For other uses, see QI (disambiguation).

Quality improvement is "the attainment or process of attaining a new level of performance or qualit."[1].

The Malcolm Baldrige Health Care version of the Criteria for Performance Excellence (HCPE) award has been created to foster a culture of quality improvement across an organization. Two studies of the impact of the award have found:

  • "No significant difference in process of care results or outcomes between Baldrige recipients and their competitors, there was a significant difference in patient experience results" [2].
  • "Slight enhancements in clinical outcomes, while hospital financial and efficiency measures all showed overwhelmingly positive operating results"[3]

Wennberg's classification framework can categorize causes of unwarranted variation[4].

Lean Sigma

Lean sigma combines approaches[5].

Measuring quality

Quality measures and their benchmarks are available form several organizations including:

  • CQI Resource Center (coordinated by the Centers for Medicare & Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC); U.S. Department of Health and Human Services)

Why quality improvement efforts succeed and fail

Various organizational characteristics, some based on complexity science[6][7], may predict why quality improvement projects succeed[8][9][9][10] and fail[11][12].[13]

Studies using appreciative inquiry have been done.[11][14]

Different approaches may be needed depending on the level of certainty in the clinical science behind a quality improvement project.[15]

Work culture and quality improvement

A cross-sectional study of 537 American hospitals found that clinical improvement was associated with the following, ranked in descending order of impact<ref name="pmid22547471">Bradley EH, Curry LA, Spatz ES, Herrin J, Cherlin EJ, Curtis JP; et al. (2012). "Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction". Ann Intern Med. 156 (9): 618–26. doi:10.7326/0003-4819-156-9-201205010-00003. PMC 3386642. PMID 22547471. </:

  • 'having physician and nurse champions rather than nurse champions alone'
  • 'fostering an organizational environment in which clinicians are encouraged to solve problems creatively'
  • 'holding monthly meetings to review AMI cases between hospital clinicians and staff who transported patients to the hospital'
  • 'having cardiologists always on site'
  • 'not cross-training nurses from intensive care units for the cardiac catheterization laboratory'

References

  1. ↑ Anonymous (2024), Quality improvement (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Schulingkamp, R. C., & Latham, J. R. (2015). Health Care Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors.
  3. ↑ Unger, K. L. (2013). An investigation into the effects of winning the Malcolm Baldrige National Quality Award on the performance of hospitals/healthcare systems (Doctoral dissertation, Colorado State University).
  4. ↑ Harrison R, Manias E, Mears S, Heslop D, Hinchcliff R, Hay L (2018). "Addressing unwarranted clinical variation: A rapid review of current evidence". J Eval Clin Pract. doi:10.1111/jep.12930. PMID 29766616.
  5. ↑ Danese, P., Manfè, V. and Romano, P. (2017), A Systematic Literature Review on Recent Lean Research: State-of-the-art and Future Directions. International Journal of Management Reviews. doi:10.1111/ijmr.12156
  6. ↑ Massoud MR, Barry D, Murphy A, Albrecht Y, Sax S, Parchman M (2016). "How do we learn about improving health care: a call for a new epistemological paradigm". Int J Qual Health Care. 28 (3): 420–4. doi:10.1093/intqhc/mzw039. PMC 4931911. PMID 27118664.
  7. ↑ Jordon M, Lanham HJ, Anderson RA, McDaniel RR (2010). "Implications of complex adaptive systems theory for interpreting research about health care organizations". J Eval Clin Pract. 16 (1): 228–31. doi:10.1111/j.1365-2753.2009.01359.x. PMC 3667707. PMID 20367840.
  8. ↑ Leykum LK, Pugh J, Lawrence V, Parchman M, Noël PH, Cornell J; et al. (2007). "Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes". Implement Sci. 2: 28. doi:10.1186/1748-5908-2-28. PMC 2018702. PMID 17725834.
  9. ↑ 9.0 9.1 Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR (2010). "The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure". Implement Sci. 5: 66. doi:10.1186/1748-5908-5-66. PMC 2936445. PMID 20735859.
  10. ↑ Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT (2013). "How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts". Soc Sci Med. 93: 194–202. doi:10.1016/j.socscimed.2012.05.040. PMID 22819737.
  11. ↑ 11.0 11.1 Ruhe MC, Bobiak SN, Litaker D, Carter CA, Wu L, Schroeder C; et al. (2011). "Appreciative Inquiry for quality improvement in primary care practices". Qual Manag Health Care. 20 (1): 37–48. doi:10.1097/QMH.0b013e31820311be. PMC 4222905. PMID 21192206.
  12. ↑ Arar NH, Noel PH, Leykum L, Zeber JE, Romero R, Parchman ML (2011). "Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home". Qual Prim Care. 19 (5): 289–300. PMC 3313551. PMID 22186171.
  13. ↑ Michel, P., et al. "What are the Barriers and Facilitators to the Implementation and/or Success of Quality Improvement and Risk Management in Hospitals: A Systematic Literature Review." J Epidemiol Public Health Rev 1.4 (2016).
  14. ↑ Peelle, Henry E. (2006). "Appreciative Inquiry and Creative Problem Solving in Cross-Functional Teams". The Journal of Applied Behavioral Science. SAGE Publications. 42 (4): 447–467. doi:10.1177/0021886306292479. ISSN 0021-8863.
  15. ↑ Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF; et al. (2014). "Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science". Implement Sci. 9: 165. doi:10.1186/s13012-014-0165-1. PMC 4239371. PMID 25407138.



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