Quality improvement: Difference between revisions

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Quality measures and their benchmarks are available form several organizations including:
Quality measures and their benchmarks are available form several organizations including:
* [https://ecqi.healthit.gov 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)
* [https://ecqi.healthit.gov 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)
[[Goodhart's law]] is when measures become organizational goals, problems may ensue.


==Tactics for improvement==
==Tactics for improvement==

Revision as of 12:18, 14 October 2020

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

Wennberg's classification framework can categorize causes of unwarranted variation[2].

Methods

Lean Sigma

Lean sigma combines approaches[3].

Positive deviance

A positive deviance approach has been recommended to identify and disseminate best organizational practices[4][5] [6]Early description of this method was[4]:

  • "Develop case definitions"
  • "Identify four to six people who have achieved an unexpected good outcome despite high risk"
  • "Interview and observe these people to discover uncommon behaviours or enabling factors that could explain the good outcome"
  • "Analyse the findings to confirm that the behaviours are uncommon and accessible to those who need to adopt them"
  • "Design behaviour change activities to encourage community adoption of the new behaviours"
  • "Monitor implementation and evaluate the results"

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)

Goodhart's law is when measures become organizational goals, problems may ensue.

Tactics for improvement

A conceptual model has been developed[7] and recommended by the AHRQ[8].

Practice facilitation

Practice facilitation may help based on the experience of the American Academy of Family Physicians' (AAFP) National Demonstration Project (NDP)[9][10].

The Heart Health NOW Study found uncertain evidence from organizational leadership and Adaptive Reserve[11].

The VA's PACT used in-person[12] and online[13] collaborative methods.

The NHS...

Workforce redesign

Workforce redesign may help[14].

Why quality improvement efforts succeed and fail

Various organizational characteristics, some based on complexity science[15][16], may predict why quality improvement projects succeed[17][18][19] and fail[20][21][22]. Causes include:

Studies using appreciative inquiry have been done.[20][26]

Different approaches may be needed depending on the level of certainty in the clinical science behind a quality improvement project.[27]

Recommendations for QI projects to implement guidelines may not include tactics to foster a positive workplace culture[28][28].

Work culture and quality improvement

A systematic review found an association with workplace culture and clinical outcomes[29]. However, this review did not provide details of attributes of positive culture. This review did not find any randomized trials.

A cross-sectional study of 537 American hospitals found that clinical improvement was associated with the following, ranked in descending order of impact[30]:

  • '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'

A cohort of 10 American hospitals found[31]:

  • 'effective inclusion of staff from different disciplines and levels in the organisational hierarchy in the team guiding improvement efforts (referred to as the ‘guiding coalition’ in each hospital)'
  • 'authentic participation in the work of the guiding coalition'
  • 'distinct patterns of managing conflict'

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" [32].
  • "Slight enhancements in clinical outcomes, while hospital financial and efficiency measures all showed overwhelmingly positive operating results"[33]

References

  1. Anonymous (2024), Quality improvement (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 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.
  3. 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
  4. 4.0 4.1 Marsh DR, Schroeder DG, Dearden KA, Sternin J, Sternin M (2004). "The power of positive deviance". BMJ. 329 (7475): 1177–9. doi:10.1136/bmj.329.7475.1177. PMC 527707. PMID 15539680.
  5. Bock, L. (2015). The Two Tails. In: Work rules!: Insights from inside Google that will transform how you live and lead. Twelve. ISBN 1455554790
  6. Baxter R, Taylor N, Kellar I, Lawton R (2016). "What methods are used to apply positive deviance within healthcare organisations? A systematic review". BMJ Qual Saf. 25 (3): 190–201. doi:10.1136/bmjqs-2015-004386. PMC 4789698. PMID 26590198.
  7. Garman AN, McAlearney AS, Harrison MI, Song PH, McHugh M (2011). "High-performance work systems in health care management, part 1: development of an evidence-informed model". Health Care Manage Rev. 36 (3): 201–13. doi:10.1097/HMR.0b013e318201d1bf. PMID 21646880.
  8. Appendix 1. Definitions of High-Performance Work Practices. Content last reviewed August 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-hpwpreport/clabsi-hpwpap.html
  9. Wang A, Pollack T, Kadziel LA, Ross SM, McHugh M, Jordan N; et al. (2018). "Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review". J Gen Intern Med. doi:10.1007/s11606-018-4581-9. PMID 30066117.
  10. Chase SM, Crabtree BF, Stewart EE, Nutting PA, Miller WL, Stange KC; et al. (2015). "Coaching strategies for enhancing practice transformation". Fam Pract. 32 (1): 75–81. doi:10.1093/fampra/cmu062. PMID DOI: 10.1093/fampra/cmu062[Indexed for ME 25281823 DOI: 10.1093/fampra/cmu062[Indexed for ME Check |pmid= value (help).
  11. Henderson KH, DeWalt DA, Halladay J, Weiner BJ, Kim JI, Fine J; et al. (2018). "Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study". Ann Fam Med. 16 (Suppl 1): S29–S34. doi:10.1370/afm.2210. PMC 5891311. PMID 29632223.
  12. Bidassie B, Davies ML, Stark R, Boushon B (2014). "VA experience in implementing Patient-Centered Medical Home using a breakthrough series collaborative". J Gen Intern Med. 29 Suppl 2: S563–71. doi:10.1007/s11606-014-2773-5. PMC 4070243. PMID 24715402.
  13. Luck J, Bowman C, York L, Midboe A, Taylor T, Gale R; et al. (2014). "Multimethod evaluation of the VA's peer-to-peer Toolkit for patient-centered medical home implementation". J Gen Intern Med. 29 Suppl 2: S572–8. doi:10.1007/s11606-013-2738-0. PMC 4070245. PMID 24715401.
  14. Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJ (2018). "Nurses as substitutes for doctors in primary care". Cochrane Database Syst Rev. 7: CD001271. doi:10.1002/14651858.CD001271.pub3. PMID 30011347.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 20.0 20.1 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.
  21. 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.
  22. 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).
  23. Rose AJ, Petrakis BA, Callahan P, Mambourg S, Patel D, Hylek EM; et al. (2012). "Organizational characteristics of high- and low-performing anticoagulation clinics in the Veterans Health Administration". Health Serv Res. 47 (4): 1541–60. doi:10.1111/j.1475-6773.2011.01377.x. PMC 3401398. PMID 22299722.
  24. 24.0 24.1 Curry LA, Spatz E, Cherlin E, Thompson JW, Berg D, Ting HH; et al. (2011). "What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study". Ann Intern Med. 154 (6): 384–90. doi:10.7326/0003-4819-154-6-201103150-00003. PMC 4735872. PMID 21403074.
  25. 25.0 25.1 Gabbay RA, Friedberg MW, Miller-Day M, Cronholm PF, Adelman A, Schneider EC (2013). "A positive deviance approach to understanding key features to improving diabetes care in the medical home". Ann Fam Med. 11 Suppl 1: S99–107. doi:10.1370/afm.1473. PMC 3707253. PMID 23690393.
  26. 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.
  27. 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.
  28. 28.0 28.1 Harrison MB, Légaré F, Graham ID, Fervers B (2010). "Adapting clinical practice guidelines to local context and assessing barriers to their use". CMAJ. 182 (2): E78–84. doi:10.1503/cmaj.081232. PMC 2817341. PMID 19969563.
  29. Braithwaite J, Herkes J, Ludlow K, Testa L, Lamprell G (2017). "Association between organisational and workplace cultures, and patient outcomes: systematic review". BMJ Open. 7 (11): e017708. doi:10.1136/bmjopen-2017-017708. PMC 5695304. PMID 29122796.
  30. 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.
  31. Bradley EH, Brewster AL, McNatt Z, Linnander EL, Cherlin E, Fosburgh H; et al. (2018). "How guiding coalitions promote positive culture change in hospitals: a longitudinal mixed methods interventional study". BMJ Qual Saf. 27 (3): 218–225. doi:10.1136/bmjqs-2017-006574. PMC 5867433. PMID 29101290.
  32. Schulingkamp, R. C., & Latham, J. R. (2015). Health Care Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors.
  33. 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).


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