continuous quality improvement (CQI) or total quality management (TQM)
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Introduction
A framework for monitoring & enhancing the outcomes of medical care.
Based on Plan-Do-Study-Act cycles to test changes in systems of care
Providers offer input into the clinical care processes
10 step process (JCAHO)
- assign responsibility
- define scope of care
- consider important aspects of care
- develop key indicators
- determine evaluation thresholds
- collect & organize data
- evaluate the care
- initiate problem-solving actions
- assess the results of those actions
- communicate relevant information
Features
- goals: identify & control variability in outcomes
- data collection
- timing: real time & continuous
- performance: hands-on staff
- data analysis:
- more sofisticated searching for causes of problems or outlyers
- feedback to staff: regular to all staff
- staff training:
- on the job
- specific training in outcome monitoring & analysis of work process
- staff involvement:
- high
- includes staff suggestions for improvement
- motivation for improvement
- staff participation in process & acheiving improved outcomes
- consumer feedback
Keys to successful CQI projects
- don't underestimate how hard it is to implement & maintain CQI projects
- obtain support of facility leadership
- communicate the CQI model clearly to all staff & obtain their buy-in
- pick one area of interest at a time that is of importance to leaders, staff, residents & their families
- don't re-invent the wheel
- use relevant guidelines & experience of others where applicable
- minimize paperwork
- generate easy to read data that can be used for medical records & committee reports
- use computers
- obtain resident & family feedback
- work with inspectors & provide them specific examples of CQI projects
CMS has outlined five elements of QAPI programs
- design & scope
- governance & leadership
- feedback, data systems, & monitoring
- performance improvement projects
- systematic analysis & systemic action[7]
More general terms
More specific terms
- agile method
- lean model
- Model for Improvement
- Operational Excellence
- Plan Do Study Act (PDSA) cycle
- Six sigma
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015
- ↑ Ouslander, JG: In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Chassin MR, Loeb JM, Schmaltz SP, Wachter RM. Accountability measures--using measurement to promote quality improvement. N Engl J Med. 2010 Aug 12;363(7):683-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20573915
- ↑ Morley JE. Rapid cycles (continuous quality improvement), an essential part of the medical director's role. J Am Med Dir Assoc. 2008 Oct;9(8):535-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19083284
- ↑ Fan E, Laupacis A, Pronovost PJ, et al. How to Use an Article About Quality Improvement. JAMA. 2010;304(20):2279-2287. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21098772
Curtis JR, Levy MM. Improving the Science and Politics of Quality Improvement. JAMA. 2011;305(4):406-407. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21248160 - ↑ Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007 Jun;82(6):735-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17550754
- ↑ 7.0 7.1 Centers for Medicare and Medicaid Services. QAPI Five Elements. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/qapifiveelements.pdf