continuous quality improvement (CQI) or total quality management (TQM)

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

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

More general terms

• quality assurance (QA)

More specific terms

• agile method
• lean model
• Model for Improvement
• Operational Excellence
• Plan Do Study Act (PDSA) cycle
• Six sigma

Additional terms

• quality indicator (QI); quality measure