Clinical Quality Improvement: Principles that Drive

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Clinical quality improvement has transformed healthcare into an ever-growing, ever-changing, and ever-improving industry. There are a few primary principles established, originally for the automotive industry by Dr. Williams Edward Deming, that drive successful process and quality improvement in healthcare. Deming described the necessity of change effectively, directly relating change to survival, when he said, “it is not necessary to change. Survival is not mandatory.”

Quality Measures Must be Data-Driven

In order to identify trends, broken processes, and opportunity for improvement, a quality improvement department must have measurable, quantitative, detailed data with which to work. For example: There were fifteen falls last month, doesn’t provide nearly the detail as, There were fifteen falls last month, seven of which were the result of an inaccurate care plan, three of which were the result of a change in status, and five of which were the result of equipment failure.

Clinical quality improvement measures focus first on gathering accurate, detailed data. Next is the analyzing of the data and surrounding details to identifying opportunities. Finally, making necessary improvements. Much of this happens by way of communication and measuring of the results effectively.

Quality Improvement is About Processes, Not People

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flickr.com/photos/billohl

In the past, hospitals took great care to manage doctors and nurses by telling them what to do and how to do it. Today, we know that managing means teaching these professionals why they should do it. Effective clinical quality improvement programs engage providers and staff in patient safety and outcomes, along with gaining their insight when making decisions about care. This resulted in providers and staff who were personally vested in what they do and committed to doing it well.

Healthcare is Not That Different

Many other industries have much to lend to healthcare in the way of process management. Healthcare doesn’t vary from the automotive industry, for example, as much as you might think it does. Just as in the automotive industry, the need to measure, evaluate, analyze, and tweaking one process at a time takes a lot of insight and information. In a complex healthcare system, comprised of thousands of processes, the necessity to understand what items or actions require change also requires digging deep into the data.

A patient’s experience, especially positive outcomes, is also relatable to the auto manufacturing. Both involve safety and satisfaction, which cannot be reached by either if you can’t describe or measure what is happening and define the processes that are leading away from these characteristics.

When you look at the healthcare system as a whole, clinical quality improvement is a daunting task. When you look at one process at a time, understand why it isn’t working efficiently, then changing the system as a whole may not seem so enormous. Even small impacts on quality and improvement can lead to dramatic results in the long-term progress of an organization.

Engage All Staff

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Every staff member, from front-line clinicians to back-of-the-house IT personnel, should understand the vision of the organization and how clinical quality improvement is necessary. This means that every professional onsite needs to understand which quality measures apply to their position, and what data points are being measured. They are then clued into the opportunities to improve the overall care that is administered. Every staff member should also understand their involvement when it comes to implementing changes. When a team doesn’t work together, they cannot win. When an organization doesn’t work together, the impact can be felt far beyond the walls of any hospital or clinic. In some respects, this is an all or nothing game: everyone plays to improve the quality of care, or the system falls short and fails.

“Quality is never an accident.
It is always the result of intelligent effort.”
John Ruskin

Healthcare administration and quality improvement departments need measurable, accurate, detailed data. They need administrative support. They need medical staff support. They need to effectively identify the processes that have the most potential to improve care. They should learn from leaders in other industries and apply that knowledge to their role in healthcare. None of this is going to happen overnight, nor will it happen across the board. Bite-size changes can be identified, and everyone can learn from just a few, such as a specific department within the organization, who have implemented actionable data into their work.