Quality Improvement in Healthcare

Quality improvement in healthcare entails making healthcare equitable, efficient, timely, patient-centered, effective, and safe.

It is whereby a healthcare organization employs a systematic approach to assess, monitor, and improve healthcare standards.

Presently, the healthcare systems are grappling with various challenges, like plummeting cash flow, delayed patient discharge, hospital-acquired infections, avoidable medical errors, and clinical variation.

Thus, healthcare systems need to work on improving the quality of care and other processes in the sector.

Furthermore, the healthcare sector is highly dynamic, with significant transformation been reported.

While there is a rapid expansion of technology and knowledge, the healthcare system is still performing below satisfactory levels for maintaining patient safety and providing quality care.

The medical environment should reflect the capabilities and advancements in the modern healthcare sector.

Health care professionals also need to understand the fundamental quality improvement terminology and methodologies.

This article explores the concepts of quality improvement in healthcare.

The Importance of Quality Improvement (QI) in Healthcare

 A healthcare organization that implements programs for quality improvement records various benefits, including:

  1. Enhanced clinical (patient health) that entails both health outcomes (such as reduced mortality and morbidity) and process outcomes (such as providing appropriate screenings).
  2. Enhanced efficiency of clinical and managerial processes: An organization reduces the costs and waste associated with redundancy and system failures when it improves outcomes and processes relevant to high-quality health needs.
  3. Minimized costs linked to poor outcomes, process failures, and errors incurred when inefficient and nonstandard systems increase errors and reworking. The maintenance of reliable and streamlined processes is inexpensive.
  4. The adoption of proactive processes that identify and address issues before they happen ensures that the care systems are predictable and reliable.
  5. Enhanced communication with internal and external resources like civic and community organizations or funders: An organization that is keen on continuous quality improvements gets positive publicity, which may increase funding opportunities.

Continuous Quality Improvement

In healthcare, continuous quality improvement (CQI) occurs when the organization has a structured process.

It involves health care providers in planning and executing ongoing proactive improvements in care processes to ensure quality health care outcomes.

Hospitals use CQI to enhance clinical care by reducing costs and variability to help in meeting regulatory requirements and enhancing the quality of customer service.

The QI issue gained more attention nationally after the Institute of Medicine (IMO) released a report titled “Crossing the Quality Chasm.”

The template guided QI processes. IMO followed up with To Err is Human, which further reinforced QI.

Principles of Quality Improvement in Healthcare

 A successful QI program always incorporates QI principles to attain an improved performance level and a successful healthcare system.

Below are the four primary QI principles that organizations can consider.

      I.        Focus on Care-Coordination

The activities in the healthcare system should be very coordinated, especially when caring for patients with chronic conditions.

The idea is to minimize patient care fragmentation, create a safe network of reliable healthcare providers, and ensure effective referrals and streamlines transition between different healthcare practitioners.

    II.        Leveraging Data

The present healthcare system is increasingly using data for QI. Data elaborates on the functioning of the present healthcare system.

It also helps in tracking the changes, enables comparison as well as monitoring for sustainable enhancements.

Data-informed insights produce better health outcomes, reduced re-admission, minimum variation, fewer medical errors, and lower rates of infection.

Both quantitative and qualitative data collection methods enhance QI approaches.

   III.        Emphasis on the Patient

The key concept behind QI in healthcare is to ensure that the patient’s needs and expectations are in alignment.

The QI focus should be on advancing the patient’s health literacy, patient-centered communications, evidence-based care provisions, systems that support patient access, patient engagement, and patient safety. 

  IV.        Work as Process and Systems

A healthcare organization should understand its key processes and delivery system. The focus should be on streamlining “Input-Process-Output” to meet the needs of the healthcare system of a specific organization.

Quality Improvement Approaches

Several approaches can be used by healthcare organizations to perform quality improvement effectively. They include:

Model for Improvement (PDSA Cycle)

This model incorporates a ‘trial-and-learning’ approach whereby a suggested solution or hypothesis for improvement is established and tested on a small scale before adopting it in the entire system.

It has a logical sequence of four repetitive processes, which include plan-do-study-act.

At the planning stage, improvement ideas are established, responsibilities assigned, measures of improvement selected, and expectations confirmed.

The do phase entails the implementation of the plan and documentation of any deviations from the plan deviations.

In the study phase, the deviations are analyzed, and questions on what went wrong or right are answered, and new strategies developed.

Lessons learned in the study phase are integrated into the test change in the active phase and a decision made regarding the continuation of the test cycles.

Lean Model

The lean model draws on the approaches used by Toyota and other Japanese car manufacturers to manage their production process.

The approach concentrates on five fundamental principles, including using ‘pull’ mechanisms to support flow, regulating the flow of production (to avoid bottlenecks and quiet patches), managing value steam, and customer value.

Value stems from what the customer seeks. This approach determines how value moves to the patient and ensures process competency by making it time-efficient and cost-effective.

Six Sigma

This adopts a systematic approach to enhancing processes and products. It concentrates on comprehending how the customers of an organization would describe the defects within its products and services.

It minimizes factors that patients would consider as being important to quality, drawing on statistical approaches to establish standards for quality variation.

It originated from Motorola, Inc. as a statistical measurement methodology used to eliminate defects, decrease process variation, and reduce costs.

Six-sigma has two models, including:

(1) DMAIC (defining, measuring, analyzing, improving, and controlling) designed to investigate the current processes.

(2) DMADV (defining, measuring, analyzing, designing, and verifying) designed to develop new processes.

Some organizations combine lean and six-sigma (lean-sigma) methodologies and introduce a testing phase during Six-sigma’s improvement step.

The Lean-Sigma model is focused on process analysis and utilizing mapping to attain QI.

FADE

This approach has four steps, including:

Focus-defining the processes that need improvement

Analyze– collecting and analyzing data

Develop– developing an action plan

Execute– implementing the action plans, and evaluate– measuring and monitoring system to ensure success.

Care Model

The care model has six key care aspects, which develop a system that promotes good prevention and management of a disease.

The care model supports the productive association between patients who are active participants in their care and healthcare provides, who have the requisite expertise and resources.

Overall, improving the performance and quality of care in the healthcare environment can provide cost-effective, reliable, and sustained healthcare processes and allow providers to attain their aim of enhancing patient outcomes and improving care delivery.

The process begins with getting the service providers in the healthcare sector to get inculcated to the setting where continuous quality improvement is prioritized for them to participate in the process actively.

Leaders in the healthcare sector should always work towards enhancing patient care for them to survive and thrive in the modern healthcare industry that is highly competitive.

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