Hm 418 harris ch04 ppt

1. Chapter Four
Differentiating Quality
Improvement Projects and
Quality Improvement

2. Introduction
• Health Resources and Services Administration
– Quality improvement
• Systematic and continuous process that leads to
measurable improvement in healthcare services and
health status of a targeted patient population
• Institute of Medicine
– Quality in health care
• Direct relationship between level of improved health
services and expected health outcomes of individuals
and populations

3. Quality Improvement
• Quality Improvement
– Model for Improvement (MFI) foundational to
many quality models (Six Sigma, Lean Toyota, and
the define–measure–analyze–improve–control
(DMAIC) process)
– IOM’s perspective: Quality considered within an
organization’s current system
• Defined as how work gets done

4. Quality Improvement—cont’d
• Four Key Principles
– Quality improvement work as systems and
processes
– Focus on patients
– Focus on being part of the team
– Focus on use of the data

5. Quality Improvement as
Systems and Processes
• Quality Improvement Approaches
– Available resources (inputs) and tasks carried out
(processes), which collectively determine quality
of care (outputs/outcomes)
• Processes
– Activities focusing on what is to be done and how
the project will be carried out

6. Quality Improvement as
Systems and Processes—cont’d
• Process Flow Maps and Concept Maps
– Tools used in illustrating the steps in carrying out
the work
• Failure Model Effect Analysis (FMEA)
– Tool used for risk mitigation
– Essential to achieving safe, quality outcomes
– Each step (or process) assessed for severity and
frequency

7. Quality Improvement as
Systems and Processes—cont’d
• Outputs or outcomes results or patterns
– Health services delivered
– Changes in health behaviors and health status
– Patient satisfaction
• Consideration of resources, activities, and
results that exist and are desired
– Customize quality improvement projects and
programs to address unmet needs

8. Focus on Patients
• Patient-Centered Care
– Engaging patients in a true partnership
– Personalizing care to include patients’ normal
routines and values
– Healing physical environment
• One in which spiritual and emotional needs are met
– Healthcare Providers and Systems (HCAHPS)
patient survey

9. Focus on Patients—cont’d
• Patient-Centered Care
– Systems that affect patient access
– Care provision that is evidence based
– Patient safety
– Support for patient engagement
– Coordination of care with other parts of the larger
healthcare system
– Cultural competence

10. Focus on Being Part of the Team
• Team Effectiveness
– Considering process or system as complex
– Acknowledging no one person in an organization
knows all the dimensions of an issue
– Recognizing the process involves more than one
discipline or work area
– Advocating for solutions that require creativity
– Realizing staff commitment and buy-in needed
– Effective infrastructure

11. Focus on the Use of the Data
• Data
– Determine how effectively current systems are
working and what occurs when changes applied
– Document successful performance
– Baseline can be established
– Team can determine the efficacy of solutions

12. Focus on the Use of the Data—cont’d
• Data—cont’d
– Quantitative and qualitative methods of collecting
data essential to QI projects
– Quantitative
• Use of numbers (rates, scores) and frequencies that
results in measurable data
– Qualitative
• Observable (not measurable), consider patterns and
relationships between systems, and are contextual in
nature

13. Quality Improvement Programs and
Quality Improvement Research
• QI program
– Considers systematic activities designed and
implemented to monitor, assess, and improve
organization’s quality of health care for population
it serves
– Donabedian model of structure, process, and
outcomes
• Theoretical framework for integrating quality
improvement strategies within the system

14. Quality Improvement Programs and
Quality Improvement Research—cont’d
• QI program—cont’d
– Leadership and interdisciplinary teams essential
– Knowledge of the infrastructure and principles of
quality improvement
– Improved patient outcomes focus on process
outcomes and health outcomes
– Can result in a balance of quality, efficiency, and
profitability in its achievement of organizational
goals

15. Quality Improvement Research
• QI programs and QI research should not:
– Pose any risk to individuals
– Infringe on individual privacy
– Breach individual confidentiality

16. Quality Improvement Research—
cont’d
• QI research
– QI initiatives not requiring IRB review
• Not intended to yield generalizable knowledge
– QI research requiring IRB approval
• Planned in advance to go beyond scope of the unit,
department, or services
– Mandatory IRB review for QI activities that:
• Entail a systematic investigation that will develop or
contribute to generalizable knowledge

17. Quality Improvement and Beyond
• QI activities
– Can increase nurses’ influence and involvement in
decision making at the policy level
– Translational science important to developing QI
science
– Many forms of disseminating QI projects and
research
– Importance of using research evidence to develop
evidence-based practice guidelines

18. Quality Improvement and Beyond—
cont’d
• Henderson Repository (resource of Honor
Society of Nursing, Sigma Theta Tau
International) offers:
– Online dissemination
– Free open access
– Peer review

19. Summary
• Quality improvement projects and improvement
research share common aims for making
healthcare systems safe and quality driven.
• Leading a quality team focused on patient-
centered care and using data to inform the
process are essential to the work of clinical nurse
leaders, executive leadership students, doctors of
nursing practice (DNP), and highly functioning
interprofessional project teams.

20. Summary—cont’d
• The foundational work for the development of
quality improvement projects and research is
key to sustaining success over the long term.