Quality improvement as a concept has various definitions and so does quality improvement in the healthcare industry. Put simply, quality improvement is the systematic approach to reduction or elimination of waste, rework, redundancy, and losses in the production process. Quality can also be defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge.
The Robert Wood Johnson Foundation defines quality improvement as, “The process-based, data-driven approach to improving the quality of a product or service. It operates under the belief that there is always room for improving operations, processes, and activities to increase quality.”
CDC’s definition is focused on three areas. The definition focuses on activities that improve population health, ensure healthcare’s affordability, and deliver the best patient experience. These three dimensions mirror The Institute for Healthcare Improvement (IHI) Triple Aim; the framework all quality improvement in healthcare ties back to Improve the health of populations, reduce the per capita cost of healthcare, and improve the patient experience.
The Health Foundation believes that there is a compelling case for applying organizational or industrial quality improvement approaches to healthcare. And this approach will ensure Continuous Healthcare Quality Improvement.
All staff in a healthcare organization have a role to play in ensuring that healthcare services continue to improve. At present, the evidence is clear that healthcare is not always safe and can lead to poor patient experience and outcomes. At the same time, the economic downturn means an end to year-on-year financial increases. Healthcare services are being challenged to respond to this not through indiscriminate cuts, but by improving efficiency, driving up quality and reducing levels of harm. Improving the quality of services is also a key requirement within the NHS, supported by initiatives such as quality accounts and the
Commissioning for Quality and Innovation (CQUIN) payment framework.
Every quality improvement attempt or process should be continuous. This is because
quality improvement cannot happen without constant measurement and evaluation. Although it is possible to implement the quality improvement cycle once, single cycle improvement isn’t quality improvement in the purest sense; it eliminates the critical “study” step in the “plan, do, study, and act” sequence; the evaluative step that’s so critical for successful quality improvements. Healthcare professionals are challenged to constantly improve outcomes, so how do systems continue to push for improvement when it seems like every improvement increment is harder to attain? Healthcare leaders need to put their combined clinical, operational, and business hat on and ask, “What quality improvement initiatives do we prioritize based on the healthcare data we have?” They need to work with their finance teams and do a cost-benefit analysis to determine if it makes more sense to pursue a small, incremental percent reduction in heart failure readmissions (if already better than national benchmarking measures) or do something else with a bigger impact on patient outcomes and costs.
The concept of continuous quality improvement is about sustaining and hardwiring the right behaviors for a lasting effect. For example, if a health system reduces its heart failure readmission rate or some other high cause of readmission rate, it shouldn’t just check that item off the “to do list” and move on to something else within its cardiovascular program. It still needs to dedicate valuable resources to the readmissions initiative to ensure outcomes are sustained; to make sure the interventions continue to be effective. One way, quality improvement can be continuous is through external data sharing. External data sharing is based on the premise of collaboration and population health management. It provides valuable insights about what systems are doing; sharing this information creates the best practices learning culture that’s so important in quality improvement. In an industry that attracts professionals passionate about helping people, benchmarking is another tool that helps provide the best care to patients.