Introduction to Quality Improvement

With the Institute of Medicine 2001 publication Crossing the Quality Chasm came a challenge to improve quality and safety of patient care as well as an increasing urgency for healthcare organizations to adopt quality improvement science and tools. Multiple QI methods have evolved but all have foundations based on work by Shewhart, Deming and Womack. Three common healthcare methods are briefly described in this sectionLean, Model for Improvement, and Six Sigma . These methods have similarities, differences and appropriate applications. Determining which method is the most appropriate approach for your QI initiative is a critical first step.

The table below is a quick reference to identify an appropriate tool for a specific QI-related activity. Use the links to access the tool and/or the tool description.

     Function

                 Tool

Organize Project

Quality Improvement Roadmap

 

Project Planning Form

 

Project Tracking Sheet

 

Improvement Project Charter (template)

 

Measurement Plan Form

 

PDSA Worksheet (basic)

PDSA Worksheet (advanced)

 

Key Driver Diagram (template)

Define Current State

Flow Chart/Process Flow Diagram

 

Pareto Chart

 

Modeling Processes

Identify Solutions

Flow Chart/Process Flow Diagram

 

Fishbone Diagram (template)

 

Modeling Processes

 

Key Driver Diagram (template)

Analyze and Report Results

Histogram

Pareto Chart

 

Scatter Plot

 

Run Chart

 

Control Chart

Control Chart is a graphical tool used to analyze variation in processes and to accurately interpret the impact of different improvement interventions and tests of change in real-time and over time. Control charts utilize statistical calculations.

Fishbone (Cause and Effect) Diagram is a graphic tool used to explore and display the possible causes of a certain outcome or problem. It uses a structured format to fully identify the many contributing causes and helps to identify areas for improvement.

Histogram is a graphical tool used to demonstrate the distribution of data (shape and range) for a measure.

Improvement Project Charter is a written document that clearly defines the work of the team including project aim, scope, measures and team members.

Modeling Processes is a framework for conducting an improvement initiative. It outlines key components: discovery/diagnosis, testing changes and sustaining the gains. Discovery/diagnosis focuses on systematically learning about the process/issue and identifies objective and subjective tools and methods that help you do this. This framework is very useful for projects that will potentially result in a significant change, have high impact and require significant collaboration.

Pareto Chart is graphical tool used to identify the most significant factors contributing to a problem by plotting their frequency in descending order.

QI Roadmap is a high level plan comprised of the key steps involved in successful improvement activities.

Run chart is a graphical tool used to analyze variation in processes and to accurately interpret the impact of different improvement interventions and tests of change in real-time and over time. Run charts utilize rules and the median.

Scatter plot (diagram) is a graphical tool used to investigate whether a relationship exists between two variables.

Chart Guide provides basic guidance for selection and key components of your data display as well as the accurate analysis required to understand what the data means.

Measurement is a critical part of testing and implementing changes in QI activities. Effective measures are chosen to inform the team whether the changes they are making actually lead to improvement. Measurement for improvement is inherently different than measurement for research or accountability. The Three Faces of Improvement table illustrates the key differences in the aims and methods for each type of measurement.

The Measurement Plan Form is an essential tool for improvement projects. Before implementing an improvement project it is essential to identify project level measures and develop a very specific measurement plan as outlined in this form.   Accurate learning (analysis of results) from the changes you implement is only possible if effective measures are identified and a well-defined and detailed measurement plan is developed. To be effective measures should be meaningful and feasible to collect.

Next: Patient Safety