Key Principles and Framework | Quality Improvement Methodology | The Spectrum of QI Approaches
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M. Rashad F. Massoud, MD, MPH 
Associate Quality Assurance Project Director, Russia, NIS, Asia, and the Middle East

Experience with implementing quality improvement in different settings has led to a better understanding of how the methodology can be applied to the healthcare field and to further development of the methodology. Advances include the simplification of the methodology, its further application to a wide range of circumstances, and the integration of evidence-based medicine in clinical quality improvement efforts.

This article outlines the key principles and framework of quality improvement. They comprise the fundamental principle of improvement, the four principles of quality management (i.e., Focus on the Client, Understanding Work as Systems and Processes, Teamwork, and Focus on the Use of Data), and the framework for clinical quality improvement. The article also describes the four-step quality improvement methodology (i.e., Identify, Analyze, Develop, and Test/Implement). Lastly, it illustrates the application of this methodology to a spectrum of quality improvement approaches. Four points along this spectrum have been chosen to illustrate a range of approaches (e.g., individual problem solving, rapid team problem solving, systematic team problem solving, and process improvement) that can utilize the quality improvement methodology.

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¹ This article appeared in the Spring 2001 issue of the Quality Assurance Project's QA Brief. This newsletter, including other articles on quality improvement, can be accessed at http://www.qaproject.org in the products section.

Quality Assurance Project is operated by the Center for Human Services in collaboration with the Joint Commission Resources (formerly known as the Joint Commission International) and Johns Hopkins University (including the School of Hygiene and Public Health, The Center for Communication Programs, and the Johns Hopkins Program for International Education in Reproductive Health). The project is sponsored by the United States Agency for International Development under Contract Number HRN-C-00-96-90013. For additional information please contact: Dr. David Nicholas, Director Quality Assurance Project Center for Human Services 7200 Wisconsin Avenue, Suite 600 Bethesda, MD 20814-4811 dnicholas@urc-chs.com or Dr. James Heiby, Project Manager G/PHN/HN/HPR U.S. Agency for International Development Washington, DC 20523-1817 jheiby@usaid.gov

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