Quality Improvement and Performance Improvement: Different Means to the Same End? |
QA/QI
The Quality Assurance Project illustrates QA activities as three points on a QA triangle (see Figure 2). The points are: defining quality (QD), measuring quality (QM), and improving quality (QI). QD means developing statements regarding the input, process, and outcome standards that the healthcare delivery system must meet in order for its patients to achieve optimum health gains. Such statements are used to define expected quality in all aspects of healthcare. QM consists of quantifying the current level of compliance with standards. QI involves using appropriate methodologies to close the gap between the current and expected levels of quality; it uses quality management tools and principles to understand and address system deficiencies.
Approaches to conducting QI activities are numerous and lie along a continuum from simple to complex. Four basic approaches are: (a) individual problem solving, (b) rapid team problem solving, (c) systematic team problem solving, and (d) process improvement. (These four approaches are explained in "Advances in Quality Improvement: Principles and Framework"*). The PI approach is most similar to the third, systematic team problem solving (see Figure 1).
QI activities are conducted using variations on a four-step method: (a) identify (determine what to improve), (b) analyze (understand the problem), (c) develop hypotheses (determine what change[s] will improve the problem), and (d) test and implement, or Plan, Do, Study Act (PDSA). In the fourth step, the solution is tested to see whether it yields an improvement; the results are then used to decide whether to implement, modify, or abandon the proposed solution. If the tested solution does not achieve desired results, the process cycles back to the third step for reiteration. If the results are achieved, the solution is implemented on a larger scale and monitored over time for continuous improvement.
QI does not end with step four; it is an ongoing process. In fact, QI is generally considered in the context of QA, itself an ongoing process.
