Quality Improvement Methods in Health Care - Case Study Example

QI approaches and tools for healthcare Healthcare organizations around the world are facing many pressures on the quality of services. To ensure the good standards of healthcare several QI approaches and tools were developed. Each quality improvement approach uses several methodologies and tools for assessment and improvement of the services. QI utilizes databased methods to initiate improvements in the health care system. This paper will compare and contrast between two QI approaches and the methodologies that they employ. The first Quality Improvement Approach is continuous quality improvement (CQI) that is a form of process quality improvement approach. CQI is an analytical tool used for decision making that allows one to detect when a process is in health care delivery is working predictably and when it is not. Here, variation is the most essential aspect. Therefore, making decisions on when the variation is natural and when it needs correction is significant to control. CQI has been used as a means to develop clinical practice, lays its basis on the principle that there is an opportunity for making improvements in every occasion, and processes in the healthcare sector. CQI is used interchangeably with Total Quality Management (TQM) and more recently with Continuous improvement. CQI applies scientific methods to gain knowledge and control in variations that occur in healthcare processes. It ensures that when problems have been identified in health care system, they are improved, evaluated and the cycle begins again making it a continuous process. When using CQI, several methodologies can be employed such as Plan-do-study-act (PDSA) cycle, also called the Shewhart or Deming Cycle. CQI focuses overall process of the improvement and is advantageous because the whole cycle is important. However, it could be slow to implement, as the whole process must be followed systematically (Baily, 2008). The second Quality Improvement Approach is clinical practice improvement (CPI) that is a form of outcome quality improvement approach. A multidimensional outcomes methodology injects direct application to the clinical management of individual patients. This approach is led by clinicians and tries to bring a comprehensive understanding of the complex issues in health care delivery. The approach employs a team, identifies a purpose, collects data, assesses the findings and translates the findings in the improvement of practice in healthcare delivery. There are several principles in CPI. First, CPI assumes that healthcare is a process and can be analyzed. It also assumes that the process and the outcomes can be measured and that individuals working in the system and Microsystems have important knowledge of the processes. Therefore, there must be a will and leadership to guide the desired change. This approach focuses on the outcome and as such could miss out on the important aspects in the process. This approach employs several methodologies, for instance six sigma (Marshall, 2009). Six Sigma versus Plan-do-study-act (PDSA) cycle Six sigma was originally developed as a business strategy but has become an important tool in healthcare quality improvement measurement. It entails improving, designing and monitoring the process to eliminate waste and optimize stability and satisfaction. Six-sigma measures improvement through performance of a process by comparing baseline process capability with the capability of the project after piloting potential solutions for quality management. Six sigma employs two methods. The first inspects the outcome of the process and tallies the problems rate per million then uses a statistical table to convert the defect rate per million to a sigma metric. The second method utilizes the estimates of the process variation to predict process performance through calculating a sigma metric from the defined tolerance limits and the variations in the process. The CPI uses the second method mainly because it focuses on the process. Six sigma employs a five-phase process known as measure, analyze, improve and control (DMAIC) approach. The PDSA Cycle, on the other hand, is a systematic series of steps used to gain knowledge for the continual improvement of health care process. The cycle begins with a plan step where a goal is identified and other aspects initiated such as formulating a theory, defining success metrics and implementing the plan. The do step then follows where the components of the plan are implemented. The study step involves the part where outcomes are monitored. The act step then ends the cycle where the learning achieved is integrated to the entire process. The PDSA process is repeated for continuous improvement. The two methodologies differ in their steps in that PDSA involves planning, doing, studying and acting while six sigma entails defining measuring, analyzing, implementing and controlling. Six sigma is a longer process as compared to PDSA, which is a lean methodology (Varkey, Reller & Resar, 2007). Process control charts versus Pareto analysis Six sigma employs process control charts that show the variation in measurement overtime that the process is observed and can be comfortably used with CQI. The chart is simple and is plotted on an x/y axis. It monitors continuous quality control and the information found is used to make quality improvements. Pareto analysis is used to analyze a range of issues leading up to a certain outcome. It looks at causes of problems in quality improvement initiatives. The value of the Pareto analysis is that it concentrates on the vital few issues that can be used to improve quality based on a 80/20 rule. A table is created where causes are listed and their frequencies used as percentages. This can be used by CPI and PDSA effectively to measure the issues that affect the outcomes of a healthcare issue and be used to improve on that (Sokovic, Pavletic & Pipan, 2010). Advantages and limitations Clinical practice improvement methodology brings a naturalistic view of medical treatment through retrospective data taken routinely by medical personnel. Thus, it is important in the improvement of treatment alternatives for patients. Secondly, this methodology requires less cost because it uses existing data from readily available medical records whether on paper or on computers. The only limitation with this is that it is a slow process and could consume a lot of time retrieving, arranging and evaluating data. The reliance on records especially paper medical records could be unreliable when these are not found. On the other hand, the advantages of CQI are numerous. It is a no blame approach, engages all health staff for adequate information, has a dynamic and ongoing approach and promotes efficiency using the existing resources. CQI requires that health personnel are trained to work in a CQI environment, which is a costly venture in terms of time and money. Secondly, CQI could see a health care organization change processes that are working excellently because not all negative or positive feedbacks from healthcare personnel are accurate. There are several examples of research and programs that use the above approaches. For example, the Council on Accreditation (COA) uses CQI on programs such as substance abuse, foster care and adult day care. The Clinical practice improvement methodology has been used for research by the institute of clinical outcomes research and international severity information systems Inc., to study its use in the examination of the utilization of ambulatory healthcare services in HMOs. Conclusion The necessity for quality improvement in health care has become significant calling for effective QI approaches such as CQI and CPI and methodologies such as Six Sigma and PDSA. These approaches and methodologies are essential for quality improvement in healthcare delivery because they use data and information to inform the required improvements. However, the use of these approaches is coupled by certain aspects that must be looked into (Baily, 2008). Recommendations For effective results to be achieved, some aspects of Six Sigma could be combined with PDSA to offer a more reliable, inclusive and required improvement. It is important to conduct reviews using reliable QI approaches such as CQI and CPI constantly to ensure that timely improvements are initiated and completed successfully. Improvements must be done on QI approaches to ensure that they are computerized to achieve effectiveness and avoid reliance on paper records especially for CPI (Marshall, 2009). References Baily, M. A. (2008). quality improvement methods in health care. From birth to death and bench to clinic: the Hastings Center bioethics briefing book for journalists, policymakers, and campaigns garrison. New York: The Hastings Center, 147-152. Marshall, M. (2009). Applying quality improvement approaches to health care. BMJ, 339. Sokovic, M., Pavletic, D., & Pipan, K. K. (2010). Quality improvement methodologies–PDCA cycle, RADAR matrix, DMAIC and DFSS. Journal of Achievements in Materials and Manufacturing Engineering, 43(1), 476-483. Varkey, P., Reller, M. K., & Resar, R. K. (2007). Basics of quality improvement in health care. In Mayo Clinic Proceedings (Vol. 82, No. 6, pp. 735-739). Elsevier. Read More