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continuous quality improvement (CQI) or total quality management (TQM)

A framework for monitoring & enhancing the outcomes of medical care. Based on Plan-Do-Study-Act cycles to test changes in systems of care Providers offer input into the clinical care processes === 10 step process (JCAHO) === 1) assign responsibility 2) define scope of care 3) consider important aspects of care 4) develop key indicators 5) determine evaluation thresholds 6) collect & organize data 7) evaluate the care 8) initiate problem-solving actions 9) assess the results of those actions 10) communicate relevant information === Features === 1) goals: identify & control variability in outcomes 2) data collection a) timing: real time & continuous b) performance: hands-on staff 3) data analysis: -> more sofisticated searching for causes of problems or outlyers 4) feedback to staff: regular to all staff 5) staff training: a) on the job b) specific training in outcome monitoring & analysis of work process 6) staff involvement: a) high b) includes staff suggestions for improvement 7) motivation for improvement a) staff participation in process & acheiving improved outcomes b) consumer feedback === Keys to successful CQI projects === 1) don't underestimate how hard it is to implement & maintain CQI projects 2) obtain support of facility leadership 3) communicate the CQI model clearly to all staff & obtain their buy-in 4) pick one area of interest at a time that is of importance to leaders, staff, residents & their families 5) don't re-invent the wheel -> use relevant guidelines & experience of others where applicable 6) minimize paperwork -> generate easy to read data that can be used for medical records & committee reports 7) use computers 8) obtain resident & family feedback 9) work with inspectors & provide them specific examples of CQI projects === CMS has outlined five elements of QAPI programs === - design & scope - governance & leadership - feedback, data systems, & monitoring - performance improvement projects - systematic analysis & systemic action [7]

Related

quality indicator (QI); quality measure

Specific

agile method lean model Model for Improvement Operational Excellence Plan Do Study Act (PDSA) cycle Six sigma

General

quality assurance (QA)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015
  2. Ouslander, JG: In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  3. Chassin MR, Loeb JM, Schmaltz SP, Wachter RM. Accountability measures--using measurement to promote quality improvement. N Engl J Med. 2010 Aug 12;363(7):683-8 PMID: 20573915
  4. Morley JE. Rapid cycles (continuous quality improvement), an essential part of the medical director's role. J Am Med Dir Assoc. 2008 Oct;9(8):535-8. PMID: 19083284
  5. Fan E, Laupacis A, Pronovost PJ, et al. How to Use an Article About Quality Improvement. JAMA. 2010;304(20):2279-2287. PMID: 21098772 - Curtis JR, Levy MM. Improving the Science and Politics of Quality Improvement. JAMA. 2011;305(4):406-407. PMID: 21248160
  6. Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007 Jun;82(6):735-9. Review. PMID: 17550754
  7. Centers for Medicare and Medicaid Services. QAPI Five Elements. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/qapifiveelements.pdf