Continuous Quality Improvement

In Healthcare
Nursing college – Jazan University
Outlines
▪ Defination of Continuous quality improvement (CQI)
▪ The purpose of CQI
▪ CQI process
▪ The time frame of CQI
▪ Data collection methods
▪ Aspects of healthcare to evaluate
▪ Risk management
▪ Models for CQI
Continuous Quality Improvement
▪ Patients place their lives in nurses’ hands and trust them to
be knowledgeable and to use good judgment when making
decisions about care. As nurses we need to understand that
we work within a system, and whenever there is a
breakdown somewhere within the system, the risk for error
increases.
▪ Continuous quality improvement (CQI) is a progressive
incremental improvement of processes, safety, and patient
care (O'Donnell, Gupta, 2021).
Continuous Quality Improvement (Patrice Spath, 2018) chapter
5

▪ The improvement phase follows performance assessment. Once improvements are

implemented, the quality management cycle begins again. The results of process
changes are measured and analyzed to determine whether they fixed the performance
problem.
Cycle of Measurement, Assessment, and
Improvement (Patrice Spath, 2018) chapter 5

Measurment
How are we doing?

Yes

Assessment
Are we meeting
expectation?
No
Improvement
How can we improve
performance?
Purposes of CQI
▪ To improve of operations, outcomes, systems processes,
improved work environment, or regulatory compliance
(O'Donnell, Gupta, 2021).
▪ To continuously improve the capability of everyone involved
in providing care, including the organization itself.
▪ To act proactively and avoid a blaming environment.
Processes of CQI

(a) Identifying areas of concern (indicators)

(b) Continuously collecting data on these indicators
(c) Analyzing and evaluating the data
(d) Implementing needed changes

▪ Common indicators include the number of falls, frequency of medication

errors, and infection rates. Indicators can be identified by the accrediting
agency or by the facility itself.
The time frame of CQI
The time frame used in a CQI program can be
▪ retrospective (evaluating past performance, often called quality
assurance)
▪ concurrent (evaluating current performance).
▪ prospective (future oriented, collecting data as they come in).
 The procedures used to collect
data depend on the purpose of
the program.

Data Data may be obtained by

observation, performance
Collection appraisals, patient satisfaction

Methods
surveys, statistical analyses of
length-of-stay and costs,
surveys, peer reviews, and chart
audits
Aspects of Health Care to Evaluate

A CQI program can evaluate three aspects of health care:

▪ The structure within which the care is given
▪ The process of giving care
▪ The outcome of that care.
Risk Management
▪ An important part of CQI is risk
management, a process of identifying,
analyzing, treating, and evaluating real
and potential hazards.
▪ To plan proactively, an organization
must identify real or potential exposures
that might threaten it.
Severity of Risk events
1. Service occurrence: is an unexpected occurrence that does not result
in a clinically significant interruption of services and that is without
apparent patient or employee injury.
2. Serious incident: A serious incident results in a clinically significant
interruption of therapy or service, minor injury to a patient or employee,
or significant loss or damage of equipment or property.
3. Sentinel events: A sentinel event is an unexpected occurrence involving
death or serious/permanent physical or psychological injury, or the risk
thereof.
Common Risk
Areas for Nursing
▪ Medication errors
▪ Documentation errors and/or
omissions
▪ Failure to perform nursing care or
treatments correctly
▪ Errors in patient safety that result in
falls
▪ Failure to communicate significant
data to patients and other providers
▪ Once an incident has occurred,
you must complete an incident
report immediately.
▪ The incident report is used to
collect and analyze data for
determination of future risk.
▪ The report should be accurate,
objective, complete, and factual
Models for CQI

▪ Healthcare institutions use several models for CQI, including

Six Sigma, Lean, PSDA and the Care Model to implement a
CQI framework. Each model is unique, and healthcare
organizations should consider where they are in the process
of implementing a CQI culture to guide which framework will
be most effective for the specific CQI objectives and the
organizational culture
Lean
Developed by Toyota Corporation,
Lean methodology is a process of
improving value to customers and
employees with a focus on the
reduction of waste. Kaizen is a core
concept of lean and is concentrated
on continual improvement. Lean
defines 7 types of waste, i.e.,
transport, inventory, motion, waiting,
overproduction, over-processing,
and defects.
Six Sigma
PDSA
The PDSA Cycle (Plan-Do-
Study-Act) is a systematic
process for gaining valuable
learning and knowledge for the
continual improvement of a
product, process, or service.
PLAN
▪ This involves identifying a goal or purpose, formulating a
theory, defining success metrics and putting a plan into
action.

DO
• The Do step in which the components of the plan are
implemented such as making a product.
STUDY
▪ The study phase is where outcomes are monitored to test the
validity of the plan for signs of progress and success, or
problems and areas for improvement.
ACT
▪ The Act step closes the cycle, integrating the learning
generated by the entire process, which can be used to adjust
the goal, change methods, reformulate a theory altogether,
or broaden the learning – improvement cycle from a small-
scale experiment to a larger implementation Plan.
PDSA or PDCA or Deming’s Cycle

▪ These four steps can be repeated

over and over as part of a never-
ending cycle of continual learning
and improvement
CQI is a quality initiative that repeatedly asks members of the
healthcare team to determine, "How are we doing?" and "Can
we do it better?"
 Refernces
▪ Sally, A. Weiss, & Ruthy, M. T. (2015). Chapter 10, Issues of Quality and Saftey,
Essentials of Nursing leadership and management
▪ O'Donnell B, Gupta V. Continuous Quality Improvement. [Updated 2021 Apr 7]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK559239/
▪ The W. Edwards Deming Institute. (2022). PDSA Cycle.
https://deming.org/explore/pdsa/
▪ Spath, P. (2018). Chapter 5 Continuous improvement, Introduction to Healthcare
Quality Management