Interactions of Quality Improvement with Other Approaches in Healthcare

Abstract

1. Introduction to Quality Improvement in Healthcare
Quality improvement (QI) is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of the patient and others. It uses a variety of methods such as facilitation, formal or informal teams, benchmarks, and audits with feedback, coupled with more quantitative methods such as attribute and control charts, statistical process control, and structured experiments or designs to explore and possibly reduce variation, i.e., to define and address any changes. Based on the industrial engineering paradigm, QI focuses on systems, structures, and processes, and the latter determine to a great extent the desirable as well as undesirable outcomes.
The intended beneficiaries of QI are the individuals involved in healthcare. QI's impact on health system performance depends on the organization's culture. The challenge is to incorporate QI into every role of healthcare. Continuous improvement is essential for organizational performance. The committee identifies six aims for standardization and patient-centeredness.
Methods
We analyzed research and explored programs to create a typology for healthcare quality improvement. We selected four programs for in-depth study and developed a data collection instrument for interviews. We interviewed staff responsible for program design and collected background information. We pilot tested the instrument and conducted additional interviews. The study had to be flexible due to program complexity.
Conclusion
Drawing from all these examples and the abundance of information in the other chapters in this report provides an opportunity for a number of general conclusions concerning quality improvement and the development of theory and methods. The familiar concerns about evaluation and its relationship to quality improvement work are revisited. The general lesson is that methods improvements in fieldwork and program evaluation can be mutually supporting, provided that thought is given to the practical difficulties. Although this chapter used case studies and syntheses of quality improvement work as its starting point, some of the final conclusions are as much directed at what health services research can do. Familiar issues of the difficulty of measurement, the complex structural issues of professional organizations and the hierarchy as types of overall organization, and the complexity of interactions must remain central features of health services inquiry into quality of care. But the desire for interventions in situations identified as difficult can usefully suggest other parallel investigations.