Continuous Quality Improvement: An In-Depth Analysis

Introduction:

Continuous Quality Improvement is an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems: focuses on “process” rather than the individual; recognizes both internal and external “customers”; promotes the need for objective data to analyze and improve processes.

It is an active process in which a need for improvement is identified and appropriate members of a team who are affected by or involved in the problem under consideration are selected. The team collects and analyzes baseline data so they can define where they are and why they want to change. Finally, based on their data and analysis, they determine one or two root causes of the problem they think

• Most problems are found in processes, not in people. CQI does not seek to blame, but rather to improve processes.

• Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation.

• It is possible to achieve continual improvement through small, incremental changes using the scientific method.

• Continuous improvement is most effective when it becomes a natural part of the way everyday work is done1.

CORE STEPS IN CONTINUOUS IMPROVEMENT

• Form a team that has knowledge of the system needing improvement.

• Define a clear aim.

• Understand the needs of the people who are served by the system.

• Identify and define measures of success.

• Brainstorm potential change strategies for producing improvement.

• Plan, collect, and use data for facilitating effective decision making.

• Apply the scientific method to test and refine changes1.

Benefits of CQI in Hemodialysis setting

Although the roots of CQI (or total quality management) were born in the field of manufacturing back in the World War II era, the tools of CQI can be used quite effectively in healthcare today.

• It can be used to satisfy governing entity

How are we going to get there?

CQI-PDCA CYCLE

• Plan

• Do

• Check

• Act

This process can be conducted using the Plan, Do, Check, and Act (PDCA) cycle. PDCA is a simplification of the scientific method that was made popular by Deming (1986). The steps included in the PDCA cycle are:

• P- Plan the action steps. Study a particular process to determine what changes might be desirable. Organize a team and collect data to better define the problem. Decide how you will use your observations and data related to the need for that improvement. Develop a plan for an improvement.

• D- Do the action steps you have defined. Implement the change process you have described in your plan.

• C- Check the outcomes. Monitor and evaluate the processes and results of your change. What were the effects? What did you learn? Did the outcomes match the desired elements you had established?

• A- Act based on the result. Were you successful in accomplishing the desired change? Were the results different from what you expected? Review the outcomes of the PDCA cycle and modify the improvement process based on the knowledge that you have gained. Return to the Plan phase and repeat the cycle until the goals, original or modified, have been achieved (Deming,