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  • 2. Table of ContentsIntroduction 3Terms 9Vision 13Quality Improvement Program Structure 14 QI TrainingProject Identification Process 15Goals, objectives and measures with time-framed targets 16Quality Assurance and the Monitoring QI Plan 17QI Program Evaluation Process 19Communication of QI activities 19Appendix A: PDCA Checklist 21 2
  • 3. IntroductionOne of the opportunities for improvement that the Taney County Health Department (TCHD)identified through the Missouri Institute of Community Healths Accreditation Process in 2005was a need for a Continuous Quality Improvement (CQI) program. The department was slatedfor MICH reaccreditation in early 2008 and Quality Improvement was an arena that needed tobe addressed. The field of quality improvement is an extensive one. Information pertaining to itis exceedingly vast with a plethora of options tailored to suit the needs of various businessstructures. Therefore, it was important to identify and employ the most appropriate CQIstrategy for the department.What is Continuous Quality Improvement?Continuous Quality Improvement is the complete process of identifying, describing andanalyzing strengths and weaknesses and then testing, implementing, learning from and revisingsolutionsi. It relies on an organizational culture that is proactive and that supports continuouslearning. CQI is firmly grounded in the overall, mission, vision and values of the agency. Mostimportantly, it is dependent upon the active inclusion and participation of staff at all levels ofthe agency, and stakeholders throughout the processii.Which CQI strategy?As was just mentioned, the topic of quality improvement was an extensive one. Therefore, oneof the first challenges was to find a process that would suit the needs of the agency. After anexhaustive CQI literature review, it was felt that the Plan, Do, Check, Act (PDCA) or theDeming/Shewhart Cycle would be the most conducive to meet the needs of TCHD. Moreaccurately, the process is referred to as the FOCUS-PDCA approach. Having originated in thebusiness industry, the FOCUS-PDCA approach has been tweaked for effective application in avariety of healthcare institutions including a public health department.FOCUS: Find a process to improve Organize to improve a process Clarify what is known Understand variation Select a process improvement.After FOCUS has been achieved, a process improvement plan needs to be implemented. Onesuch plan is the PDCA cycle or the Plan Do Check Act cycle.Planning: Involves creating a timeline of resources, activities, training and target dates. Duringthis stage a data collection plan needs to be developed, tools for measuring outcomes need tobe identified, and thresholds for identifying when targets have been met need to be stipulated. 3
  • 4. Do: This involves the actual implementation of the various interventions as well as datacollection.Check: This step includes an analysis of the results of the data and an explanation for thereasons of variations if any.Act: Means that one can act on what was learned and then determine what was learned. If theintervention was successful, then steps to make it a part of standard operating procedure needto be implemented. If the intervention was not successful, then the various sources of failureneed to be identified. Once these are determined new solutions need to be designed and thePDCA cycle needs to be repeatediii.A studyiv showed that repetitive cycles of measuring outcomes followed by implementation ofinterventions to improve outcomes could be effectively used to improve quality of care in ruralhealth clinics.Why Continuous Quality Improvement?In addition to increased productivity, improved service quality, enhanced customerresponsiveness and enhanced employee satisfaction, there are several other benefits ofincorporating CQI into the daily workings of the health department. Some of these are v: Ownership of Process/Program Objectives CQI can bring about changes in attitudes towards a process/program. Employees can see how a set of objectives helps to identify a processs success or indications that a program is moving in the right direction. Inclusiveness/Consistency Implementation of a program on an organizational-wide level promotes a feeling of inclusiveness in the organization. Employees feel part of a team, have similar experiences, use the same CQI tools, as well as participate in organizational wide training. Improved Communication/Teamwork Regular management meetings involve sharing of information among programs and services. Staff can offer suggestions on interventions for opportunities in other areas to assist in needed improvement. This further fosters teamwork. 4
  • 5. Stakeholder Perception Reporting of trended information allows stakeholders to see performance levels on a routine basis. They can see that the organization sets goals, evaluates data collected and reviews the impact on organizational programs. Proactive vs. Reactive CQI initiatives place the organization in a proactive mode. Under a CQI philosophy, programs and services are aggressively monitored which assists with detecting problems in a timely fashion. Analysis of data also helps to distinguish between acceptable and unacceptable performance levels.What is required?The six Key Success Factors (KSFs) for CQI are as followsvi: Key Success Factor 1: Visionary Leadership. Key Success Factor 2: Commitment to Customers / Clients. Key Success Factor 3: Trained Teams. Key Success Factor 4: Employee Participation. Key Success Factor 5: Total Quality Management Process (detailed below). Key Success Factor 6: Alignment of Management Systems. 5
  • 6. The CQI Framework: Fig. 1 VALUES Adopt Apply outcomes Learnings indicators and standards M V I Train and S I support leaders, S S staff and I I O stakeholders O N N Review, analyze and Collect data interpret and data information ORG. CULTURE 6
  • 7. The Crux of Continuous Quality ImprovementThe central idea of CQI lies in the philosophies of scientific method which include hypothesisgeneration, experimentation, observation and hypothesis testing. CQI is all about improvementwhich can only be brought about by change. The PDCA cycle mentioned earlier is a proven toolused to help agencies develop tests and implement changes. In other words, the PDCA is aframework for efficient trial-and-error methodology. The cycle begins with a plan and ends withan action based on the learning gained from the cycle. Improvement comes from theapplication of the knowledge gained and generally, the more complete the appropriateknowledge, the better the improvements will be when the knowledge is applied to makingchanges. Any approach to improvement must be based on building and applyingknowledge.This view leads to a set of fundamental questions, the answers to which form thebasis of improvement: 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in improvement?These questions provide the framework for a trial and learning approach. The word trialimplies that the change is going to be tested.The term learning imples that the criteria thatare intended to be studied from the trial have been identified. This approach stresses learningby testing changes on a small scalevii.Plan of Action Proposal Identify a process that needs improvement that is common to all departments The literature emphasizes that CQI be adopted using a team based approach. This allows for synergistic problem solving, assumed empowerment and can aid in consens

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