Modern paradigm for improving healthcare quality

The monograph starts by outlining the principles and frameworks underlying modern quality improvement in health care, describing "change" as the key element of any improvement. It next describes the framework for quality improvement in health care, including the integration of evidence-based medicine and quality improvement. It explains the four principles of quality improvement: focus on the client, understanding work as processes and systems, teamwork, and testing changes to processes and systems using data. Section 2 describes the spectrum of quality improvement methods. This shows how, depending on the needs of the improvement, there exists an infinite number of quality improvement approaches all built upon the quality improvement principles and methodology. The monograph arbitrarily defines four points along this spectrum of increasing complexity that demonstrate the application of the methodology to different situations: (1) Individual problemsolving: The hallmark of this approach is that there is no interdependency in the improvement, which can be accomplished by one individual. (2) Rapid team problemsolving: This approach emphasizes accomplishing results as quickly as possible by eliminating all non-vital steps. (3) Systematic team problemsolving: This is a more rigorous approach that uses root cause analysis. (4) Process improvement: This approach is used when the team is dealing with a core service process and where a permanent team continually follows up the process. The next four sections detail and exemplifies the methodology for each of the four approaches. The final section describes a number of tools used in quality improvement, including data collection, process description, and data analysis tools. Examples of the use of each tool are also provided. The tools section also serves as a reference on the use of the tools of quality management in various situations. Most of these tools have been used in the examples in the previous sections, and details regarding their application may be found in this section. (Author abstract, modified)