The History of ContinuousQuality Improvement (CQI)
HQS510
Learning Outcomes
1. Examine how quality improvement developed from
manufacturing to healthcare.
2. Compare quality assurance and continuous quality
improvement (CQI).
3. Apply the PDSA cycle of quality improvement.
4. Examine healthcare quality in the context of Saudi Vision
2030.
The History of Continuous Quality
Improvement (CQI)
►
Definitions
Safe. Delivering health care that
minimizes risks and harm to service
users, including avoiding preventable
injuries and reducing medical errors.
➢ Effective. Providing services based on
scientific knowledge and evidence-based
guidelines.
➢ Timely. Reducing delays in providing and
receiving health care.
➢
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Definitions (cont.)
Efficient. Delivering health care in a manner
that maximizes resource use and avoids waste.
➢ Equitable. Delivering health care that does not
differ in quality according to personal
characteristics such as gender, race, ethnicity,
geographical location, or socioeconomic
status.
➢ People-centered. Providing care that takes
into account the preferences and aspirations
of individual service users and the culture of
their community.
➢
HQ5S10
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Quality Assurance
➢
HQS510
Quality assurance (QA) is closely
related to, and sometimes
confused with, CQI. QA focuses on
conformance quality, which is
defined as “conforming to
specifications; having a product or
service that meets predefined
standards” (McLaughlin & Kaluzny,
2006).
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Continuous Quality Improvement
(CQI)
➢
“The combined efforts of everyone—
health care professionals, patients and
their families, researchers, payers,
planners and educators—to make
changes that will lead to better patient
outcomes (health), better system
performance (care) and better
professional development (learning)”
(Batalden & Davidoff, 2007).
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Characteristics of CQI
■ A link to key elements of the
organization’s strategic plan
■ A quality council made up of the
institution’s top leadership
■ Training programs for personnel
■ Mechanisms for selecting
improvement opportunities
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Characteristics of CQI (cont.)
■ Formation of process improvement teams
■ Staff support for process analysis and
redesign
■ Personnel policies that motivate and
support staff participation in process
improvement
■ Application of the most current and
rigorous techniques of the scientific method
and statistical process control
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Continuous Quality Improvement (CQI)
➢
Institutional Improvement
1.
Localized improvement efforts
2.
Organizational learning
3.
Process reengineering
4.
Evidence-based practice and
management
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Continuous Quality Improvement (CQI)
➢
Societal Learning
➢
➢
Concern for quality and cost is a matter of
public policy.
Professional Responsibility
➢
Professional development as a potential
engine of quality improvement.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Rationale and Distinguishing
Characteristics:
➢
Customer Focus
➢
System Focus
➢
Measurement and Decision Making
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Elements of CQI
➢
Philosophical Elements
➢
Structural Elements
➢
Health Care–Specific Elements
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► Evolution of the Quality Movement
➢
➢
Like the field itself, its name has evolved from total
quality management (TQM) to continuous quality
improvement (CQI), or simply quality improvement
(QI).
From TQM to CQI➢
Represents a fundamental change in how
organizations have come to recognize the
importance of ensuring that changes are
improvements and that the improvement
processes are ongoing, requiring learning and
involvement in the process at all levels, from
the individual to the organization level.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► Ongoing Evolution in Japan
➢
1.
2.
3.
4.
HQS510
Recent Contributions of Japanese Quality Engineers
Total participation is required of all members of an
organization (quality must be company-wide).
The next step of a process is its “customer,” just as
the preceding step is its “supplier.”
Communicating with both customer and supplier is
necessary (promoting feedback and creating channels
of communication throughout the system).
Emphasis is placed on participative teams, starting
with “quality circles.”
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
➢
Ongoing Evolution in Japan
Recent Contributions of Japanese Quality
Engineers (cont.)
5.
6.
7.
8.
Emphasis is placed on education and
training.
Instituted the Deming Prize to recognize
quality improvement.
Statistics are used rigorously.
Instituted “just in time” processes.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Cross-Disciplinary Thinking
CQI:
Philosophy
Process Tools
Mission
Goals
Outcomes
Mission
Goals
Outcomes
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► Shewart (PDSA) Cycle
Act: Adopt the
change or
abandon it or
run through the
cycle again
Plan: a change
or a test aimed
at improvement
Study the
results- what
did we learn?
What went
wrong?
Do: carry out
the change or
test, on a small
scale
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
The Evolution Across Sectors of Health
Care
►
Now includes all segments of the health
care system and has become woven into
the education of future practitioners,
including not only administrators and
physicians but also nurses, public health
practitioners, and a wide array of other
health professionals.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
The Big Bang—The Quality Chasm
➢
Quality improvement was acknowledged
to be a professional responsibility, a
quality-of-care issue rather than a
managerial tactic.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► From Industrialization to Personalization
Craft requires that the individual improve with
experience and use the tacit knowledge produced to
develop a better individual reputation and group
reputation. Craft activities can be leveraged to a
limited extent by a community of cooperating and
teaching crafts-persons.
➢ Mass production requires the discipline that
produces conformance quality in high volume at low
cost. Critics sometimes refer to this approach using
terms such as industrialization or the deskilling of
the profession and occasionally mention Henry
Ford’s assembly lines as a negative model.
➢
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► From Industrialization to Personalization
➢ Process enhancement requires that processes be
analyzed and modified to develop a best-practice
approach using worker feedback and processowning teams within the organization.
➢ Mass customization requires that the
organization takes that best practice, modularizes
and supports it independently, and then uses
those modules to build efficient, low-cost
processes that are responsive to individual
customer wants and needs.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► The Scientific Method of CQI
Key features of PDSA application:
1.
The use of repeated iterative cycles
2.
Prediction-based test of change (developed in the
plan stage)
3.
Small-scale testing (build as confidence grows—
adapting according to feedback and learning)
4.
Use of data over time (to understand the impact of
change)
5.
Documentation (to support local learning and
transferability to other settings)
➢
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
The FOCUS-PDCA Model
1.
2.
3.
4.
5.
6.
7.
8.
9.
HQS510
What are we trying to accomplish?
How will we know when that change is an
improvement?
What changes can we predict will make an
improvement?
How shall we pilot test the predicted improvements?
What do we expect to learn from the test run?
As the data come in, what have we learned?
If we get positive results, how do we hold on to the
gains?
If we get negative results, what needs to be done next?
When we review the experience, what can we learn
about doing a better job in the future?
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Conclusions
➢
➢
The trend is continuing on a global scale.
The institutionalization of CQI in public
health continues to grow due to various
influences that mirror other health care
sectors, such as national and local
accreditation efforts.
HQS510
Course Code and Title
The History of Continuous
Quality Improvement (CQI)
HQS510
Learning Outcomes
1. Examine how quality improvement developed from
manufacturing to healthcare.
2. Compare quality assurance and continuous quality
improvement (CQI).
3. Apply the PDSA cycle of quality improvement.
4. Examine healthcare quality in the context of Saudi Vision
2030.
The History of Continuous Quality
Improvement (CQI)
►
Definitions
Safe. Delivering health care that
minimizes risks and harm to service
users, including avoiding preventable
injuries and reducing medical errors.
➢ Effective. Providing services based on
scientific knowledge and evidence-based
guidelines.
➢ Timely. Reducing delays in providing and
receiving health care.
➢
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Definitions (cont.)
Efficient. Delivering health care in a manner
that maximizes resource use and avoids waste.
➢ Equitable. Delivering health care that does not
differ in quality according to personal
characteristics such as gender, race, ethnicity,
geographical location, or socioeconomic
status.
➢ People-centered. Providing care that takes
into account the preferences and aspirations
of individual service users and the culture of
their community.
➢
HQ5S10
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Quality Assurance
➢
HQS510
Quality assurance (QA) is closely
related to, and sometimes
confused with, CQI. QA focuses on
conformance quality, which is
defined as “conforming to
specifications; having a product or
service that meets predefined
standards” (McLaughlin & Kaluzny,
2006).
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Continuous Quality Improvement
(CQI)
➢
“The combined efforts of everyone—
health care professionals, patients and
their families, researchers, payers,
planners and educators—to make
changes that will lead to better patient
outcomes (health), better system
performance (care) and better
professional development (learning)”
(Batalden & Davidoff, 2007).
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Characteristics of CQI
■ A link to key elements of the
organization’s strategic plan
■ A quality council made up of the
institution’s top leadership
■ Training programs for personnel
■ Mechanisms for selecting
improvement opportunities
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Characteristics of CQI (cont.)
■ Formation of process improvement teams
■ Staff support for process analysis and
redesign
■ Personnel policies that motivate and
support staff participation in process
improvement
■ Application of the most current and
rigorous techniques of the scientific method
and statistical process control
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Continuous Quality Improvement (CQI)
➢
Institutional Improvement
1.
Localized improvement efforts
2.
Organizational learning
3.
Process reengineering
4.
Evidence-based practice and
management
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Continuous Quality Improvement (CQI)
➢
Societal Learning
➢
➢
Concern for quality and cost is a matter of
public policy.
Professional Responsibility
➢
Professional development as a potential
engine of quality improvement.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Rationale and Distinguishing
Characteristics:
➢
Customer Focus
➢
System Focus
➢
Measurement and Decision Making
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Elements of CQI
➢
Philosophical Elements
➢
Structural Elements
➢
Health Care–Specific Elements
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► Evolution of the Quality Movement
➢
➢
Like the field itself, its name has evolved from total
quality management (TQM) to continuous quality
improvement (CQI), or simply quality improvement
(QI).
From TQM to CQI➢
Represents a fundamental change in how
organizations have come to recognize the
importance of ensuring that changes are
improvements and that the improvement
processes are ongoing, requiring learning and
involvement in the process at all levels, from
the individual to the organization level.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► Ongoing Evolution in Japan
➢
1.
2.
3.
4.
HQS510
Recent Contributions of Japanese Quality Engineers
Total participation is required of all members of an
organization (quality must be company-wide).
The next step of a process is its “customer,” just as
the preceding step is its “supplier.”
Communicating with both customer and supplier is
necessary (promoting feedback and creating channels
of communication throughout the system).
Emphasis is placed on participative teams, starting
with “quality circles.”
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
➢
Ongoing Evolution in Japan
Recent Contributions of Japanese Quality
Engineers (cont.)
5.
6.
7.
8.
Emphasis is placed on education and
training.
Instituted the Deming Prize to recognize
quality improvement.
Statistics are used rigorously.
Instituted “just in time” processes.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Cross-Disciplinary Thinking
CQI:
Philosophy
Process Tools
Mission
Goals
Outcomes
Mission
Goals
Outcomes
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► Shewart (PDSA) Cycle
Act: Adopt the
change or
abandon it or
run through the
cycle again
Plan: a change
or a test aimed
at improvement
Study the
results- what
did we learn?
What went
wrong?
Do: carry out
the change or
test, on a small
scale
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
The Evolution Across Sectors of Health
Care
►
Now includes all segments of the health
care system and has become woven into
the education of future practitioners,
including not only administrators and
physicians but also nurses, public health
practitioners, and a wide array of other
health professionals.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
The Big Bang—The Quality Chasm
➢
Quality improvement was acknowledged
to be a professional responsibility, a
quality-of-care issue rather than a
managerial tactic.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► From Industrialization to Personalization
Craft requires that the individual improve with
experience and use the tacit knowledge produced to
develop a better individual reputation and group
reputation. Craft activities can be leveraged to a
limited extent by a community of cooperating and
teaching crafts-persons.
➢ Mass production requires the discipline that
produces conformance quality in high volume at low
cost. Critics sometimes refer to this approach using
terms such as industrialization or the deskilling of
the profession and occasionally mention Henry
Ford’s assembly lines as a negative model.
➢
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► From Industrialization to Personalization
➢ Process enhancement requires that processes be
analyzed and modified to develop a best-practice
approach using worker feedback and processowning teams within the organization.
➢ Mass customization requires that the
organization takes that best practice, modularizes
and supports it independently, and then uses
those modules to build efficient, low-cost
processes that are responsive to individual
customer wants and needs.
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
► The Scientific Method of CQI
Key features of PDSA application:
1.
The use of repeated iterative cycles
2.
Prediction-based test of change (developed in the
plan stage)
3.
Small-scale testing (build as confidence grows—
adapting according to feedback and learning)
4.
Use of data over time (to understand the impact of
change)
5.
Documentation (to support local learning and
transferability to other settings)
➢
HQS510
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
The FOCUS-PDCA Model
1.
2.
3.
4.
5.
6.
7.
8.
9.
HQS510
What are we trying to accomplish?
How will we know when that change is an
improvement?
What changes can we predict will make an
improvement?
How shall we pilot test the predicted improvements?
What do we expect to learn from the test run?
As the data come in, what have we learned?
If we get positive results, how do we hold on to the
gains?
If we get negative results, what needs to be done next?
When we review the experience, what can we learn
about doing a better job in the future?
Course Code and Title
The History of Continuous Quality
Improvement (CQI)
►
Conclusions
➢
➢
The trend is continuing on a global scale.
The institutionalization of CQI in public
health continues to grow due to various
influences that mirror other health care
sectors, such as national and local
accreditation efforts.
HQS510
Course Code and Title
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