Continuous quality improvement
What's in a name?
For practical purposes, we will use the term CQI (continuous quality improvement) in this particular section. Similar related or identical terms are quality management, TQM (total quality management), total quality care, quality improvement, and TQS (total quality service).
CQI offers the potential to affect positively every aspect of an institution's health care service delivery. It has been used as a means to accomplish goals like cost containment and increased accessibility. It teaches employees to see beyond their own immediate tasks and roles and makes everyone more aware of the larger work process of which they are a part, a "niche", from which they contribute to the institution's accomplishment of goals.
It is defined as an ongoing, organization-wide framework in which the health service organization and their employees are committed to and involved in monitoring and evaluating all aspects of the institution's activities (inputs, process, and outputs) in order to continuously improve them.
Remember the important elements:
1. organization-wide
2. process-focused - this refers to all the steps that happen in the conversion of inputs to outputs
3. use of output or inspection measures - continuous performance and outcome monitoring, whether time-series (intrainstitutional evaluation) or inter-institutional comparisons
4. customer driven - the goal is to meet or even exceed customer (in its broadest sense) expectations
The goal of CQI is to do the right things right, the first time. Are we doing the right things? The "right things" refer to the output of the institution, and I repeat, this might be predominantly one of, but mostly a mixture of service, training, and research. Output that meets customers' expectations is a quality product or service, and means that the institution is doing the right things.
Are we doing things right? We are working on the premise that the output can only be improved by improving the input or the processes that it goes through to be become the output. Another premise is that all processes can be improved. Monitoring, evaluating, and intervening to improve processes should be continuous. Needless to say, processes should be written down, understood, and documented, and all employees must actively seek or be on the lookout for opportunities to improve these processes and therefore the output. If one lags behind in comparison to one's peers in the field, one should not be shy or "feel humiliated" to ask or observe how their processes are done with the point of adapting them if they look promising, considering the institution's own environment.
CQI procedures must be prospective in addition to being retrospective. The aim is for excellent quality and preventing shoddy output before it happens. On the other hand, it must have in place procedures for recognizing shoddy or below-par work. Statistical control, or the use of control charts might be of help in monitoring output quality. If the output is in conformance meeting customer expectations, the institution is doing the right thing.
What are the costs of poor quality?
Why is there never enough time to do it right, but always enough time to do it over? That is from an ashtray in my living room, but it could well be from a bumper sticker too. Most everyone becomes frustrated with poor quality output. It can be very costly, too.
The most usual and more measurable costs of poor quality output to a health care institution are in the form of more customer complaints, insurance billing errors, excessive overtime, unnecessary/inaccurate/lost laboratory or radiology results, and therefore more quality control department expenses. Those are things that are on the top of the iceberg.
"Psychic" or less measurable, "hidden" costs are in the form of a frustrated staff, loss of professional integrity, lack of teamwork between doctors, nurses, technologists, and other members of the health care team, ineffective communication at all levels, lack of competitive knowledge, apathy and lack of enthusiasm at all levels, dissatisfied/lost patients, inaccurate or missing insurance information, medication and prescription errors, overdue receivables, and worst of all, bad reputation....
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