• UNC Chapel Hill

Institute for Healthcare Quality Improvement

Effective quality improvement presentations are designed to capture the hearts and engage the minds of the audience. Presentations that are too data heavy can be dull and hard to follow while presentations that rely too much on anecdotes and sentimentalism can come across as lacking scientific merit. The following presentation guidelines and elements will help you create a quality improvement presentation that captures the best of both worlds.

Presentation Guidelines

  • Presentations should be engaging and stimulating.
  • Presentations about quality improvement projects lend themselves to a narrative format so your presentation should tell the story of your project including the highs & lows, twists & turns.
  • Improvement is all about trial and error so it’s critical that your presentation reflect some of the error!
  • Emphasize the value your improvement project provides to patients, families and clinicians.
  • Rehearse and time your presentations.

Presentations should address these elements

  • Project Aim
  • Explanation of Need for Improvement
  • Patient Perspective (or care team member perspective if patient perspective not appropriate)
  • Annotated Run Charts (2-4) – the annotations help you tell the story of the project
  • Sustainment Plan
  • Spread Plan (if appropriate)

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presentation about quality improvement project

Quality Improvement

Transcript: Quality Improvement "If you think adventure is dangerous, try routine. It is lethal." - Paulo Coelho What's Been Going On? Training Program Projects & Support Dental Patient Satisfaction Survey Development PDSA Review Lunch N Learn 80 People 2 Tribes Success Stories Methodologies Quality Tools Launched Webinar Series Training Program New Projects

presentation about quality improvement project

Transcript: Treatment -turn patient as often as ordered -thorough assessments -recognize the value in taking preventative measures! Why is it important to chart? Concerns Huddles, another way to improve quality. What is a huddle? Summary The interdisciplinary team approach creates teamwork, collaboration, and communication. This improves quality of patient safety and care. A group of healthcare professionals from diverse fields who work in a coordinated fashion toward a common goal for the patient. An example of this team in action is joint rounding. At Menorah, these rounds were done with the nurse, charge nurse, and sometimes pharmacy & dietary. -Risk for infection -Pain management -Patient's low nutritional intake Why do huddles work? Prevention is Key! How could this have been prevented? It's important to remember this team is part of a system of care that affects outcomes for patients and family members. Freedom Rider - Use of data & improvement methods Heather Biggar - Interdisciplinary team & huddles Brian Buhman - Patient background & diagnosis Allison Martinez - Root analysis of the patient situation Sarah Blackman - Provider education Michelle Kim - Charting: Skin Breakdown Kerry Blankenship - Summary of competency Analysis of the Patient Situation Our voice as a patient advocate Appreciate the value of what individuals and teams can do to improve care Identify the "gaps" between local and best practices Use definitive measures to evaluate the effect of the change HAVE THE COURAGE TO SPEAK UP!! *Who was involved? Which departments? *What factors contributed to the patient's skin breakdown? They demand rapid team formation & preparation at the practice level. They allow the team to: *Problem solve *Educate each other *Communicate *Improve quality of care -If you don't chart then..... -Legal matters -Improved quality care of patient with ongoing treatment -Shift changes Much like a football team before a play, the Med/Tele unit at Menorah huddles at the same time and the same place before every shift. -Paraplegic -PVD -Bilateral AKA -Intracranial bleeding -End stage renal disease -Multiple stage IV pressure ulcer wounds Who makes up this team? Interdisciplinary Team Credits Physician(s) Nurse Charge Nurse Nursing Student Wound Care Nurse Respiratory Therapy Occupational Therapy Physical Therapy Dietary Pharmacy Use of data to monitor the outcomes of care processes and use of improvement methods to design and test changes to continuously improve quality and safety of health care systems. Why do you chart? -Chart initial assessment -Chart physical changes (skin integrity & odor) -Pain meds helpful? -What labs were done? Results? Mobility Systemic Process ID Potential Causes Develop Strategies Measured Care A short 5 minute period, prior to shift, when the charge nurse goes over important items. Examples: *Departmental issues *Core measures *Potential problems, like skin breakdown in our patient that Brian will later describe. Education! Patient X Patient History -what movement can the patient tolerate? -how to move the patient appropriately -proper body mechanics -ask for assistance Charting: Skin Breakdown Quality Improvement Definition of Quality Improvement: -Repositioning -Support surfaces -Antibiotics -Cleaning -Packing and bandaging Huddles Fundamental Concept

presentation about quality improvement project

Quality improvement

Transcript: Efficient: Prevent waste of equipment, supplies, ideas and energy Questions to Ask for Patient Centered Care 1. Total Quality Management (TQM) 2. Continuous Quality Improvement (CQI) 3. Continuous Process Improvement, Statistical Process Control, and Performance Improvement (PI) determined by customer needs and expectations health care quality management is specifically related to the quality of health care services provided Customer's perspective must be considered, including interactions with personnel as well as the service they receive. Brittany Jones & Stephanie Gilson Transfer of Accountability rather than a basic update Language of discussion should allow for patient understanding Encourage patient to contribute or ask questions as they feel necessary What is the most important thing I could do for my patient at this moment? How can the patient or family participate in assessing the patient's pain and determine the best pain management plan? How can I assist family members with visiting hours and access to their family member to reduce anxiety and include them as partners in care? patients are subjected to at least one med error per day 25% of patients do not receive care that is recommended, related to socioeconomic/racial reasons 98,000 patients are killed each year from medical errors Caused by: overuse of expensive invasive technology underuse of inexpensive care services error-prone implementation of care that could harm patients and wast money Need for Quality Improvement Chaboyer, W., McMurray, A., Johnson, J., Hardy, L., Wallis, M., & Chu, S. (2009, April). Bedside Handover, One Quality Improvement Strategy to "Transform Care at the Bedside". Journal of Nursing Care Quality, 24(2), 136-142. Cherry, B., Jacob, S. (2014). Contemporary Nursing: Issues, trends, & management. Missouri: Mosby. Transforming care at the bedside. (2015). In Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/Engage/Initiatives/Completed/TCAB/Pages/default.aspx Weston, M., & Roberts, D. W. (2013, September). The Influence of Quality Improvement Efforts on Patient Outcomes And Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems. In The Online Journal of Issues in Nursing. Retrieved from http://www.nursingworld.org/Quality-Improvement-on-Patient-Outcomes.html Equitable: Providing care that does not vary in quality because of gender, ethnicity, location, and socioeconomic status Transforming Care at the Bedside (TCAB) Safe: Preventing injuries from care that is meant to help them Timely: Reducing wait and harmful delays for those who receive and give care Groups of 2 or 3 Short skit on bedside handoff Each group with have a specific handoff characteristic to portray Handoff activity Patient Centered: Providing care that is respectful and responsive to patient preferences, needs and values Effective: Provide services, based on science, to all and only those that could benefit Quality improvement Bedside Handoff Quality Management 6 guiding aims for improvement for every individual and group involved in the provision of healthcare Categories: Safe and reliable care Vitality and Teamwork Patient Centered Care Value-added Care processes Three Cornerstones of Quality Management Bar code med administration Use of smart infusion pumps Available online resources Mandatory education modules for employees Examples of Quality Improvement References Improvements: Use of Rapid Response teams Communication Models Enhance preceptorships and educational opportunities Redesign workspace for efficiency STEEEP

presentation about quality improvement project

Transcript: Quality Improvement By: Perpetue Obama, Rikira Smith, Tiffany Ekstrom, Catalina Gonzalez, Brianna McNabb, Robyn Calvio, Eric Debrah, & Stephanie Zafra Johnson, Carson, Tucker & Willette, 2003 A Nurse’s role is to be an active participant in a hospital’s quality improvement process “QI strategies models are important to increase hospital response when current systems do not work effectively or when improvement is needed in a system to increase patient outcomes (Wickman et al., 2013)” “Nurses share accountability to ensure quality and safety of the healthcare system (Wickman et al., 2013)” QI disadvantages Lack of research evidence Implementing changes too fast Different QI language QI Implications All nurses share QI responsibility Lifelong QI education Publications of QI process and findings Implement creative QI activities Constant communication and collaboration Haemodialysis staff are at high risk of exposure to blood-borne viruses. Therefore it is important to identify the risks and find ways to decrease them. This QI project was conducted during the 2nd quarter of 2011 until the 2nd quarter of 2012. In this research 19 haemodialysis clinics across Australia and New Zealand were studied. Incident reports on the risk management system were evaluated twice every week for three months. Needlestick injury preventive measures and prevention protocols were implemented in order to reduce the risk of future occurrences. “The majority of sharps-related injuries occur after use and before and during sharps disposal” (Chenoweth, 2013). After staff training sessions and new protocols there was a decrease of 47% in needlestick injuries. “Awareness of needlestick injuries and safe work practices needs to become a part of a dialysis culture with ongoing education, auditing of policy compliance followed immediately by more education and introduction of needle-safe devices” (Chenoweth, 2013). QI: Patient safety and Increased Workflow Proficiency (Bar Code Medication Administration-BCMA) Morriss, et al (2009). Pyxis Quality Improvement Staff on a 28-bed medical telemetry unit learned the steps of effective nurse-led quality improvement through their participation in the Transforming Care at the Bedside initiative. Quality Improvement vs. Traditional Problem Solving Using Plan, Do, Check, Adjust (PDCA) cycles, staff generated and trialed solutions for unit-based problems. The use of PDCA cycles allowed the team to test several solutions to the problem before choosing a simple, inexpensive measure that made a substantial, positive impact on team vitality, patient care quality and safety, and the effectiveness of the care team. Successful implementation Leadership is a crucial component of the nurse-led quality improvement model because formal unit leaders must act as the coaches, supporters, and mentors of staff innovators, especially during the early stages of the process improvement. Identifying nurses willing to engage actively as improvement change agents is imperative to the success of nurse-led quality improvement. The process of nurse-led quality improvement requires a set of skills that must be taught, practiced, and refined to be successful. Comparison of Classes of Medication Errors Between Hospital Systems with BCMA and Ones Without BCMA. The primary cause of error-related inpatient deaths is adverse drug events such as medication errors that result in patient harm. In an effort to reduce medication administration errors and ensure patients safety, the VA hospital implemented the bar code medication administration (BCMA) system in 1995. The BCMA ensures that the correct patient receives the correct medication, the correct dose, at the correct time, via the correct route, and visually alerts nursing staff when the proper parameters are not met. It improves nursing workflow during medication administration by decreasing opportunity for error through workarounds. It is safer for patients, user-friendly, and effective in reducing errors; requires justification for overriding. Reports on its effectiveness indicate reductions in medication error rates ranging from 60% to 93% (Rivish & Moneda, 2010). Quality improvement has a long history in healthcare from Semmelweis who introduced hand washing to medical care to Florence Nightingale who determined that living conditions correlated with deaths of soldiers at army hospitals. More recently, some organizations have adopted lessons of high-reliability science which is the consistent performance of high levels of safety over long periods of time. Three requirements for achieving high reliability: Leadership: leaders must show commitment and support for the process Safety Culture: Encouraging organizational safety culture allows for employees to feel at ease and free of blame when errors/near misses are reported, investigated, and fixed. Robust Process Improvement: systemic approach to dealing with complicated safety issues and guiding the organization to finding and

presentation about quality improvement project

Transcript: Background Information and Data/Evidence Findings/Results/Outcomes of Interventions Conclusions and Recommendations for Practice DO Establish Service Expectations: Standard response time to call light, Non-clinical personnel guidelines, Adequately fulfill call light requests Provide proper training: Identify responsibilities of support staff, Scripting, Role Play Patient Satisfaction: Improving Responsiveness to Call Lights HCAHPS Question: "During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?" May 2013 MBU scores: 81.8% of patients responded call lights "always" answered Problem statement: In order to maintain and improve call light response time, global standards such as acknowledgment and resolution must be reached National Context: Hospital consumer assessment of healthcare providers and systems (HCAHPS) is a patient satisfaction survey based on core measures and patient perception of care. Why does this matter? Scores are used nationally by companies to determine insurance coverage and reimbursement. Reduces stress and patient stay in hospital. Encourages healing and communication. Reduces medication errors and law suits. Incentives for individual and unit. PLAN "No Pass Zone" Anyone can answer a call bell Responsiveness to Call Lights and the National Context References Bournes, D., & Flint, F. (2003). Mis-takes: Mistakes in the nurse-person process. Nursing Science Quarterly, 16(2), 127-130. DiNapoli, P. P., Turkel, M., Nelson, J., & Watson, J. (2010). Measuring the caritas process: Caring factor survey. International Journal of Human Caring, 14(3), 15-20. Ganz, F. (2012). Tend and Befriend in the Intensive Care Unit. Critical Care Nurse, 32(3), 25-34. doi:10.4037/ccn2012903 Henderson, S. (2003). Power imbalance between nurses and patients: A potential inhibitor of partnership in care. Journal of Clinical Nursing, 12(4), 501-508. doi:10.1046/j.1365-2702.2003.00757.x Knudsen, E. & Grenier, J. (2010). A great patient experience = positive HCAHPS scores [PowerPoint slides]. Retrieved from http://campaignforquality.sites campaignforquality.com/files/presentations/A%20Great%20Patient %20Experience%20-%20Positive%20HCAHPS%20Scores.pdf Lachman, V. (2012). Applying the ethics of care into your nursing practice. Ethics, Law, and Policy, 21(2), 112-116. Regions Hospital. (2012). 2012 Quality Report. Retrieved from: http:// www.regionshospital.com/ucm/groups/public/@hp/@public/documents/ webcontent/cntrb_036843.pdf Suliman, W. A., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson's nursing theory to assess patient perceptions of being cared for in a multicultural environment. Journal of Nursing Research, 17(4), 293-300. Tonges, M. (2011). Translating caring theory into practice. The Journal of Nursing Administration, 41(9), 374-381. Viamontes, G. I., & Nemeroff, C. B. (2009). Brain-body interactions: The physiological impact of mental processes -- The neurobiology of the stress response. Psychiatric Annals, 39(12), 975-984. doi:10.3928/00485718-20091124-03 Viamontes, G. I., & Nemeroff, C. B. (2010). The physiological effect of mental processes on major body systems. Psychiatric Annals, 40(8), 367-380. doi:10.3928/00485713-20100804-03 The No Passing Zone initiative does not mean that non-clinical team members are expected to go into a patient’s room and provide clinical care. Simply put, it means that call lights are everyone’s responsibility, and team members are expected to take the time to acknowledge a call light and ask what the patient needs, and then make the connection with the appropriate team member who can assist the patient. Work as of now... Continue compiling Patient Satisfaction Survey comments and reviewing HCAHPS  Focus group sessions with RNs, Aides, and Unit Clerks on implementing No Pass Zone  Measure response time to call bells Evidence-Based Practice: - Stress caused by external stimuli leads to activation of stress response, including BS increase and anxiety - HCAHPS is evaluated using PEP Audits: must score 100% to receive incentives - Communication is more beneficial to patient healing using Human Caring Theory and reduces medical errors (i.e. always including teaching and follow up on medications and side effects) - Hourly rounding is the foundation ␣ - Restroom rounds - A supplement to hourly rounding , i.e. after meals and before bed ␣- Service Volunteer Rounding programs - "No Pass Zone" PDSA ACT Non-nursing associates can assist with: moving and obtaining equipment assist with making phone calls and answering phone if beyond reach change TV channels or turn TV on/off turn room lights on/off obtain blanket, pillow, towel, washcloth, slippers, etc open and/or close curtains Regions Hospital (St. Paul, MN) piloted a program in 2012 called the No Pass Zone in which every employee takes responsibility to answer a call light. This resulted in a 12 percent improvement in lights responded to within two minutes and a

presentation about quality improvement project

Transcript: EQUITY Complaint handling Informed Consent Trusted PATHWAYS The GOAL! AVOID WASTE National Voices definition: Equipment Booking procedure Inpatients Ionising Radiation Report Turnaround CUSTOMER CARE PROMISES EFFICIENT Valued Service Improvement Staff Room for DISCUSSION Interventional Procedures YOUR VOICE "I can plan my care with people who work together, to understand me and my carers, allow me control, and bring together services to achieve the outcomes important to me" Privacy and Dignity MRI Safety Waiting Times Drugs and Contrast Media RISK MANAGEMENT Information AIM INNOVATION ACTION CLINICAL EFFECTIVENESS Best Provider of Integrated Care Reliable High Quality Service Facilities Report Accuracy Emergency ISAS Improve Communication with staff SUSTAINABILITY Rewarded FRIENDS AND FAMILY TEST RESEARCH IT / PACS Community ATTRACTIVE RESOURCES Infection Control SAFE EFFECTIVE PATIENT SAFETY Feedback on performance Positive and Negative STAFF EXPERIENCE Intervention Success rate Outpatients INTEGRATED CARE Respected Quality Improvement Sessions PATIENT EXPERIENCE

presentation about quality improvement project

Transcript: Data Flow Maps & Recommendations - - -blahablah blha Deliverables (take 1) Challenges e-Tool Mock Up Data Flow : Mitigated Areas Questions? 1) Literature Review 2) Summary description of recommended tool 3) Implementation design & Process flow Map 1) Literature review on strategies to improve staff motivation & tools for improved data quality 2) Recommendations based on literature 3) Current data flow highlighting opportunities for improvement & a new data flow incorporating changes 4) A mock-up of an excel tool that would populate a digital MSPP page for easy tracking and transfer of numbers to the paper MSPP monthly report Quality Improvement Our Process Data Flow : Ideal State Deliverables (Revised) Tools for Quality Improvement Introduction --Skype with Efua & modify deliverables Strategies to Increase Motivation Tools for Quality Improvement Implementation Design Recommended Strategies & Tools Data Flow: Current State -Data Quality Assurance -Incomplete Information -Lack of Motivation/Accountability -Tedious & inaccurate calculations 1) 5S dlfslkfslfjl 2) DMAIC dlsjflaksdjflksl The Literature Says... Strategies to Increase Motivation Scope of Work Data Flow : Areas for Improvement

presentation about quality improvement project

Transcript: Where have we been? Creating a Culture of Safety and Overhauling our Q&S Program "Quality and Safety is a primary focus at Sick Kids Critical Care." - Peter Laussen Developing our Q&S team Developing a Comprehensive Q&S Communication Strategy Where are we now? Local solutions for local problems Building Capacity in the Front Line Stewardship Where are we going? Measurements and Metrics- Local and Real time Enhancing the voice of patients and families in Q&S Modifying the environment to enhance Q&S Sustainability Create a safer environment? Better meet your expectations? Safety and Quality Improvement at Sick Kids Critical Care Unit- A Journey Provide better care? How might we... The Way out

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  • Quality improvement...

Quality improvement into practice

Read the full collection.

  • Related content
  • Peer review
  • Adam Backhouse , quality improvement programme lead 1 ,
  • Fatai Ogunlayi , public health specialty registrar 2
  • 1 North London Partners in Health and Care, Islington CCG, London N1 1TH, UK
  • 2 Institute of Applied Health Research, Public Health, University of Birmingham, B15 2TT, UK
  • Correspondence to: A Backhouse adam.backhouse{at}nhs.net

What you need to know

Thinking of quality improvement (QI) as a principle-based approach to change provides greater clarity about ( a ) the contribution QI offers to staff and patients, ( b ) how to differentiate it from other approaches, ( c ) the benefits of using QI together with other change approaches

QI is not a silver bullet for all changes required in healthcare: it has great potential to be used together with other change approaches, either concurrently (using audit to inform iterative tests of change) or consecutively (using QI to adapt published research to local context)

As QI becomes established, opportunities for these collaborations will grow, to the benefit of patients.

The benefits to front line clinicians of participating in quality improvement (QI) activity are promoted in many health systems. QI can represent a valuable opportunity for individuals to be involved in leading and delivering change, from improving individual patient care to transforming services across complex health and care systems. 1

However, it is not clear that this promotion of QI has created greater understanding of QI or widespread adoption. QI largely remains an activity undertaken by experts and early adopters, often in isolation from their peers. 2 There is a danger of a widening gap between this group and the majority of healthcare professionals.

This article will make it easier for those new to QI to understand what it is, where it fits with other approaches to improving care (such as audit or research), when best to use a QI approach, making it easier to understand the relevance and usefulness of QI in delivering better outcomes for patients.

How this article was made

AB and FO are both specialist quality improvement practitioners and have developed their expertise working in QI roles for a variety of UK healthcare organisations. The analysis presented here arose from AB and FO’s observations of the challenges faced when introducing QI, with healthcare providers often unable to distinguish between QI and other change approaches, making it difficult to understand what QI can do for them.

How is quality improvement defined?

There are many definitions of QI ( box 1 ). The BMJ ’s Quality Improvement series uses the Academy of Medical Royal Colleges definition. 6 Rather than viewing QI as a single method or set of tools, it can be more helpful to think of QI as based on a set of principles common to many of these definitions: a systematic continuous approach that aims to solve problems in healthcare, improve service provision, and ultimately provide better outcomes for patients.

Definitions of quality improvement

Improvement in patient outcomes, system performance, and professional development that results from a combined, multidisciplinary approach in how change is delivered. 3

The delivery of healthcare with improved outcomes and lower cost through continuous redesigning of work processes and systems. 4

Using a systematic change method and strategies to improve patient experience and outcome. 5

To make a difference to patients by improving safety, effectiveness, and experience of care by using understanding of our complex healthcare environment, applying a systematic approach, and designing, testing, and implementing changes using real time measurement for improvement. 6

In this article we discuss QI as an approach to improving healthcare that follows the principles outlined in box 2 ; this may be a useful reference to consider how particular methods or tools could be used as part of a QI approach.

Principles of QI

Primary intent— To bring about measurable improvement to a specific aspect of healthcare delivery, often with evidence or theory of what might work but requiring local iterative testing to find the best solution. 7

Employing an iterative process of testing change ideas— Adopting a theory of change which emphasises a continuous process of planning and testing changes, studying and learning from comparing the results to a predicted outcome, and adapting hypotheses in response to results of previous tests. 8 9

Consistent use of an agreed methodology— Many different QI methodologies are available; commonly cited methodologies include the Model for Improvement, Lean, Six Sigma, and Experience-based Co-design. 4 Systematic review shows that the choice of tools or methodologies has little impact on the success of QI provided that the chosen methodology is followed consistently. 10 Though there is no formal agreement on what constitutes a QI tool, it would include activities such as process mapping that can be used within a range of QI methodological approaches. NHS Scotland’s Quality Improvement Hub has a glossary of commonly used tools in QI. 11

Empowerment of front line staff and service users— QI work should engage staff and patients by providing them with the opportunity and skills to contribute to improvement work. Recognition of this need often manifests in drives from senior leadership or management to build QI capability in healthcare organisations, but it also requires that frontline staff and service users feel able to make use of these skills and take ownership of improvement work. 12

Using data to drive improvement— To drive decision making by measuring the impact of tests of change over time and understanding variation in processes and outcomes. Measurement for improvement typically prioritises this narrative approach over concerns around exactness and completeness of data. 13 14

Scale-up and spread, with adaptation to context— As interventions tested using a QI approach are scaled up and the degree of belief in their efficacy increases, it is desirable that they spread outward and be adopted by others. Key to successful diffusion of improvement is the adaption of interventions to new environments, patient and staff groups, available resources, and even personal preferences of healthcare providers in surrounding areas, again using an iterative testing approach. 15 16

What other approaches to improving healthcare are there?

Taking considered action to change healthcare for the better is not new, but QI as a distinct approach to improving healthcare is a relatively recent development. There are many well established approaches to evaluating and making changes to healthcare services in use, and QI will only be adopted more widely if it offers a new perspective or an advantage over other approaches in certain situations.

A non-systematic literature scan identified the following other approaches for making change in healthcare: research, clinical audit, service evaluation, and clinical transformation. We also identified innovation as an important catalyst for change, but we did not consider it an approach to evaluating and changing healthcare services so much as a catch-all term for describing the development and introduction of new ideas into the system. A summary of the different approaches and their definition is shown in box 3 . Many have elements in common with QI, but there are important difference in both intent and application. To be useful to clinicians and managers, QI must find a role within healthcare that complements research, audit, service evaluation, and clinical transformation while retaining the core principles that differentiate it from these approaches.

Alternatives to QI

Research— The attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods. 17

Clinical audit— A way to find out if healthcare is being provided in line with standards and to let care providers and patients know where their service is doing well, and where there could be improvements. 18

Service evaluation— A process of investigating the effectiveness or efficiency of a service with the purpose of generating information for local decision making about the service. 19

Clinical transformation— An umbrella term for more radical approaches to change; a deliberate, planned process to make dramatic and irreversible changes to how care is delivered. 20

Innovation— To develop and deliver new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health. Health innovation responds to unmet needs by employing new ways of thinking and working. 21

Why do we need to make this distinction for QI to succeed?

Improvement in healthcare is 20% technical and 80% human. 22 Essential to that 80% is clear communication, clarity of approach, and a common language. Without this shared understanding of QI as a distinct approach to change, QI work risks straying from the core principles outlined above, making it less likely to succeed. If practitioners cannot communicate clearly with their colleagues about the key principles and differences of a QI approach, there will be mismatched expectations about what QI is and how it is used, lowering the chance that QI work will be effective in improving outcomes for patients. 23

There is also a risk that the language of QI is adopted to describe change efforts regardless of their fidelity to a QI approach, either due to a lack of understanding of QI or a lack of intention to carry it out consistently. 9 Poor fidelity to the core principles of QI reduces its effectiveness and makes its desired outcome less likely, leading to wasted effort by participants and decreasing its credibility. 2 8 24 This in turn further widens the gap between advocates of QI and those inclined to scepticism, and may lead to missed opportunities to use QI more widely, consequently leading to variation in the quality of patient care.

Without articulating the differences between QI and other approaches, there is a risk of not being able to identify where a QI approach can best add value. Conversely, we might be tempted to see QI as a “silver bullet” for every healthcare challenge when a different approach may be more effective. In reality it is not clear that QI will be fit for purpose in tackling all of the wicked problems of healthcare delivery and we must be able to identify the right tool for the job in each situation. 25 Finally, while different approaches will be better suited to different types of challenge, not having a clear understanding of how approaches differ and complement each other may mean missed opportunities for multi-pronged approaches to improving care.

What is the relationship between QI and other approaches such as audit?

Academic journals, healthcare providers, and “arms-length bodies” have made various attempts to distinguish between the different approaches to improving healthcare. 19 26 27 28 However, most comparisons do not include QI or compare QI to only one or two of the other approaches. 7 29 30 31 To make it easier for people to use QI approaches effectively and appropriately, we summarise the similarities, differences, and crossover between QI and other approaches to tackling healthcare challenges ( fig 1 ).

Fig 1

How quality improvement interacts with other approaches to improving healthcare

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QI and research

Research aims to generate new generalisable knowledge, while QI typically involves a combination of generating new knowledge or implementing existing knowledge within a specific setting. 32 Unlike research, including pragmatic research designed to test effectiveness of interventions in real life, QI does not aim to provide generalisable knowledge. In common with QI, research requires a consistent methodology. This method is typically used, however, to prove or disprove a fixed hypothesis rather than the adaptive hypotheses developed through the iterative testing of ideas typical of QI. Both research and QI are interested in the environment where work is conducted, though with different intentions: research aims to eliminate or at least reduce the impact of many variables to create generalisable knowledge, whereas QI seeks to understand what works best in a given context. The rigour of data collection and analysis required for research is much higher; in QI a criterion of “good enough” is often applied.

Relationship with QI

Though the goal of clinical research is to develop new knowledge that will lead to changes in practice, much has been written on the lag time between publication of research evidence and system-wide adoption, leading to delays in patients benefitting from new treatments or interventions. 33 QI offers a way to iteratively test the conditions required to adapt published research findings to the local context of individual healthcare providers, generating new knowledge in the process. Areas with little existing knowledge requiring further research may be identified during improvement activities, which in turn can form research questions for further study. QI and research also intersect in the field of improvement science, the academic study of QI methods which seeks to ensure QI is carried out as effectively as possible. 34

Scenario: QI for translational research

Newly published research shows that a particular physiotherapy intervention is more clinically effective when delivered in short, twice-daily bursts rather than longer, less frequent sessions. A team of hospital physiotherapists wish to implement the change but are unclear how they will manage the shift in workload and how they should introduce this potentially disruptive change to staff and to patients.

Before continuing reading think about your own practice— How would you approach this situation, and how would you use the QI principles described in this article?

Adopting a QI approach, the team realise that, although the change they want to make is already determined, the way in which it is introduced and adapted to their wards is for them to decide. They take time to explain the benefits of the change to colleagues and their current patients, and ask patients how they would best like to receive their extra physiotherapy sessions.

The change is planned and tested for two weeks with one physiotherapist working with a small number of patients. Data are collected each day, including reasons why sessions were missed or refused. The team review the data each day and make iterative changes to the physiotherapist’s schedule, and to the times of day the sessions are offered to patients. Once an improvement is seen, this new way of working is scaled up to all of the patients on the ward.

The findings of the work are fed into a service evaluation of physiotherapy provision across the hospital, which uses the findings of the QI work to make recommendations about how physiotherapy provision should be structured in the future. People feel more positive about the change because they know colleagues who have already made it work in practice.

QI and clinical audit

Clinical audit is closely related to QI: it is often used with the intention of iteratively improving the standard of healthcare, albeit in relation to a pre-determined standard of best practice. 35 When used iteratively, interspersed with improvement action, the clinical audit cycle adheres to many of the principles of QI. However, in practice clinical audit is often used by healthcare organisations as an assurance function, making it less likely to be carried out with a focus on empowering staff and service users to make changes to practice. 36 Furthermore, academic reviews of audit programmes have shown audit to be an ineffective approach to improving quality due to a focus on data collection and analysis without a well developed approach to the action section of the audit cycle. 37 Clinical audits, such as the National Clinical Audit Programme in the UK (NCAPOP), often focus on the management of specific clinical conditions. QI can focus on any part of service delivery and can take a more cross-cutting view which may identify issues and solutions that benefit multiple patient groups and pathways. 30

Audit is often the first step in a QI process and is used to identify improvement opportunities, particularly where compliance with known standards for high quality patient care needs to be improved. Audit can be used to establish a baseline and to analyse the impact of tests of change against the baseline. Also, once an improvement project is under way, audit may form part of rapid cycle evaluation, during the iterative testing phase, to understand the impact of the idea being tested. Regular clinical audit may be a useful assurance tool to help track whether improvements have been sustained over time.

Scenario: Audit and QI

A foundation year 2 (FY2) doctor is asked to complete an audit of a pre-surgical pathway by looking retrospectively through patient documentation. She concludes that adherence to best practice is mixed and recommends: “Remind the team of the importance of being thorough in this respect and re-audit in 6 months.” The results are presented at an audit meeting, but a re-audit a year later by a new FY2 doctor shows similar results.

Before continuing reading think about your own practice— How would you approach this situation, and how would you use the QI principles described in this paper?

Contrast the above with a team-led, rapid cycle audit in which everyone contributes to collecting and reviewing data from the previous week, discussed at a regular team meeting. Though surgical patients are often transient, their experience of care and ideas for improvement are captured during discharge conversations. The team identify and test several iterative changes to care processes. They document and test these changes between audits, leading to sustainable change. Some of the surgeons involved work across multiple hospitals, and spread some of the improvements, with the audit tool, as they go.

QI and service evaluation

In practice, service evaluation is not subject to the same rigorous definition or governance as research or clinical audit, meaning that there are inconsistencies in the methodology for carrying it out. While the primary intent for QI is to make change that will drive improvement, the primary intent for evaluation is to assess the performance of current patient care. 38 Service evaluation may be carried out proactively to assess a service against its stated aims or to review the quality of patient care, or may be commissioned in response to serious patient harm or red flags about service performance. The purpose of service evaluation is to help local decision makers determine whether a service is fit for purpose and, if necessary, identify areas for improvement.

Service evaluation may be used to initiate QI activity by identifying opportunities for change that would benefit from a QI approach. It may also evaluate the impact of changes made using QI, either during the work or after completion to assess sustainability of improvements made. Though likely planned as separate activities, service evaluation and QI may overlap and inform each other as they both develop. Service evaluation may also make a judgment about a service’s readiness for change and identify any barriers to, or prerequisites for, carrying out QI.

QI and clinical transformation

Clinical transformation involves radical, dramatic, and irreversible change—the sort of change that cannot be achieved through continuous improvement alone. As with service evaluation, there is no consensus on what clinical transformation entails, and it may be best thought of as an umbrella term for the large scale reform or redesign of clinical services and the non-clinical services that support them. 20 39 While it is possible to carry out transformation activity that uses elements of QI approach, such as effective engagement of the staff and patients involved, QI which rests on iterative test of change cannot have a transformational approach—that is, one-off, irreversible change.

There is opportunity to use QI to identify and test ideas before full scale clinical transformation is implemented. This has the benefit of engaging staff and patients in the clinical transformation process and increasing the degree of belief that clinical transformation will be effective or beneficial. Transformation activity, once completed, could be followed up with QI activity to drive continuous improvement of the new process or allow adaption of new ways of working. As interventions made using QI are scaled up and spread, the line between QI and transformation may seem to blur. The shift from QI to transformation occurs when the intention of the work shifts away from continuous testing and adaptation into the wholesale implementation of an agreed solution.

Scenario: QI and clinical transformation

An NHS trust’s human resources (HR) team is struggling to manage its junior doctor placements, rotas, and on-call duties, which is causing tension and has led to concern about medical cover and patient safety out of hours. A neighbouring trust has launched a smartphone app that supports clinicians and HR colleagues to manage these processes with the great success.

This problem feels ripe for a transformation approach—to launch the app across the trust, confident that it will solve the trust’s problems.

Before continuing reading think about your own organisation— What do you think will happen, and how would you use the QI principles described in this article for this situation?

Outcome without QI

Unfortunately, the HR team haven’t taken the time to understand the underlying problems with their current system, which revolve around poor communication and clarity from the HR team, based on not knowing who to contact and being unable to answer questions. HR assume that because the app has been a success elsewhere, it will work here as well.

People get excited about the new app and the benefits it will bring, but no consideration is given to the processes and relationships that need to be in place to make it work. The app is launched with a high profile campaign and adoption is high, but the same issues continue. The HR team are confused as to why things didn’t work.

Outcome with QI

Although the app has worked elsewhere, rolling it out without adapting it to local context is a risk – one which application of QI principles can mitigate.

HR pilot the app in a volunteer specialty after spending time speaking to clinicians to better understand their needs. They carry out several tests of change, ironing out issues with the process as they go, using issues logged and clinician feedback as a source of data. When they are confident the app works for them, they expand out to a directorate, a division, and finally the transformational step of an organisation-wide rollout can be taken.

Education into practice

Next time when faced with what looks like a quality improvement (QI) opportunity, consider asking:

How do you know that QI is the best approach to this situation? What else might be appropriate?

Have you considered how to ensure you implement QI according to the principles described above?

Is there opportunity to use other approaches in tandem with QI for a more effective result?

How patients were involved in the creation of this article

This article was conceived and developed in response to conversations with clinicians and patients working together on co-produced quality improvement and research projects in a large UK hospital. The first iteration of the article was reviewed by an expert patient, and, in response to their feedback, we have sought to make clearer the link between understanding the issues raised and better patient care.

Contributors: This work was initially conceived by AB. AB and FO were responsible for the research and drafting of the article. AB is the guarantor of the article.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: This article is part of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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  • ↵ University of Sheffield. Differentiating audit, service evaluation and research. 2006. https://www.sheffield.ac.uk/polopoly_fs/1.158539!/file/AuditorResearch.pdf .
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[Updated 2023] Top 10 Healthcare Quality Improvement Templates to Meet Patient and Program Needs

[Updated 2023] Top 10 Healthcare Quality Improvement Templates to Meet Patient and Program Needs

Apoorva Gupta


As a business, are you tired of struggling to meet the evolving needs of your healthcare program? Are you looking for a way to enhance patient care and satisfaction? 

The resolution of these major pain points lies in healthcare quality improvement templates from SlideTeam. These innovative presentation templates provide you with strategies to streamline processes, boost efficiency and ensure the highest quality of care. 

What’s even better, each of these templates is 100% editable and customizable. The content-ready nature gives you the starting point and a structure to begin your presentation. The editability feature means you can tailor the presentation to audience profile. 

At this point, you might also consider having a SWOT analysis done of the marketing effort of your organization. Click here to get the best marketing SWOT analysis templates to help you do it in the best manner possible. 

Whether you’re a small clinic or a large hospital, these PPT Templates will this fit the bill. Let’s explore these healthcare quality improvement templates now. 

Template 1: Healthcare Quality Improvement Process Analyzing Assessment Framework Success PPT

This powerful PPT Presentation provides insights into the Four Stage Healthcare Quality Improvement Process, guiding you through a systematic approach to achieving excellence in healthcare. The steps outlined are assessment of gaps in processes, analysis of data, planning and implementation and ongoing quality assurance. Use this presentation template to empower organizations to streamline operations and optimize patient outcomes. The icons ensure accurate documentation, just at a mere glance, and ensure seamless communication. Unlock success with our carefully-curated metrics of success, allowing you to measure and track performance effectively. Don’t miss out on this indispensable resource. Download this PPT now and revolutionize your healthcare practices to stay ahead in the ever-evolving landscape of quality improvement.

Healthcare Quality Improvement

Download Now!

Template 2: Digital Technologies Used for Healthcare Quality Improvement in Organization

This PPT Template covers topics such as augmented reality training, highlighting its potential to revolutionize medical education and enhance patient outcomes. Explore the increasing importance of artificial intelligence and the Internet of Things, showcasing how these technologies optimize healthcare operations, enable predictive analytics, and drive personalized patient care. Use this presentation template to highlight the transformative benefits of using wearable devices in healthcare, empowering patients and healthcare providers with real-time data for better diagnostics and monitoring. Lastly, delve into hospitals using smart technology, where efficiency, safety, and patient experience intertwine. Get this presentation template to unlock the full potential of digital advancements and revolutionize healthcare quality improvement within your organization.

Digital technologies used for healthcare quality improvement in organization

Template 3: Four Key Quality Improvement Principles for Successful Initiatives in Healthcare PPT

This presentation template delineates four healthcare strategies and principles to drive effective change. The first is to focus on the delivery system that brings success. The action here is to optimize healthcare delivery processes for better outcomes. Then, the business must discover and stick to approaches prioritizing individual needs, satisfaction, and engagement. Then, team involvement with communication is central to good healthcare delivery. In the fourth principle, focusing on the power of data-driven decision-making, leveraging analytics and insights to identify improvement opportunities, enhance efficiency, and drive evidence-based healthcare practices must be priority. Download the PPT now to gain valuable insights and actionable strategies for successful quality improvement in healthcare.

Four Key Quality Improvement Principles for Successful Initiatives in Healthcare

Template 4: Quality and Patient Safety Improvement Plan for Healthcare Company PPT

This all-inclusive presentation provides a step-by-step guide to transforming your organization’s safety protocols. Our plan covers everything from defining a problem to sharing the results, ensuring a seamless journey toward enhanced quality and patient care. With sections dedicated to data collection, root cause analysis, testing solutions, implementation, and evaluation, this presentation template empowers your team to make data-driven decisions. Download our plan today and move toward major improvements in your healthcare company’s safety practices. Take charge of patient well-being and drive positive change with this comprehensive template.

Quality and patient safety improvement plan for healthcare company

Template 5: Data Quality Improvement in Healthcare Framework PPT

Unlock key strategies to enhance data accuracy and reliability, starting with a revolutionary mindset: Think of Data as a Product. Delve into addressing structural data quality issues and gain insights into defining content-level data quality for seamless decision-making. Collaborate with industry experts and stakeholders by creating a powerful coalition to drive data quality improvement initiatives. Get our insightful PPT today and take the first step towards harnessing high-quality healthcare data for improved patient outcomes and operational efficiency. Your data transformation journey starts here!

Data quality improvement in healthcare framework

Template 6: Process Flow for Improving Healthcare Quality Database Management Healthcare Organizations PPT

This informative presentation outlines step-by-step procedures to optimize healthcare databases and enhance quality. It covers aspects such as data collection, organization, analysis, and implementation of quality improvement initiatives. With our PPT Template, healthcare organizations can streamline their database management processes, identify areas for improvement, and make data-driven decisions for enhanced patient care. Stay ahead of the competition and drive positive outcomes. The process flow we have outlined serves all stakeholders. Download the PPT now and unlock the potential to revolutionize your healthcare organization's data management and quality improvement practices.

Process Flow for Improving Healthcare Quality

Template 7: Quality Improvement Framework in Healthcare System PPT

This presentation highlights components such as input, process, output, outcome, and impact, shedding light on the interconnectedness of these elements in driving quality improvement. Furthermore, this PPT provides a deep dive into three essential methodologies: WEI (Workplace Environment Improvement), CQI (Continuous Quality Improvement), and TQM (Total Quality Management). These proven frameworks offer practical approaches to streamline operations, optimize patient care, and achieve sustainable improvements in healthcare settings. Take advantage of this invaluable tool that empowers professionals to navigate the complexities of quality improvement effortlessly. Download our PPT today and take a significant step towards delivering exceptional patient outcomes and advancing your organization’s success.

Quality improvement framework in healthcare system

Template 8: IoT in Healthcare Quality Improvement Management PPT

This presentation showcases a range of services that revolutionize the industry. Get insights into children’s health, community healthcare, and indirect emergency medical access. Discover the power of IoT applications, such as body temperature and blood pressure monitoring, medication management, and rehabilitation management, to optimize patient care and outcomes. Download our insightful PPT and harness the power of innovation to elevate healthcare quality management.

IOT in Healthcare Quality Improvement Management

Template 9: Quality Framework Structure for Evaluating and Improving Healthcare PPT

This PPT showcases three vital components: Outcomes and Impact, Service Delivery, and Vision and Leadership. It focuses on measurable outcomes and tangible impacts, and our framework enables you to assess and optimize your healthcare services. It ensures efficiency, effectiveness, and patient satisfaction. Furthermore, it emphasizes how a visionary leadership can drive transformative change in your healthcare organization. Download our PPT Template and unlock the secrets to elevating your healthcare practices. Empower your team with insights and actionable strategies to deliver exceptional care and achieve remarkable results.

Quality Framework Structure for Evaluating and Improving Healthcare

Template 10: KPIs for Healthcare Quality Improvement for Patient Satisfaction PPT

Enhance healthcare quality, patient satisfaction, and streamline operations with our comprehensive PPT. This invaluable resource unveils vital dimensions, including clinical efficiency, production efficiency, personal and social accountability, reactivity, safety, and a dedicated focus on patients. Dive into the depths of each dimension and uncover the associated Key Performance Indicators (KPIs) that drive success. Use this presentation template’s data-driven insights to optimize clinical processes, enhance patient experiences, and deliver exceptional care. With this PPT, healthcare professionals can measure and track progress, identify improvement areas, and make informed decisions to achieve desired outcomes. Download this template and take the first step towards elevating your organization’s performance.

KPIs for healthcare quality improvement for patient satisfaction


Healthcare is a great responsibility. Striving to improve it is a universal longing. What works is strategy, planning and wise investment. Our templates provide you a healthy mix of all three to execute fast improvement in healthcare. Download these now!

On a separate note, if you require the best situation analysis templates? Click here .

PS Marketing planning is an important part of the delivery process of a business, reaching the customers and providing them with a good experience. Find the  best marketing templates to execute this vision with a click here .

FAQs on Healthcare

What is quality improvement in health care.

Quality improvement in healthcare refers to systematic efforts and strategies to enhance healthcare service delivery to achieve better patient outcomes. It involves a continuous cycle of measuring, assessing, and improving aspects of care, including safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. Quality improvement initiatives often use evidence-based guidelines and best practices to identify areas of improvement and implement interventions to enhance care processes and outcomes. This can involve streamlining workflows, reducing medical errors, improving communication among healthcare providers, increasing patient engagement, etc. 

What are types of quality improvement in healthcare?

In healthcare, there are many quality improvement initiatives. These include process improvement, aimed at enhancing efficiency and reducing errors; patient-centeredness, focusing on improving patient experience and satisfaction; safety enhancement, to prevent adverse events and promote a culture of safety; outcome improvement, targeting better health outcomes for patients; and evidence-based practice, encouraging the use of scientific research to inform clinical decision-making. These approaches work together to enhance the quality of care and promote better patient health outcomes.

What are the components of quality improvement in healthcare?

Quality improvement in healthcare requires effective data collection and analysis to identify areas for improvement. Secondly, it consists in developing evidence-based protocols and guidelines to standardize care. Thirdly, it requires promoting a culture of continuous learning and innovation among healthcare providers. Fourthly, patient engagement and feedback are essential for understanding their needs and preferences. Finally, quality improvement involves implementing strategies for monitoring and evaluating outcomes to ensure sustained progress. These components work together to enhance the quality and safety of healthcare delivery.

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How to Write Up Your Quality Improvement Initiatives for Publication

The Journal of Graduate Medical Education often receives submissions from trainees and educators highlighting work they do in quality improvement (QI). This is remarkably encouraging given the emphasis that the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System has placed on integrating QI into the clinical learning environment. 1 A major challenge for editors reviewing these manuscripts is the inconsistency with which authors report QI initiatives. After reviewing a large number of these submissions, we have noted common problems that arise and have prepared the following guide to help prospective authors prepare QI reports for publication.

Consistent with the Journal 's common format for Original Research or Educational Innovation articles (ie, Introduction, Methods, Results, Discussion, and Conclusion), our suggestions will highlight what authors should explicitly emphasize within each of these manuscript sections as it pertains to their QI initiative. We realize that a number of other frameworks and guidelines exist, the most common being the SQUIRE guidelines, which were updated in the fall of 2015. 2 Our suggestions are synergistic with the updated SQUIRE 2.0 guidelines, yet they also provide a high-level view of the philosophies that underpin these guidelines to help authors not only at the time of writing, but also when planning and implementing their QI initiatives.

What Is the Quality Problem, Why Is It Important, and What Is Your Aim?

The Introduction section must be brief. This is not the time to provide an in-depth review of the literature on your quality problem of interest—which could be an important but separate paper. Instead, it is most important to articulate why this quality problem is relevant beyond your local institution . Is it a common safety problem ubiquitous to multiple care settings, such as the need to improve patient handoffs? Or perhaps there are legislative changes or financial incentives that promote interest in your issue, such as the linking of financial reimbursement to readmission rates. Whatever the reason, it is critical to make clear what the external impact of your QI initiative would be for other groups and the readers of the journal. If the QI problem can be framed only as a need specific to your own setting, then the results may be best published in a local newsletter rather than a national or international journal.

After succinctly outlining the importance and relevance of the QI problem, the Introduction must describe the gap between current practice and preferred practice . What prior QI strategies have or have not worked to address this quality problem? If there is no gap in our understanding on how to improve practice, then further study of the area would be of limited value. Authors must demonstrate understanding of the pertinent literature in order to briefly discuss prior strategies that have been attempted; this usually includes the strategy as well as the required resources and resulting outcomes. Replication of a successful intervention in a new setting can help to fill key gaps in understanding: here the evidence gap is whether a prior strategy can be replicated in a different setting, one that is dissimilar in important features to the initial study.

Finally, the Introduction must also make clear what you hoped to achieve by carrying out your QI initiative. In 1 or 2 sentences, the final paragraph should clearly state the primary aim of your QI project. There are numerous references providing guidance on how to write good “aim” statements, by making sure that they are “SMART” (specific, measurable, achievable, realistic, anytime bound). 3 A clear and concise statement of the primary aim, and any relevant sub-aims, will ground the readers in the main purpose of your QI project.

Describing the Proposed Intervention, Including a Theory for Change, and the Road Toward Improvement

For QI reports the Methods section is probably the most important section as it ensures that readers understand how they can translate your reported innovation into their own settings. To facilitate this, authors must attend to several important issues. These include the context in which the QI work was carried out (ie, setting and participants) and a detailed description of the implementation strategy . The strategy must also include a theory for why a specific intervention (or set of interventions) was chosen.

Let's start with the proposed intervention. In QI, too often authors simply reach for the first available solution off the shelf without first considering why that particular solution could address the problem at hand. Frequently, authors appear to believe that checklists and order sets will solve everything. The truth is that if authors do not articulate a theory or rationale for why their proposed intervention should fix the quality problem of interest, they run the risk of designing a suboptimal intervention or choosing the wrong approach altogether. For example, attempts to reduce physician prescribing of unnecessary antibiotics to children with upper respiratory tract infections (URTIs; eg, continuing medical education, postcard reminders summarizing treatment guidelines, etc) consistently fail because they primarily address provider awareness rather than the dominant driver, which is parental demand for antibiotics. Theorizing that the ideal intervention should address parental expectations, one would instead choose an approach such as implementing the use of delayed antibiotic prescriptions, which in a recent Cochrane review has been shown to significantly reduce antibiotic utilization for the treatment of URTIs in children. 4

Similar to the general call for more theory-based interventions in medical education, 5 there has been a recent call for more theory-based QI interventions. 6 Therefore, the preferred approach is to clearly articulate the link between the proposed solution and the problem it will solve. For example, a hospitalist team seeking to reduce unnecessary urinary catheter use might theorize that a key driver is that residents do not know whether a patient has a urinary catheter in situ . A sensible solution therefore might bypass the physician altogether. For example, instituting automatic stop orders 7 and nursing advanced directives 8 to remove urinary catheters are 2 interventions that have previously been shown to be effective.

It is also crucial that authors state not only what the intervention was and its underlying rationale, but also how it was iteratively tested, refined, and eventually implemented. A common framework used in QI is rapid cycle change methodology or PDSA (plan-do-study-act) cycles. 9 Unfortunately, many published QI reports, despite claiming to use PDSA cycles, demonstrate little evidence that they refined their intervention prior to implementation. 10 This is a problem because for QI initiatives the devil really is in the details. It is simply not good enough to say that “we implemented a checklist” or “we created a new care pathway.” Instead, authors need to report how changes were tested and refined; reflect on what worked, what did not, and why; and provide a description of the eventual intervention. Recognizing how challenging it can be to chronicle the evolution of the proposed intervention from start to finish in a concise manner, authors should consider the use of a figure or a table to summarize the key PDSA cycles, which will avoid excess word length while still providing a concise summary of what was actually done. Another option for providing more details is to include additional supplemental information for publication online. For QI projects it is imperative that at least 2 cycles, and usually more, are described in the Methods section.

The Local Context and Its Impact on the QI Initiative

In evaluative research, authors go to great lengths to describe how they have controlled for contextual factors to ensure that they have eliminated any bias that might unduly influence their outcomes of interest. QI is different in this regard: context is critical to understand and characterize, not control . Authors must include details about their context and how these might influence the implementation or outcomes of QI projects to sensitize readers to the contextual factors that require careful consideration when introducing the QI intervention to local institutions.

Batalden and Davidoff 11 described the importance of context in a brief commentary. They provided a framework for QI that links generalizable scientific evidence to a particular context in order to generate measured performance improvement. Importantly, they emphasized that the focus should be both on the context, as well as how the generalizable scientific evidence (or the proposed intervention) integrates within the particular local context. In QI, a detailed description of the context is just as important as a detailed description of the proposed intervention.

Consider the example of a QI project to reduce unnecessary lab ordering. The reader would want to know: Does the institution have computer-based or paper-based orders? If computer-based, is it easy to make changes to the order entry system to introduce clinical decision support? How engaged is the lab in clinical QI initiatives? What is the front line staff capacity and capability for QI? All of these contextual factors play heavily into the choice of the intervention, how the intervention gets implemented, and how it affects project outcomes.

This emphasis on context for QI reports parallels a similar need in reports of educational interventions. For example, educators implementing bedside procedure training must also account for and describe relevant contextual factors, such as whether a simulation lab is available, whether faculty have maintained competence in bedside procedures, whether a culture of direct observation and feedback exists, and whether there is a mechanism to track procedures and monitor for complications. Similar to medical education research, explicitly acknowledging the role of context is paramount in the reporting of any QI initiative.

What Is the Evaluation Plan?

Most QI initiatives rely on the Donabedian model of outcome, process, and balancing measures to evaluate the impact of their intervention. 12 While beyond the scope of this article to address the specifics of measurement in QI, we will offer several practical suggestions. First, most QI projects will focus on improving processes of care and may not be able to demonstrate downstream impact on clinical outcomes. This is acceptable, as long as the authors have selected process measures that are tightly coupled with the clinical outcome of interest. For example, an orthopedic surgery residency team aiming to improve venothromboembolism (VTE) prophylaxis rates could justifiably track VTE prophylaxis administration as a clinical process because hospitalized patients who receive VTE prophylaxis have a very low likelihood of developing VTEs. 13

Another useful process measure to report is one that measures the fidelity of the intervention. In other words, include a process measure that tracks how consistently or reliably your intervention is applied. For example, if your main intervention to improve VTE prophylaxis is the creation and implementation of a standardized order set, a measure of implementation fidelity would be to track whether residents and faculty actually used the order set. This is particularly informative for unsuccessful QI projects—interventions with high fidelity suggest that other contributing factors require attention, whereas interventions with low fidelity suggest that the evaluation may have been premature and more work is needed to increase uptake of the intervention before large-scale implementation and evaluation are undertaken.

Last but not least, balancing measures, which are intended to measure unintended consequences, often are missing from QI reports. A medical journal would not accept a clinical trial that reports only on the potential benefits and not the harms of a novel therapy, and we need to hold reports of QI interventions to a similar standard. Therefore, balancing measures of unintended consequence should be reported to ensure that the QI intervention improves care and does not create new problems. For example, if a QI initiative focuses on improving resident adherence to guidelines for a clinical area, such as diabetes care, does adherence to other guidelines, such as preventive screening, decline? If a new electronic handover tool is developed to support handoff communication, are there errors in the new document due to cut/paste activities? Selecting and reporting on sound balancing measures ensures a healthy respect for the law of unintended consequences in QI.

Providing Data With Greater Clarity

When it comes to displaying the data, it is best to avoid simple before-after comparisons. This evaluative approach is suboptimal because secular trends make it difficult to attribute observed differences to the intervention. Traditional approaches to research and evaluation would typically address this limitation through the inclusion of a contemporaneous control group or setting, which is also suitable for QI studies.

An alternative approach would be to display your outcome or process measures over time through the use of statistical process control. This methodology often utilizes run charts or control chart s to display data over time ( figure ). Following run chart or control chart “rules,” one can interpret the data plotted sequentially over time to identify instances when variation is not due to random chance (so-called special cause variation). Such handling of data enhances the ability to determine whether changes that occurred were a result of the interventions introduced, and greatly strengthens the evaluative approach as compared to aggregated before-after data. The BMJ Quality & Safety journal has published an overview on the use and interpretation of run charts. 14

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Example of Control Chart to Display Quality Data Over Time

Note: This is an example of a control chart (specifically a P-chart). A typical control chart has the quality measure of interest on the Y-axis. The X-axis is always a time scale (in this case, consecutive months). As the team carries out the quality improvement initiative, they collect data prospectively over time and plot the data on a control chart. Using statistical process control software, several lines are plotted. The dotted line is the center line (CL) and is equivalent to the mean. The dashed lines on either side of the mean are the upper and lower control limits (UCL and LCL; approximately 3 standard deviations, or sigmas, on either side of the mean). Using this information, the statistical process control software can identify segments of the chart where nonrandom variation is occurring (so-called special cause variation). On this graph, the 2 times where nonrandom variation are occurring are indicated by the triangle and circle markers, suggesting that modification to the order set, and not education, was likely responsible for the improvement seen in venothromboembolism (VTE) prophylaxis ordering.

What Are the Implications of the Work? What Are the Next Steps?

For QI papers, the Discussion section will be similar to papers describing educational innovations or research. This section should concisely summarize the main findings of the QI project, relate the key findings to what is already known in the published literature, reflect on the broader implications of the findings, discuss how important limitations could have affected the findings, and briefly introduce next steps to further understand the field.

Perhaps most important are the reflections on lessons learned and future directions. In particular, reflections on the influence of the local context on project implementation and outcomes are highly relevant as readers will need to understand this if they want to replicate the intervention within their local context.

Well-conducted QI interventions that produced “negative” results (ie, did not achieve their intended outcomes) are still important and worthwhile for dissemination. Your reflections on why the intervention did not work can be helpful to others who might consider a similar initiative. In some cases, the problem may be the intervention itself, which signals the need to consider an alternative approach to addressing the QI problem of interest. More commonly, the implementation of the intervention lacked fidelity, or the integration of the intervention within the local context was suboptimal. In these instances, your QI report will still be helpful to others who can build on your work.

The Conclusion section of the report is also similar to Original Research and Educational Innovation articles. This short paragraph succinctly summarizes the most important findings from the study, without speculating beyond the results. Conclusions should be appropriately conservative in relation to the study findings. See the table for a summary of elements essential for QI reports.

Quality Improvement (QI) Reports: Recommended Elements and Common Pitfalls

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By providing this overview of the approach to writing up QI initiatives, we hope to clarify, up front, those aspects of your initiative that require the most emphasis. The considerations presented here can serve as a high-level guide to authors, with the goal of disseminating QI reports that are more useful for other programs. QI studies that involve residents, faculty, or the general graduate medical education environment as key elements of the context or intervention are appropriate for submission to the Journal of Graduate Medical Education . We look forward to publishing reports that inform programs and educators about effective faculty and learner engagement in QI activities within the graduate medical education learning environment.

quality improvement project

Quality Improvement Project

Jan 04, 2020

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Quality Improvement Project. AIM OF PROJECT PLAN. What will the project accomplish (what variable will be improved)? What phase of the lab will this Improvement Plan target? Pre-Analytical Analytical Post –Analytical

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  • acceptable results
  • corrective action
  • project plan
  • define acceptable results
  • inter departmental hospital meeting


Presentation Transcript

AIM OF PROJECT PLAN • What will the project accomplish (what variable will be improved)? • What phase of the lab will this Improvement Plan target? Pre-Analytical Analytical Post –Analytical • Why do you want to target this variable? (Provide background data / information)

PLAN: • How do you plan to organize this project? • How long do you estimate this project will take to complete? • What resources are required to organize and complete this project? • People: • Materials: • Monies: • Who will benefit from the success of this project?

PLAN: • Define the variable to be measured: • How will you measure progress of this plan? • Measurement Method / Tool: • How often will you measure progress? (weekly, monthly) • How long will you measure progress? • Define acceptable results you expect to achieve: • Who is responsible for conducting & monitoring the activities for this plan? • How will the results be evaluated at each review point?

DO: • How will you explain the IP to your lab staff? • Staff meeting? • What steps will you take to gain staff buy-in and assistance? • Show HOW their involvement will benefit ‘them’ and improve ‘patient care’ • What is the Corrective Action proposal (How will you implement your IP)? • Date for follow-up of Corrective Action?

CHECK: • This is when and where you review the “DO” that you established: • Do you see improvement from your baseline data? • Are you still on schedule to meet the acceptable results you defined in the PLAN section? Why or why not? • What obstacles have slowed progress? • What sped up progress? • Do you need to change part of the PLAN & DO? If so, list the changes and review date to measure new plan:

ACT: • Was your Corrective Action Effective? • Describe how (why) if answer is YES: • Describe how (why) if answer is NO: may need to go back and review / edit the DO section and then follow-up with CHECK to achieve expected results 2. If Improvement Project Plan/DO/CHECK achieved acceptable results: • Share results at a staff meeting • Share results at inter-departmental hospital meeting and tell how IP benefits hospital / patient care

TIPS for SUCCESS: • Involve your staff • It takes 21 consecutive days to effect any change of behavior • Offer praise to staff for assisting in project at appropriate times • Don’t get discouraged. Many times you will have to change your Corrective Action to achieve your Acceptable Results (if implementing change was easy- there would be little need for Improvement Projects!)

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