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==Why quality improvement efforts succeed and fail==
==Why quality improvement efforts succeed and fail==
Various organizational characteristics, some based on [[complexity science]]<ref name="pmid27118664">{{cite journal| author=Massoud MR, Barry D, Murphy A, Albrecht Y, Sax S, Parchman M| title=How do we learn about improving health care: a call for a new epistemological paradigm. | journal=Int J Qual Health Care | year= 2016 | volume= 28 | issue= 3 | pages= 420-4 | pmid=27118664 | doi=10.1093/intqhc/mzw039 | pmc=4931911 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27118664  }} </ref><ref name="pmid20367840">{{cite journal| author=Jordon M, Lanham HJ, Anderson RA, McDaniel RR| title=Implications of complex adaptive systems theory for interpreting research about health care organizations. | journal=J Eval Clin Pract | year= 2010 | volume= 16 | issue= 1 | pages= 228-31 | pmid=20367840 | doi=10.1111/j.1365-2753.2009.01359.x | pmc=3667707 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20367840  }} </ref>, may predict why quality improvement projects succeed<ref name="pmid17725834">{{cite journal| author=Leykum LK, Pugh J, Lawrence V, Parchman M, Noël PH, Cornell J et al.| title=Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes. | journal=Implement Sci | year= 2007 | volume= 2 | issue=  | pages= 28 | pmid=17725834 | doi=10.1186/1748-5908-2-28 | pmc=2018702 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17725834 }} </ref><ref name="pmid20735859">{{cite journal| author=Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR| title=The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure. | journal=Implement Sci | year= 2010 | volume= 5 | issue=  | pages= 66 | pmid=20735859 | doi=10.1186/1748-5908-5-66 | pmc=2936445 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20735859 }} </ref><ref name="pmid20735859">{{cite journal| author=Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR| title=The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure. | journal=Implement Sci | year= 2010 | volume= 5 | issue=  | pages= 66 | pmid=20735859 | doi=10.1186/1748-5908-5-66 | pmc=2936445 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20735859  }} </ref><ref name="pmid22819737">{{cite journal| author=Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT| title=How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts. | journal=Soc Sci Med | year= 2013 | volume= 93 | issue=  | pages= 194-202 | pmid=22819737 | doi=10.1016/j.socscimed.2012.05.040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22819737  }} </ref> and fail<ref name="pmid21192206">{{cite journal| author=Ruhe MC, Bobiak SN, Litaker D, Carter CA, Wu L, Schroeder C et al.| title=Appreciative Inquiry for quality improvement in primary care practices. | journal=Qual Manag Health Care | year= 2011 | volume= 20 | issue= 1 | pages= 37-48 | pmid=21192206 | doi=10.1097/QMH.0b013e31820311be | pmc=4222905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21192206  }} </ref><ref name="pmid22186171">{{cite journal| author=Arar NH, Noel PH, Leykum L, Zeber JE, Romero R, Parchman ML| title=Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home. | journal=Qual Prim Care | year= 2011 | volume= 19 | issue= 5 | pages= 289-300 | pmid=22186171 | doi= | pmc=3313551 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22186171  }} </ref>.<ref>Michel, P., et al. "[https://www.sciforschenonline.org/journals/epidemiology-public-health/JEPHR-1-123.php What are the Barriers and Facilitators to the Implementation and/or Success of Quality Improvement and Risk Management in Hospitals: A Systematic Literature Review]." J Epidemiol Public Health Rev 1.4 (2016).</ref>
Various organizational characteristics, some based on [[complexity science]]<ref name="pmid27118664">{{cite journal| author=Massoud MR, Barry D, Murphy A, Albrecht Y, Sax S, Parchman M| title=How do we learn about improving health care: a call for a new epistemological paradigm. | journal=Int J Qual Health Care | year= 2016 | volume= 28 | issue= 3 | pages= 420-4 | pmid=27118664 | doi=10.1093/intqhc/mzw039 | pmc=4931911 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27118664  }} </ref><ref name="pmid20367840">{{cite journal| author=Jordon M, Lanham HJ, Anderson RA, McDaniel RR| title=Implications of complex adaptive systems theory for interpreting research about health care organizations. | journal=J Eval Clin Pract | year= 2010 | volume= 16 | issue= 1 | pages= 228-31 | pmid=20367840 | doi=10.1111/j.1365-2753.2009.01359.x | pmc=3667707 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20367840  }} </ref>, may predict why quality improvement projects succeed<ref name="pmid17725834">{{cite journal| author=Leykum LK, Pugh J, Lawrence V, Parchman M, Noël PH, Cornell J et al.| title=Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes. | journal=Implement Sci | year= 2007 | volume= 2 | issue=  | pages= 28 | pmid=17725834 | doi=10.1186/1748-5908-2-28 | pmc=2018702 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17725834  }} </ref><ref name="pmid20735859">{{cite journal| author=Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR| title=The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure. | journal=Implement Sci | year= 2010 | volume= 5 | issue=  | pages= 66 | pmid=20735859 | doi=10.1186/1748-5908-5-66 | pmc=2936445 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20735859  }} </ref><ref name="pmid22819737">{{cite journal| author=Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT| title=How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts. | journal=Soc Sci Med | year= 2013 | volume= 93 | issue=  | pages= 194-202 | pmid=22819737 | doi=10.1016/j.socscimed.2012.05.040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22819737  }} </ref> and fail<ref name="pmid21192206">{{cite journal| author=Ruhe MC, Bobiak SN, Litaker D, Carter CA, Wu L, Schroeder C et al.| title=Appreciative Inquiry for quality improvement in primary care practices. | journal=Qual Manag Health Care | year= 2011 | volume= 20 | issue= 1 | pages= 37-48 | pmid=21192206 | doi=10.1097/QMH.0b013e31820311be | pmc=4222905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21192206  }} </ref><ref name="pmid22186171">{{cite journal| author=Arar NH, Noel PH, Leykum L, Zeber JE, Romero R, Parchman ML| title=Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home. | journal=Qual Prim Care | year= 2011 | volume= 19 | issue= 5 | pages= 289-300 | pmid=22186171 | doi= | pmc=3313551 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22186171  }} </ref>.ref>Michel, P., et al. "[https://www.sciforschenonline.org/journals/epidemiology-public-health/JEPHR-1-123.php What are the Barriers and Facilitators to the Implementation and/or Success of Quality Improvement and Risk Management in Hospitals: A Systematic Literature Review]." J Epidemiol Public Health Rev 1.4 (2016).</ref>. Causes include:
 
* Lack of clinical champion<ref name="pmid22299722">{{cite journal| author=Rose AJ, Petrakis BA, Callahan P, Mambourg S, Patel D, Hylek EM et al.| title=Organizational characteristics of high- and low-performing anticoagulation clinics in the Veterans Health Administration. | journal=Health Serv Res | year= 2012 | volume= 47 | issue= 4 | pages= 1541-60 | pmid=22299722 | doi=10.1111/j.1475-6773.2011.01377.x | pmc=3401398 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22299722  }} </ref><ref name="pmid21403074">{{cite journal| author=Curry LA, Spatz E, Cherlin E, Thompson JW, Berg D, Ting HH et al.| title=What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study. | journal=Ann Intern Med | year= 2011 | volume= 154 | issue= 6 | pages= 384-90 | pmid=21403074 | doi=10.7326/0003-4819-154-6-201103150-00003 | pmc=4735872 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21403074  }} </ref><ref name="pmid23690393">{{cite journal| author=Gabbay RA, Friedberg MW, Miller-Day M, Cronholm PF, Adelman A, Schneider EC| title=A positive deviance approach to understanding key features to improving diabetes care in the medical home. | journal=Ann Fam Med | year= 2013 | volume= 11 Suppl 1 | issue=  | pages= S99-107 | pmid=23690393 | doi=10.1370/afm.1473 | pmc=3707253 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23690393  }} </ref>, especially a physician<ref name="pmid21403074"/><ref name="pmid23690393"/>


Studies using appreciative inquiry have been done.<ref name="pmid21192206">{{cite journal| author=Ruhe MC, Bobiak SN, Litaker D, Carter CA, Wu L, Schroeder C et al.| title=Appreciative Inquiry for quality improvement in primary care practices. | journal=Qual Manag Health Care | year= 2011 | volume= 20 | issue= 1 | pages= 37-48 | pmid=21192206 | doi=10.1097/QMH.0b013e31820311be | pmc=4222905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21192206  }} </ref><ref name="Peelle 2006 pp. 447–467">{{cite journal | last=Peelle | first=Henry E. | title=Appreciative Inquiry and Creative Problem Solving in Cross-Functional Teams | journal=The Journal of Applied Behavioral Science | publisher=SAGE Publications | volume=42 | issue=4 | year=2006 | issn=0021-8863 | doi=10.1177/0021886306292479 | pages=447–467}}</ref>
Studies using appreciative inquiry have been done.<ref name="pmid21192206">{{cite journal| author=Ruhe MC, Bobiak SN, Litaker D, Carter CA, Wu L, Schroeder C et al.| title=Appreciative Inquiry for quality improvement in primary care practices. | journal=Qual Manag Health Care | year= 2011 | volume= 20 | issue= 1 | pages= 37-48 | pmid=21192206 | doi=10.1097/QMH.0b013e31820311be | pmc=4222905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21192206  }} </ref><ref name="Peelle 2006 pp. 447–467">{{cite journal | last=Peelle | first=Henry E. | title=Appreciative Inquiry and Creative Problem Solving in Cross-Functional Teams | journal=The Journal of Applied Behavioral Science | publisher=SAGE Publications | volume=42 | issue=4 | year=2006 | issn=0021-8863 | doi=10.1177/0021886306292479 | pages=447–467}}</ref>

Revision as of 02:54, 21 May 2019

For other uses, see QI (disambiguation).

Quality improvement is "the attainment or process of attaining a new level of performance or qualit."[1].

The Malcolm Baldrige Health Care version of the Criteria for Performance Excellence (HCPE) award has been created to foster a culture of quality improvement across an organization. Two studies of the impact of the award have found:

  • "No significant difference in process of care results or outcomes between Baldrige recipients and their competitors, there was a significant difference in patient experience results" [2].
  • "Slight enhancements in clinical outcomes, while hospital financial and efficiency measures all showed overwhelmingly positive operating results"[3]

Wennberg's classification framework can categorize causes of unwarranted variation[4].

Lean Sigma

Lean sigma combines approaches[5].

Measuring quality

Quality measures and their benchmarks are available form several organizations including:

  • CQI Resource Center (coordinated by the Centers for Medicare & Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC); U.S. Department of Health and Human Services)

Tactics for improvement

Workforce redesign may help[6].

Practice facilitation may help[7].

Why quality improvement efforts succeed and fail

Various organizational characteristics, some based on complexity science[8][9], may predict why quality improvement projects succeed[10][11][12] and fail[13][14].ref>Michel, P., et al. "What are the Barriers and Facilitators to the Implementation and/or Success of Quality Improvement and Risk Management in Hospitals: A Systematic Literature Review." J Epidemiol Public Health Rev 1.4 (2016).</ref>. Causes include:

Studies using appreciative inquiry have been done.[13][18]

Different approaches may be needed depending on the level of certainty in the clinical science behind a quality improvement project.[19]

Work culture and quality improvement

A systematic review found an association with workplace culture and clinical outcomes[20]. However, this review did not provide details of attributes of positive culture. This review did not find any randomized trials.

A cross-sectional study of 537 American hospitals found that clinical improvement was associated with the following, ranked in descending order of impact[21]:

  • 'having physician and nurse champions rather than nurse champions alone'
  • 'fostering an organizational environment in which clinicians are encouraged to solve problems creatively'
  • 'holding monthly meetings to review AMI cases between hospital clinicians and staff who transported patients to the hospital'

A cohort of 10 American hospitals found[22]:

  • 'effective inclusion of staff from different disciplines and levels in the organisational hierarchy in the team guiding improvement efforts (referred to as the ‘guiding coalition’ in each hospital)'
  • 'authentic participation in the work of the guiding coalition'
  • 'distinct patterns of managing conflict'

References

  1. ↑ Anonymous (2025), Quality improvement (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Schulingkamp, R. C., & Latham, J. R. (2015). Health Care Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors.
  3. ↑ Unger, K. L. (2013). An investigation into the effects of winning the Malcolm Baldrige National Quality Award on the performance of hospitals/healthcare systems (Doctoral dissertation, Colorado State University).
  4. ↑ Harrison R, Manias E, Mears S, Heslop D, Hinchcliff R, Hay L (2018). "Addressing unwarranted clinical variation: A rapid review of current evidence". J Eval Clin Pract. doi:10.1111/jep.12930. PMID 29766616.
  5. ↑ Danese, P., Manfè, V. and Romano, P. (2017), A Systematic Literature Review on Recent Lean Research: State-of-the-art and Future Directions. International Journal of Management Reviews. doi:10.1111/ijmr.12156
  6. ↑ Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJ (2018). "Nurses as substitutes for doctors in primary care". Cochrane Database Syst Rev. 7: CD001271. doi:10.1002/14651858.CD001271.pub3. PMID 30011347.
  7. ↑ Wang A, Pollack T, Kadziel LA, Ross SM, McHugh M, Jordan N; et al. (2018). "Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review". J Gen Intern Med. doi:10.1007/s11606-018-4581-9. PMID 30066117.
  8. ↑ Massoud MR, Barry D, Murphy A, Albrecht Y, Sax S, Parchman M (2016). "How do we learn about improving health care: a call for a new epistemological paradigm". Int J Qual Health Care. 28 (3): 420–4. doi:10.1093/intqhc/mzw039. PMC 4931911. PMID 27118664.
  9. ↑ Jordon M, Lanham HJ, Anderson RA, McDaniel RR (2010). "Implications of complex adaptive systems theory for interpreting research about health care organizations". J Eval Clin Pract. 16 (1): 228–31. doi:10.1111/j.1365-2753.2009.01359.x. PMC 3667707. PMID 20367840.
  10. ↑ Leykum LK, Pugh J, Lawrence V, Parchman M, Noël PH, Cornell J; et al. (2007). "Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes". Implement Sci. 2: 28. doi:10.1186/1748-5908-2-28. PMC 2018702. PMID 17725834.
  11. ↑ Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR (2010). "The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure". Implement Sci. 5: 66. doi:10.1186/1748-5908-5-66. PMC 2936445. PMID 20735859.
  12. ↑ Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT (2013). "How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts". Soc Sci Med. 93: 194–202. doi:10.1016/j.socscimed.2012.05.040. PMID 22819737.
  13. ↑ 13.0 13.1 Ruhe MC, Bobiak SN, Litaker D, Carter CA, Wu L, Schroeder C; et al. (2011). "Appreciative Inquiry for quality improvement in primary care practices". Qual Manag Health Care. 20 (1): 37–48. doi:10.1097/QMH.0b013e31820311be. PMC 4222905. PMID 21192206.
  14. ↑ Arar NH, Noel PH, Leykum L, Zeber JE, Romero R, Parchman ML (2011). "Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home". Qual Prim Care. 19 (5): 289–300. PMC 3313551. PMID 22186171.
  15. ↑ Rose AJ, Petrakis BA, Callahan P, Mambourg S, Patel D, Hylek EM; et al. (2012). "Organizational characteristics of high- and low-performing anticoagulation clinics in the Veterans Health Administration". Health Serv Res. 47 (4): 1541–60. doi:10.1111/j.1475-6773.2011.01377.x. PMC 3401398. PMID 22299722.
  16. ↑ 16.0 16.1 Curry LA, Spatz E, Cherlin E, Thompson JW, Berg D, Ting HH; et al. (2011). "What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study". Ann Intern Med. 154 (6): 384–90. doi:10.7326/0003-4819-154-6-201103150-00003. PMC 4735872. PMID 21403074.
  17. ↑ 17.0 17.1 Gabbay RA, Friedberg MW, Miller-Day M, Cronholm PF, Adelman A, Schneider EC (2013). "A positive deviance approach to understanding key features to improving diabetes care in the medical home". Ann Fam Med. 11 Suppl 1: S99–107. doi:10.1370/afm.1473. PMC 3707253. PMID 23690393.
  18. ↑ Peelle, Henry E. (2006). "Appreciative Inquiry and Creative Problem Solving in Cross-Functional Teams". The Journal of Applied Behavioral Science. SAGE Publications. 42 (4): 447–467. doi:10.1177/0021886306292479. ISSN 0021-8863.
  19. ↑ Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF; et al. (2014). "Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science". Implement Sci. 9: 165. doi:10.1186/s13012-014-0165-1. PMC 4239371. PMID 25407138.
  20. ↑ Braithwaite J, Herkes J, Ludlow K, Testa L, Lamprell G (2017). "Association between organisational and workplace cultures, and patient outcomes: systematic review". BMJ Open. 7 (11): e017708. doi:10.1136/bmjopen-2017-017708. PMC 5695304. PMID 29122796.
  21. ↑ Bradley EH, Curry LA, Spatz ES, Herrin J, Cherlin EJ, Curtis JP; et al. (2012). "Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction". Ann Intern Med. 156 (9): 618–26. doi:10.7326/0003-4819-156-9-201205010-00003. PMC 3386642. PMID 22547471.
  22. ↑ Bradley EH, Brewster AL, McNatt Z, Linnander EL, Cherlin E, Fosburgh H; et al. (2018). "How guiding coalitions promote positive culture change in hospitals: a longitudinal mixed methods interventional study". BMJ Qual Saf. 27 (3): 218–225. doi:10.1136/bmjqs-2017-006574. PMC 5867433. PMID 29101290.



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