How can professionals contribute to quality improvement

The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement QI work. The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships.

These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work.

However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute.

Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

This cycle essentially mimics the steps of the scientific method, but is adapted for action-oriented learning. Once your plan is underway, be sure to communicate with your team and with your organization at large. Share milestones both large and small as well as setbacks.

Congratulate those who have contributed and made an impact on your progress. Your plan is more likely to succeed when staff are engaged. Certain websites such as Patient Care Link allow consumers and healthcare industry workers to view hospital data and trends. Research online and in the literature, and reach out to see if you can learn from their quality improvement programs.

Most organizations are open to sharing this information for the greater good of patients. In its annual report to Congress , the Agency for Healthcare Research and Quality AHRQ reported promising improvements in healthcare quality as a result of improvement efforts nationwide.

Some of their findings included lower patient death rates, higher vaccination rates, and improved patient-provider communication. Still, according to AHRQ, quality problems persist, such as variation in services, underuse, overuse or misuse of services, and disparities in quality—making healthcare quality improvement efforts all the more important.

For more information about healthcare quality improvement and an in-depth update on the state of healthcare quality in the US, read our article entitled An Update on United States Healthcare Quality Improvement Efforts. For an overview of successful improvement efforts, read an essay published in Health Affairs entitled Improving Quality and Safety. Harvard T.

To learn more about this opportunity, click here. It can also be difficult in a practice where buy-in to improvement efforts is low. The enthusiastic practice may lack patience for systematic improvement work and may have difficulty instituting the discipline needed to use the PDSA process. Practices where buy-in is low may lack the commitment and associated energy needed to engage in a systematic approach to change.

Large and lofty goals are excellent for inspiration and rallying troops, but the actual work of improvement can be mundane and tedious and involve small changes, tested, and then spread, in sequence until the goal is attained. They will need to be skilled in navigating their reactions to processes they may have used with limited success in the past.

Without some type of systematic approach, improvement work can become chaotic, ineffective, and unlikely to produce the outcomes desired.

Some of these are covered in subsequent modules and include workflow mapping, audit and feedback, benchmarking, academic detailing, and best practices research. Best practices research is a powerful but less well-known QI approach that you should make an effort to become very familiar with and comfortable using. It can be used to identify the best process for activities such as managing lab test results, managing prescription refills, delivering adult immunizations, managing walk-ins, and caring for diabetic patients.

The first step in best practices research is to clearly define the process you are seeking to improve and break it down into discrete elements or subprocesses. The second step is to define what constitutes a best practice for each element or subprocess. The third step is to identify exemplars in the overall process or for each element or subprocess through peer nomination and confirmation through performance audit, or through chart audit reviews. The next step is to combine the methods used by exemplars into a best approach.

Best practices research is an approach that can help you identify exemplar practices appropriate to spread. Best practices research. Fam Med Feb, 35 2 Mold J, Peterson K. Primary care practice-based research networks: working at the interface between research and quality improvement. Internet Citation: Module 4. Approaches to Quality Improvement.

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