HA425_CH1 - Chapter 1 The global evolution of continuous...

Chapter 1
The global evolution of continuous quality
improvement:
from Japanese manufacturing to global health
services

Introduction
•
Continuous quality improvement (CQI) has
evolved over time and across countries
•
The need for CQI is increasing, particularly as
evidence shows that there has been little
improvement in safety and quality of care over
the last decade

Definition of CQI
•
CQI is defined as a structured organizational
process for involving personnel in planning
and executing a continuous flow of
improvements to provide quality health care
that meets or exceeds expectations

Characteristics of CQI
• a link to key elements of the
organization’s strategic
plan;
• a quality council made up of
the institution’s top
leadership;
• training programs for
personnel;
• mechanisms for selecting
improvement opportunities;
•
formation of process
improvement teams;
• staff support for process
analysis and redesign;
• personnel policies that
motivate and support staff
participation in process
improvement;
• application of the most
current and rigorous
techniques of the scientific
method and statistical
process control.

Institutional Improvement
CQI
CQI
Localized
improvement
efforts
Localized
improvement
efforts
Organizational
learning
Organizational
learning
Process
re-engineering
Process
re-engineering
Evidence
based
medicine and
management
Evidence
based
medicine and
management

Cost of Poor Quality Care
•
Poor quality care has a direct impact on the patients
directly affected, the services which provide that care,
and society at large
•
Poor quality care has a number of direct and indirect
costs which need to be balanced with the ‘cost of
quality’
•
Improving the quality of care is not just about
reducing the number of errors or improving customer
satisfaction (as important as these are)

Improving the Quality of Care
•
Improving quality involves (Berwick, 2008:
759):
–
Improving the experience of care
–
Improving the health of populations
–
Reducing the per capita costs of health care
•
At a more micro level, improving quality
also involves professional responsibility and
development

Rationale for Implement CQI
•
Engaging in true process improvement;
•
Gaining a competitive advantage;
•
(Temporary) conformance to external review
or accreditation requirements
(Linder, 1991)
•
Other rationales …

Characteristics and Functions of CQI
1. Understanding and adapting external environments;
2. Empowering all staff to participate in CQI;
3. Valuing and responding to customer preferences;
4. Utilizing a multidisciplinary approach;
5. Adopting a philosophy of ongoing adaptation;
6. Establishing mechanisms to support best practices
through planned organizational learning;
7. Providing motivation for a rational, data-based,
cooperative approach to CQI.