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The Quality Improvement Process Simplified
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Geoffrey Krueger, BA, RRT, RCP
President 
Proactive Solutions HME Consulting LLC 
  
  Whaddya’ Call It?

  QI, QA, QM, PI, PM, QIP, QAP, CQI, CPI, CQA, CQM, blah, b-blah, b-blah .......

  The sheer number of different acronyms that have been created to describe essentially the same process can be confusing and a little intimidating, especially     for anyone approaching the quality improvement process for the first time.  The fact is, though, that regardless of what grouping of letters is being used to 
  label it, the process always boils down to some very basic elements, namely:   

  • What are we doing?
  • How are we doing it?
  • How well are we doing it?
  • How can we improve the way we are doing it?

  The term “QI” will be used throughout the rest of this article for purposes of simplicity to identify this quality improvement process.

  The Hub of the Wheel

  QI is such an integral part of an organization’s operations that it should be thought of as a central function.  In other words, if we think about all of the activities   that occur within an organization as being the outer rim of a wheel, the tracking of these activities as the connecting spokes, then the QI process is the hub. 




























  The overall idea here is that by increasing the integration of organizational activities into the QI process, the structure of the business becomes strengthened 
  and it's operations more efficient and smooth. The QI process is itself, in fact, a great business operations model for any type of organization. 

  Cycling and Recycling 

  Just as other elements of organizational operations have their individual cycles (e.g., billing, budgeting, reporting, inventory, deliveries, etc.), so too does the 
  QI process have it's own activity cycle.  

  There are two very important aspects of the QI cycle:

  • It is Continuous (ongoing throughout the life of the business)
  • It is Consistent (in it's methodology) 





























  Through consistently repeating this cycle of activities, data patterns such as trends and clusters will eventually emerge.  The continual re-integration of new 
  data into the system serves to (re)focus efforts, identify problem areas, and (re)define activites, methods, and performance goals.  


Nuts and Bolts

  OK.  So we've looked at wheels and hubs and spokes and cycles.  That's nice, and the pictures are pretty, but what holds it all together?  In other words (for  
  those of us old enough to remember): "Where's the beef?!".

  In short, the "beef" is in the methodology and documentation of the QI activities.  The way(s) in which QI activities are defined, planned, recorded, analyzed,   and reported are where the proverbial rubber meets the road.  Just understanding the concepts involved is not enough.  Understanding the concepts and just  
  "mentally" tracking activities is not enough.  Understanding the concepts and just simply documenting the tracking of activities is not really enough, either.  
  Well then, what IS enough?

  In order for any QI program to be optimally effective, it must include at least the following elements:

  • Involvement of all ownership, leadership, and staff members of the organization;
  • The written designation of an individual and/or group within the organization to oversee the implementation of the QI activites;
  • Specific and detailed written descriptions of what activities are to be tracked, how the data will be collected and analyzed, how often the results of tracking are to be reported and to whom, quantifiable performance goals/thresholds, and plans to correct any deficiencies that are discovered;
  • Consistent documentation of all activity results and interpretations, action/correction plans, meeting minutes/agendas, and periodic summaries and annual reports.

  In addition to tracking and documenting activities (sometimes referred to as indicators) that may be required by an accrediting body or other regulatory 
  agency, it is important to have an understanding of how to find areas of interest in an organization's operational activities that may warrant focused monitoring  
  and tracking.  A relatively simple way to approach this is by looking at activities that are:

  • "High-Volume"  -  Activities that occur frequently or consistently over time.
      and/or
  • "High-Risk"  -  Activities that pose a risk of material adverse effect on customers, staff, and/or the organization if they are not performed correctly.
      and/or
  • "Problem-Prone"   -  Activities that tend to involve recurring complaints, delays, incidents, inefficiencies, or other problems.   

  To sum up:  Be specific and put it in writing!   Accreditors and other regulators are interested not only in compliant policies, but also in organizational 
  knowledge and documentation of QI activities.


The Paper Trail

  How best to put it in writing?  

  While there is certainly a good degree of flexibility regarding the formatting of QI documentation (i.e., source documents, logs, audit and scoring tools, 
  reports, etc.), there are some guidelines to follow in terms of content, including, but not necessarily limited to:

  • Training of all organization personnel regarding proper use of documenting forms is essential, including any changes to documentation forms/methods.
  • Chosen indicators should be meaningful to organizational operations.
  • Periodic written QI summaries should address each and every activity (indicator) being tracked, including notation of information such as "none reported for the period" in cases of no complaints, incidents, infections, etc.. 
  • Annual QI reports should be completed and include not only an analysis of data and trends, but also a narrative explanation of the data and its impact on all relevant aspect of organizational operations. 
  • Performance thresholds should be quantifiable.
  • Performance thresholds should be challenging to meet, but at the same time, ultimately attainable.
  • Performance thresholds can be changed over time, as long as the change is a result of data collection and is documented.
  • Documentation should show a clear relational pathway between activities description, data collection, results analysis, and results reporting.
  • Use of graphic and tabular data formats should be used when they add some value to the information in terms of analysis and/or presentation.
  • The consistent use of established data collection and analysis methodologies is essential for comparability of data results over time.  If there are 
          changes made to any methodologies, they must be communicated to all personnel involved and retraining documented.

  One way of looking at QI documentation involves separating the various applicable forms and documents into categories:


























 
  Proper documentation of QI activities will not only ensure that you have something of substance to show to accreditors and regulators, but more importantly,    
  will serve as an invaluable resource in maintaining and improving organizational operations and services. 


"...a rose by any other name..."

  The time and effort involved in the actual development and implementation of a QI program may not "smell sweet", especially at first,  But no matter what 
  name is used to describe the process (see "blah, b-blah, b-blah" above), the results of an understanding of the foregoing basic elements and a diligent 
  pursuit of the process will utimately result in some "sweet" positive outcomes for you, your organization, and the people you serve.

  There have been and continue to be many sort of "branded" approaches to the QI process that utilize their own individual lexicons and jargon.  This article has 
  been written to provide the reader with some of the elements that are basic to all approaches, so that, no matter what "brand" of "QI" is involved, there is a 
  basis for learning and understanding any specific approach. 

  Copyright 2010 Proactive Solutions HME Consulting LLC  

The organizational activities shown in this diagram are representative of some common major areas of operational concern.  There are, of course, others that could be included.







The arrows emanating from the center of the diagram represent the fact that the QI process potentially affects every aspect of organizational operations. 

As more activities are tracked and improved on an ongoing basis, the "rounder" the wheel becomes, and the smoother it "rolls along".








As refinements are made to the manner in which data is collected and analyzed, more meaningful outcomes and improvements result.  The "spokes" of the wheel are strengthened.  

QI POLICIES AND PROCEDURES 
--------------
INDICATOR DEFINITIONS


INITIAL DATA COLLECTION FORMS
--------------
ACTIVITY 
SUMMARY LOGS
--------------
PERSONNEL RECORDS
CUSTOMER RECORDS
FINANCIAL RECORDS


INDICATOR ACTIVITY AUDIT TOOLS AND CHECKLISTS
--------------
INDICATOR SCORING FORMS


PERIODIC SUMMARY REPORTS OF RESULTS OF DATA ANALYSIS
--------------
MINUTES OF 
QI MEETINGS
--------------
ANNUAL QI PROGRAM REPORTS

What, specifically, is to be monitored and tracked?
Ongoing business operations.
What are the methods to be used for 
collecting, recording, scoring, analyzing,
and interpreting the actual data resulting from monitoring and tracking?  What are the 
established performance goals or 
benchmarks? 
How, when, and to whom are the data results reported?
What are the written action plans to correct any deficiencies in performance that are found?
Are there any resulting changes necessary in terms of what is tracked and how it is tracked?