Quality Assurance and Improvement
Fellows should contribute to and support the college in improving safety and quality of patient care. This involves:
- Quality Assurance
Establishing that facilities meet acceptable standards. - Quality Improvement
Promotion of continuous improvement.
Such projects include:
- Mortality, mortality and morbidity committees
- Sentinel event and adverse event reporting
- Perioperative care and pain management
The Triple Aim
The goal of QA and QI is called the triple aim:
- Improved quality, safety, and experience of patient care
- Improved population health and equity
- Best value for the available resources
Achieving the triple aim requires:
- Doing the right things
- Doing things right the first time
Quality in Healthcare
Key Principles:
- Safety
- Timeliness
- Efficacy
- Efficiency
- Equitability
- Patient-centredness
Measuring Outcomes
Qualitative and quantitative measurements, focusing on:
- Structure
- Process
- Outcomes
Ultimate objective, but:- May be harder to measure
- May be outside of clinician control
e.g. Case mix.
Principles of Conducting a QA or QI Project
Should be:
- Systematic
- Scientific
- Plausible
- Supported by evidence
- Appropriate use of expert advice
- Collaborative
- Cost-effective
Time and monetary cost of data collection and analysis should be measured against potential benefit.
Conduct of a QA or QI Project
Key steps:
- Planning
Design and preparation, including:- Defining topic
- Determining data to be collected
- Determining analytic method
- Implementation
- Data collection and analysis
- Results review
- Actions to be taken
- Review
- Monitor outcome
- Demonstrate impact
- Setting
- Incorporate improvements into practice
Rapid Improvement Cycle
A standard QI methodology using an iterative feedback loop:
- Plan
- Identify improvement opportunities
- Plan of action
- Do
- Implement the plan
- Check
- Evaluate results
- Modify the plan based on the results
- Act
- Implement revised plan