Ransom, E. R, Joshi, M. S., Nash, D. B., & Ransom, S. B. (2008). The healthcare quality book:
Vision, strategy, and tools. (2nd ed.). Health Administration Press: Chicago, IL.
Quality Improvement Processes and Approaches
“Form follows function,” a concept founded in the field of architecture, describes the importance of understanding what you want to do before you determine how you are going to do it. The premise behind the principle also applies when an organization is deciding what quality improvement process or approach to adopt. This section describes some of the many systems and processes that guide quality improvement efforts today. These quality improvement approaches are derivatives and models of the ideas and theories developed by thought leaders and include: C h a p t e r 4 : Q u a l i t y I m p r o v e m e n t 67
• Associates for Process Improvement’s (API) Model for Improvement; • FOCUS PDCA;
• Baldrige Criteria;
• ISO 9000;
• Lean; and
• Six Sigma.
Shewhart Cycle/PDCA or PDSA Cycle
As discussed earlier, in the 1920s, Walter Shewhart developed the PDCA cycle used as the basis for planning and directing performance improvement efforts. Since the creation of the PDCA/PDSA cycle, most of the formally recognized performance improvement models have some basis or relation to this original quality improvement model.
• Objective: What are you trying to accomplish? What is the goal? • Questions and predictions: What do you think will happen? • Plan to carry out the cycle: Who? What? When? Where?
• Educate and train staff.
• Carry out the plan (e.g., try out the change on a small scale). • Document the problems and unexpected observations.
• Begin analysis of the data.
• Assess the effect of the change and determine the level of success as compared to the goal/objective.
• Compare results to predictions.
• Summarize the lessons learned.
• Determine what changes need to be made and what actions will be taken next.
• Act on what you have learned.
• Determine whether the plan should be repeated with modification or a new plan should be created.
• Perform necessary changes.
• Identify remaining gaps in process or performance.
• Carry out additional PDCA/PDSA cycles until the agreed-upon goal/objective is met.
68 T h e H e a l t h c a r e Q u a l i t y B o o k
API Improvement Model
Tom Nolan and Lloyd Provost, cofounders of API, developed a simple model for improvement based on Deming’s PDSA cycle. The model (see Figure 4.2) contains three fundamental questions that form the basis of improvement: What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Focus on the three questions and the PDSA cycle allows the model’s application to be as simple or sophisticated as necessary (Langley et al. 1996). The effort required to bring about improvement may vary on the basis of the problem’s complexity, whether the focus is on a new or an old design, or the number of people involved in the process (Langley et al. 1996).
FOCUS PDCA Model
Building on the PDSA cycle, the Hospital Corporation of America designed the FOCUS PDCA model to create a more specific and defined approach to process improvement. The key feature of FOCUS PDCA is the preexistence of a process that needs improvement. The intent of this model is to maximize the performance of a preexisting process, although the inclu- 69
API Model for
• What are we trying to accomplish?
• How will we know that a change is an
• What change can we make that will
result in improvement?
Model for Improvement
SOURCE: Langley et al. (1996). Used with permission.
C h a p t e r 4 : Q u a l i t y I m p r o v e m e n t
sion of PDCA provides the option of using this model for new or redesign projects (Brown 2003)....