Where’s Quality in the Alphabet Soup?

1. Where’s Quality in the Alphabet Soup? Lori DeLorenzo, RN, MSN ADHC Quality Learning Network September 16, 2005

2. Quality Alphabet Soup

3. Quality Assurance vs. Quality Control Quality assurance and quality control are often used interchangeably to refer to ways of ensuring the quality of a service or product. The terms, however, have different meanings.

4. Quality Assurance “The planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled.” American Society for Quality

5. Examples of Quality Assurance Activities • Annual infection control and safety training • Review medication closet for outdated meds • Review emergency chart once a week for supplies and outdated meds Activities that are based on public health standards, licensing standards, institutional policies, etc. Can help identify a problem, but are more often used to comply with the standards.

6. Quality Control “The observation techniques and activities used to fulfill requirements for quality.” American Society for Quality

7. Examples of Quality Control • Infection control training sign-in sheets cross-referenced with staff roster • Review sheet of emergency cart that ensures stocked supplies and meds • Direct observation of counseling session, e.g. provision of key elements of post-test HIV counseling

8. Quality Improvement “Continuous improvement is an ongoing effort to improve products, services or processes. These efforts can seek “incremental” improvement over time or “breakthrough” improvement all at once.” American Society for Quality

9. Goals of Quality Improvement • The goals of QI are to understand the process, reduce the unintended variation in care, eliminate errors, remove unnecessary steps, and improve communication and accountability. • The process is designed toward outcomes. Quality improvement depends on measurement.

10. Core Concepts of CQI • Quality is defined as meeting and/or exceeding the expectations of our customers. • Success is achieved through meeting the needs of those we serve. • Most problems are found in processes, not in people.  CQI does not seek to blame, but rather to improve processes. 

11. CORE CONCEPTS OF CQI • Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation. • It is possible to achieve continual improvement through small, incremental changes using the scientific method.  • Continuous improvement is most effective when it becomes a natural part of the way everyday work is done.

12. Comparison of QA & QI

13. QA versus QI

14. Quality Improvement Aim: make changes that result in improvement Methods: Test observable Stable bias Just enough data Adaptation of the changes Sequential tests Research Aim: gain new knowledge Methods: Test blinded Eliminate bias More data, just in case Fixed hypotheses One large test CQI vs. RESEARCH

15. What is Quality? Quality is a never-ending cycle of continuous improvement. -Deming

16. Final Thought… If you don’t have time to do it right, when will you have time to do it over?