Other Features of Continuous Quality Improvement
Studies suggest that just measuring and reporting results improves performance indicators by up to 6%. However, organizations that continually incorporate quality improvement activities demonstrate significantly greater performance gains than organizations that do not.
Second, a Pareto chart (Fig 1-10) can provide insights into the cumulative distribution of key factors of interest. The chart combines a histogram with a cumulative frequency line, making it possible to assess performance across the range of values for the variable of interest.
Third, run charts or control charts (Fig 1-11) can help organizations understand changes that have occurred over time. Rates of events, especially uncommon ones, can fluctuate. Are the fluctuations significant, both statistically and clinically, compared with those during prior periods or from other institutions or practices? In run charts and control charts, event rates are plotted over time with both upper and lower control limits and averages. This presentation enables reviewers to determine (1) whether an aberrant data point is really a meaningful finding or is due to random error and (2) how the organization is faring compared with peer organizations, if data from peers are available.
Use of continuous quality improvement tools requires significant thought regarding how to improve care structures and processes. An essential step in improving care processes, before or after initial analysis, is developing a checklist of the steps and parties involved and then creating a flowchart (Fig 1-12) of the care system. By examining the overall process for a specific outcome (eg, making sure a patient with diabetes mellitus gets an annual eye examination), the organization can identify opportunities for improving the process.
Another graphic tool is the fishbone, or cause-and-effect, diagram, which maps out the different factors that are significant inputs in each step of the care process, including personnel. Mapping each of these important factors can help clarify where problems may occur and where work may be improved. Changes in those factors can then be measured and the results monitored, providing continuous feedback to those interested in improving the quality of care.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.