Internet Citation: Section 4: Ways To Approach the Quality Improvement Process (Page 1 of 2). Content last reviewed January 2020. Agency for Healthcare Research and Quality, Rockville, MD.
//www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html
Continuous Quality Improvement (CQI) is a deliberate, defined process which is focused on activities that are responsive to community needs and improving population health. It is a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality for state and local program levels.
The goal of CQI at the Minnesota Department of Health (MDH) Family Home Visiting (FHV) program is to improve outcomes by building capacity of local partners through:
- Establishing a culture of CQI,
- Building CQI infrastructure and,
- Applying CQI methods to daily practice
For more information about Minnesota’s FHV CQI efforts, contact .
Why We Promote CQI
Continuous Quality Improvement is considered a best practice in public health. MDH is a Maternal, Infant, Early Childhood Home Visiting (MIECHV) awardee that administers funding on behalf of the U.S. Health Resources and Services Administration (HRSA) to local grantees throughout Minnesota to deliver home visiting programs. MDH FHV is required by HRSA to develop a CQI work plan and report on it annually. MDH FHV must demonstrate utilization of CQI best practices and measurable improvement at the state program level while assisting family home visiting programs to increase their capacity to use consistent and planned CQI methods to improve program outcomes.
Who We Support
MDH FHV supports local family home visiting programs who receive federal and state funds to deliver home visiting programs. Family home visiting programs can be managed by are local public health agencies, county health boards, tribal nations, and nonprofit organizations. The majority of programs that MDH FHV supports are those using an evidence-based home visiting model funded by state and/or federal home visiting dollars.
Ways We Support CQI
An interdisciplinary team that includes a CQI Coordinator, Home Visiting Consultants, Research Scientists, and Student Workers work closely to support local family home visiting programs in building their CQI capacity by providing:
- Consultation
- Training
- Facilitation
- Coaching
- Peer learning opportunities
- Technical assistance
- Data collection, reporting, and analysis
CQI Essentials
The MDH FHV Section is committed to the principles of CQI and supports efforts at both the state and local levels to improve the effectiveness and delivery of family home visiting services provided to families with young children.
These guiding principles include:
- A focus on improving services from the client’s perspective
- Meaningful engagement at all levels is required for success
- Recognition that all processes can be improved
- Continual learning using an “all teach, all learn” philosophy
- Decision-making is improved by using both data and team knowledge
- CQI data is used for learning and improvement, not for judgment or supervision
The Minnesota Department of Health uses many different resources to support CQI efforts, but several essentials will get you on the path to success when planning a CQI project. Family Home Visiting has created a CQI Toolkit, available on the FHV Toolkits page, with more information on CQI practice and essentials.
The Model for Improvement provides a framework for rapid testing and change leading to improvement. This model consists of two parts: addressing three fundamental questions and then engaging in tests of change using the Plan-Do-Study-Act cycle.
Langley, G.J., Nolan, K.M., Nolan, T.W, Norman, C.L., & Provost, L.P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd Ed.). San Francisco: Jossey-Bass. P.24.
Key indicators that are used to measure performance and track improvement. Measures are used to evaluate if the aims and goals of an improvement project have been met.
A visual display of the theory for what “drives” or contributes to the achievement of a project aim. The driver diagram shows the relationship between primary drivers (those that contribute directly to achieving the aim), secondary drivers (components of primary drivers), and the goal(s) to achieve. The driver diagram is a tool that helps you translate a high level improvement goal into a logical set of smaller goals and projects.
Driver Diagram Template (PDF)
The Plan-Do-Study-Act (PDSA) cycle is a method for rapidly testing a change by developing a plan to test (Plan), carrying out the test (Do), observing and learning from the results (Study) and determining what modifications should be made to the test (Act).
PDSA Form (PDF)
A document that strategically sets smaller goals by timeframe. It helps plan when and who is responsible for PDSA cycles being completed in either the test, implementation, or spread stages during different action periods of an improvement project.
Project Planning Form (PDF)
Parents engaged with CQI efforts as active leaders can offer valuable feedback and develop innovate ideas for improving services and processes. To improve services for families, it is important to partner with families.
The HV CoIIN Parent Leadership is available free of charge and you will receive a copy for download after completing a simple request form.
Request for HV CoIIN Parent Leadership Toolkit
For additional CQI resources and tools, visit MDH Center for Public Health Practice.
Learning Collaboratives
A Collaborative is a time-limited effort of multiple organizations that come together with leaders and experts to learn about and to create improved processes in a specific topic area. MDH uses the Institute of Healthcare Improvement’s Breakthrough Series (BTS) Collaborative model as a framework for CQI in FHV.
The topic selection process engages internal and external stakeholders. Topics that are chosen are issues that have a high level of interest at the state and local program levels, as well as room for improvement based on national benchmarks in FHV performance measures. Past statewide CQI learning collaborative have focused on these topic areas:
In 2018, Minnesota Department of Health (MDH) facilitated an eight-month statewide Family Enrollment, Engagement, and Retention learning collaborative with 16 teams. The goal of this collaborative was to increase the proportion of eligible, referred families who participate at high levels by changing how FHV staff enroll, relate to, and engage families in services.
Project Documents
To request additional Collaborative materials, please contact:
Continuous Quality Improvement (CQI): A key component of total quality management that uses rigorous, systematic, organization-wide processes to achieve ongoing improvement in the quality of healthcare services and operations. It focuses on both outcomes and processes of care.
Outcome Indicators: Measures of quality and cost of care. Metrics used to examine and evaluate the results of the care delivered.
Outcomes Management: The use of information and knowledge gained from outcomes monitoring to achieve optimal patient outcomes through improved clinical decision making and service delivery.
Outcomes Monitoring: The repeated measurement over time of outcome indicators in a manner that permits causal inferences about what patient characteristics, care processes, and resources produced the observed patient outcomes.
Performance Improvement: The continuous study and adaptation of the functions and processes of a healthcare organization to increase the probability of achieving desired outcomes and to better meet the needs of patients.
Quality Assurance: The use of activities and programs to ensure the quality of patient care. These activities and programs are designed to monitor, prevent, and correct quality deficiencies and noncompliance with the standards of care and practice.
Quality Improvement: An array of techniques and methods used for the collection and analysis of data gathered in the course of current healthcare practices in a defined care setting to identify and resolve problems in the system and improve the processes and outcomes of care.
Quality Management: A formal and planned, systematic, organization wide (or networkwide) approach to the monitoring, analysis, and improvement of organization performance, thereby continually improving the extent to which providers conform to defined standards, the quality of patient care and services provided, and the likelihood of achieving desired patient outcomes.
Root Cause Analysis: A process used by healthcare providers and administrators to identify the basic or causal factors that contribute to variation in performance and outcomes or underlie the occurrence of a sentinel event.
Standard (Organization): An authoritative statement that defines the performance expectations, structures, or processes that must be substantially in place in an organization to enhance the quality of care.
Quality improvements focus on impacting the quality of healthcare directly. Performance improvements focus on the administrative systems performance. Both can be prospective or retrospective and aim at improving how things are done. An example of quality improvement may be to decrease the number of hospital acquired infections, whereas a performance improvement may be to reduce lost charges.
Objectives for QI include:
- reducing medical errors, morbidity and mortality
- assisting in the development of best practice guidelines
- improving customer satisfaction
- ensuring the environment of care promotes safety
- ensuring professional performance
Quality improvement is not intended to attribute blame, but to discover where errors are occurring and develop systems to prevent them.
There are 3 types of measures
- structure: physical equipment and facilities
- process: How the systems work
- outcome: the final result
There are several methods used to measure quality improvement. Below are 3 of the most common. Although they vary, they all have the same basic design, to find where the problem is, to figure out an option to fix it, and to analyze the effectiveness of the changes.
FADE Model
Focus: Define the process to be improved Analyze: Collect and analyze data to establish baseline and identify root cause Develop: Based on the data from the previous steps, develop a plans for improvement Execute: Implement the action plan
Evaluate: Ongoing measuring to ensure success.
PSDA Model
Plan: Plan a change
Do: Carry out the plan
Study: Evaluate results
Act: Decide what actions should be taken to improve.
Repeat as needed
Six Sigma
There are two Six Sigma models
DMAIC-used for an existing process that is not meeting standards and needs improvement Define
Measure Analyze Improve
Control
DMADV-used to develop new systems Define Measure Analyze Design
Verify