Quality Assurance Continuous Quality Improvement

Quality Assurance

Continuous Quality Improvement (CQI) is replacing Quality Assurance (QA) in many healthcare institutions. QA is fundamentally different from CQI. QA emphasizes the processes and structures used to carry out treatments. It develops thresholds for accepted standards of and reports on exceptions to them. With CQI, goals are established and progress toward the goals is reported. D'Aquila, Habegger, and Willwerth (1994) describe how the University of Cincinnati Ambulatory Care Services moved from QA to CQI in their article Converting a QA program to CQI. Only a few remnants of QA remained in tact after the changeover.

Unlike in QA, quality in CQI is achieved through participation of all members of the team, not just a limited number of leaders or QA experts. In the team development at the University of Cincinnati Ambulatory Care Services, D'Aquila, Habegger, and Willwerth state, "... It is vital to have staff contribute to the development, implementation and evaluation of each unit program. It is important to have acceptance and "buy-in" to make the program effective."

Thus, the Ambulatory Care Services quality committee consisted of Ambulatory Nurse Managers, physicians, and representatives from the QA Department, the College of Nursing and Health and the Community Health Instructor.

Much of the discussion by D'Aquila, Habegger, and Willwerth is devoted to developing ambulatory department-wide indicators and unit specific indicators. The authors advise that the place to start in the QA to CQI transformation is to determine whether each indicator is a true reflection of a desirable standard of care or wheter it is based on policies and procedures.

If the indicator is a standard of care, a measurable goal should replace established thresholds. Then, continuous monitoring should be performed to demonstrate progress toward the goal. The Ambulatory Care Services did not throw out procedural related indicators under their previous QA program. However, measurement became periodic rather than continuous. According to D'Aquila, Habegger, and Willwerth, continuous monitoring of the process-related monitoring should begin only when periodic reporting demonstrates less than 100% compliance.

In contrast to QA teams who look for wrongdoers to blame, CQI focuses on finding problems to correct. D'Aquila, Habegger, and Willwerth explain that when goals are not achieved, CQI attempts to prove that a higher level of performance is not possible in order to demonstrate that the highest possible quality of care is defined and offered.