Quality Improvement in Healthcare: Foundations and Practice

Introduction to Quality Improvement in Healthcare

Nearly all healthcare organizations today are aware of the Quality Improvement (QI) movement and seek to actively instill their operations with its principles. The past few decades have shown the QI movement to be the primary approach for healthcare organizations to measure performance and engage in lasting change (Colton, 2000). The foundations of QI draw from multiple arenas: "in systems engineering, as a way of defining production processes; in quantitative analysis, as a methodological approach for collecting and analyzing data; and in organizational behavior, as a way of understanding how QI fits with an organization's structure and management philosophy" (Colton, 2000).

QI fundamentally stands as a means for a healthcare organization to improve itself by enhancing the way it delivers service and by improving patient outcomes (Colton, 2000). "The U.S. Agency for Healthcare Research and Quality defines quality health care as 'doing the right thing, at the right time, in the right way, for the right person — and having the best possible results'" (Varkey et al., 2007). While these tenets may seem broad, they contain fundamental values that allow them to be applied across a wide range of disciplines and needs within the healthcare arena.

Quality first originated as a process and desirable goal in the industrial arena. Walter Shewhart introduced it in 1931, focusing on customer needs and minimizing defects; the concept eventually spread to a range of other professional fields (Varkey et al., 2007).

Various stakeholders in professional healthcare define quality differently, reflecting their widely different goals and needs. Quality to a nurse leader will mean something very different than it does to a hospital administrator. Quality to a neurosurgeon differs from quality to a pediatrician. Clinicians, for instance, have a truly critical role in driving quality improvements. As the individuals working directly with patients, they can improve care at the most immediate level — however, in order to do so, they need strong alliances and robust institutional support.

Stakeholder Perspectives on Quality

Patients also need to take an active role in QI. They can do this by communicating openly with their physicians — not withholding information about side effects, relevant medical history, or additional vitamins and supplements they may be taking (familydoctor.org). Keeping one's clinician well informed is one of the most direct ways to prevent medical errors.

QI is urgently needed in the healthcare industry for a variety of reasons. The stakes are extraordinarily high — the field deals with life and death on a daily basis — and measures must be in place to ensure a sustained dedication to quality. Furthermore, the measurement of flaws and defects is a core component of QI and is particularly essential in healthcare. "A systematic measurement of quality demonstrates whether improvement efforts (1) lead to change in the primary end point in the desired direction, (2) contribute to unintended results in different parts of the system, and (3) require additional efforts to bring a process back into acceptable ranges" (Varkey, 2007). This kind of data can be gathered and analyzed, and real changes to produce lasting improvements can be implemented promptly.