Transcript QA versus QI - hivguidelines.org

Quality Assurance or Quality
Improvement:
What’s the Difference?
Johanna Buck*
Title I Mental Health Providers
Quality Learning Network
October 3rd, 2005
*With thanks to Lori DeLorenzo, Susan Weigl and others
Quality Alphabet Soup
CQ
A
C
PD
I
PI
PD
SA
M
Q
T
QI R
CQ
I
QA
IO
P
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
Examples of Quality Assurance
Activities



Annual child abuse and domestic violence training
Chart review for patient's signature on consent forms
Utilization Review process
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.
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
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.
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.
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.
Comparison of QA & QI
QA
QI
Motivation
Measuring
compliance with
standards
Continuously improving
processes to meet
standards
Means
Inspection
Prevention, monitor over
time
Attitude
Required, defensive
Chosen, proactive
Focus
Outliers or “bad
apples”, individuals
Processes, systems,
majority
Players
Selected
departments
Organization wide,
benchmarking
Disciplines
Within profession
Multidisciplinary approach
Scope
Medical profession
focused
Patient care focused
Responsibility Few
All
QA versus QI
CQI vs. RESEARCH
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
What is Quality?
Quality is a
never-ending
cycle of
continuous
improvement.
-Deming
Final Thought…
If you don’t have
time to do it right,
when will you have
time to do it over?