How to Begin a Quality Improvement Project

Abstract

Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects.

How to Diagnose Solutions to a Quality of Care Problem

“…Hence, it is an essential tool for quality improvement. Although other approaches to understanding problems within a system exist, including Six Sigma and Lean (1), root cause analysis is the most simplistic and easy to understand, and it is the most frequently used approach in identifying quality problems.…”

“…The goals of a root cause analysis as they pertain to quality improvement include (1) determining what is happening, (2) determining why the outcome is happening, and (3) determining what can be done to prevent the outcome from happening again (3). Specific to our case, root cause analysis will help the quality improvement team determine why the dialysis program is not attaining the target of 30% of patients initiating home dialysis and help facilitate potential strategies for effective change.…”

“…The team should be encouraged to ask questions about the process and share their insights. Some important issues for the team to consider include (1) what drives the process, (2) whether there are inconsistencies in how the process is performed, (3) whether the process can be performed in a different way or by a different person more efficiently, (4) whether each step in the process adds value or if certain steps can be eliminated, and (5) whether the correct resources are used in the process.…”

“…In the previous article in this Moving Points feature (1), an interdisciplinary team consisting of (1) a lead nurse or physician from the home dialysis unit; (2) technical experts from the predialysis clinic and in-center dialysis program (nursing staff, physician, social worker, etc. ); (3) a clinical leader (i.e., manager) from the dialysis program; (4) an improvement advisor; and (5) an executive sponsor was formed with the aim of promoting home dialysis (home hemodialysis and peritoneal dialysis) uptake from its current level of 15% to a target of 30%.…”

The development of implementation management instruments for a new complex stroke caregiver intervention based on systematic stakeholder and risk analyses

“… proposed gathering the perceptions of end‐users and health professionals in the development of a cardiovascular risk reduction programme, while Silver et al. recommended stakeholder analyses to improve the quality of kidney healthcare provision. In addition, Pandi‐Perumal et al.…”