Quality Improvement (QI) in Hospitals Increased awareness and paying capabilities of patient brought quality of care issues to the forefront. No Hospital can ignore quality of patient care and survive for long. Quality brings in different levels of experience and satisfaction to patients, visitors and employees of the Hospitals.
Quality is delivering the most advanced medical knowledge, practices to help/save the patient and treating patient with empathy, respect, concern.
Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it. QI involves both prospective and retrospective reviews.
Tools used for Quality Improvement in Hospitals –
CQI : Continuous Quality Improvement – National Accreditation Board for Hospitals and Health Care Providers (NABH)
Six Sigma (Define, Measure, Analyze, Improve, Control)
TQM : Total Quality Management
What is Quality Indicator?
The Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data.
CONTINUOUS QUALITY IMPROVEMENT (CQI) as per NABH 2011
Most of the hospitals do not have proper documentation system. Even if the documentation system is in place, compliance to the same is poor and hence reliable and sufficient data is not available for month on month comparison and analysis. Unless the Hospital activities, across various departments are captured in the form of Forms, Records, Registers or in computers as soft copy, Quality Improvement cannot be measured or monitored.
Continuous Quality Improvement (CQI) is not a one time affair to achieve quality state, it is a constant and conscious effort to raise the standard of practice in all areas and process of the Hospital and sustain it for ever.
The Cycle of continuous quality improvement (CQI) goes like this –
- There should be established documentation system to collect data - The sample size and frequency of data collection is defined - The data has to be collected for various indicators across all departments or functions on a monthly basis. Target is set for each department based on National/International Benchmarks /data, if available. The target can also be set on three months data to begin with if the hospital is way behind the National/International Benchmarks/Targets. The target can be revised in phased manner gradually to scale to the level of National/International Benchmarks / Targets. - Non performances/Under performances across departments who fall below set target is identified - Root cause analysis done - Suitable corrective action taken - Effectiveness of corrective action taken is evaluated - Corrective action will be modified if required - Preventive action taken - Effectiveness of the preventive action taken is evaluated - If Consistency is maintained with respect to achieving defined target in a particular department or process, then new target is set after getting the consensus from all stake holders - The target is increased by few notches to achieve it - This cycle goes on and on improving the performances and quality of each and every department/process - Various indicators are adapted and data captured on monthly basis for comparisons and analysis
Some of the sample list of indicators are given below :-
1. Front office and Emergency - Waiting time for OPD & Emergency Patient 2. Laboratory & Imaging services –
Number of reporting error/1000 investigation
Percentage of reports co-relating with Clinical Diagnosis
Percentage of Re – dos (repeat test/procedure).
Percentage of adherence to safety precautions
3. Operation Theatre –
Re exploration rate for all invasive procedures
Percentage of rescheduling of Surgeries/procedures.
Percentage of OT utilization
4. Anesthesia Related Quality Indicators –
Percentage of Modification of anesthesia plan (after pre anesthesia assessment.) ·
Percentage of unplanned ventilation after anesthesia.
Percentage of adverse anesthesia events.
5. Hospital Infection Related indicators -
Urinary tract infection rate
Respiratory tract infection rate.
Intravascular Device infection rate.
Surgical Site Infection rate.
6. Human Resource related indicators-
Employee satisfaction index
Employee attrition rate.
Percentage of employees who are aware of employee rights, responsibilities and welfare schemes.
Employee absenteeism rate
NABH Standard 2011
Department of Community and Family Medicine, Duke University Medical Center.
The WHO Performance Assessment Tool for Quality Improvement (PATH)
Author of Article: Dr.Srivatsan, Sr.Manager, Value Added Corporate Services P. Ltd.