Section 4.5: Quality Improvement

[ Table of Contents ]

Anne Sales
Canada Research Chair in Interdisciplinary Healthcare Teams
Chair in Primary Care Research
Faculty of Nursing, University of Alberta

Sustain Knowledge Use

Theories and Models: Quality Improvement theory

  • Quality improvement (QI) is the effort to increase how much health care services contribute to desired health outcomes, consistent with current professional knowledge

Quality Improvement II

Most QI research is local and driven by local needs and activity

  • As a result, it may not apply as much outside the local setting as other types of research that try to apply to a broad range of patients, conditions, and settings

Quality improvement III

There is a large number of published papers that report on QI efforts and their results

  • There are several commonly agreed-on ways of doing QI in health care
  • Many of these papers report substantial success in using QI methods
  • Most QI methods are the result of trial and error rather than of building and applying theory
    • This makes QI a very empirical field, rather than being driven by theory

Quality Improvement IV

Despite not being built on strong theory, QI operates based on a number of theoretical frameworks

  • Donabedian's structure → process → outcome framework is very well known although it is not always appropriately applied
  • Continuous Quality Improvement (CQI) is frequently used for QI projects
    • It's both a framework and a set of tools to be used
    • The plan-do-study-act (PDSA) cycle is one of the tools that has been developed from the CQI model

Quality Improvement V

Although QI frameworks, tools, and approaches have been widely used in health care over a relatively long period of time, we still need to understand them better

  • Systematic reviews of studies using QI methods and approaches would add to our knowledge about what works and what does not work
  • Assessing the theory base that underlies different QI frameworks also holds promise for better understanding KT
  • QI projects are usually exempt from human ethics review; this is an area that requires more discussion
    • Many QI projects are geared to providing real time improvement in care to specific patients but others are more general and result in broad efforts to disseminate findings

Quality Improvement VI

In summary, there are many common areas between QI and KT research, as well as common areas between QI and evaluation

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