When a team sets its objective, it typically specifies one or more performance metrics to evaluate. Healthcare organizations can take advantage of established principles and approaches to quality improvement, which are already known to the many providers involved in clinical quality improvement (QI). This section of the Guide suggests a way to use the concept of microsystems to focus the IQ process at the center of patient experience responsibility, provides an overview of the quality improvement process, analyzes some known models of quality improvement, and presents some tools and techniques that organizations can use to address various aspects of the patient experience. Prioritize encouraging the communication, commitment and participation of all stakeholders affected by the QI process.
Find out what is most important to the people who make up the microsystem and find ways to help them accept the changes and begin to take charge of them. Start implementing improvements with small-scale demonstrations, which are easier to manage than large scale changes. Small-scale demonstrations or small change tests also make it possible to refine new processes, demonstrate their impact on practices and results, and generate greater support from stakeholders. Remind and remind others that IQ is an iterative process. You'll make frequent corrections as you learn from the experience with each step and identify other actions to add to your strategy. A useful way for health plans and medical groups to approach the improvement process is to think of the organization as a system, or more specifically, as a set of interrelated microsystems.
The term microsystems refers to the multiple small units of caregivers, administrators and other personnel that produce health care products, that is. Examples of microsystems include a team of primary care providers, a group of laboratory technicians, or call center staff. In the patient-centered medical home model, a microsystem could be the patient care team responsible for coordinating patient services that address prevention, intensive care, and chronic care. The goal of the microsystem approach is to promote an emphasis on small, replicable, and functional service systems that allow staff to provide patients with efficient, excellent and patient-centered clinical and patient-centered care. To develop and refine such systems, healthcare organizations begin by defining the smallest measurable group of activities.
Feedback on measurement and performance should be part of the microsystem's principles for learning and improving. If a quality improvement intervention is successful for one microsystem, it can be scaled to other microsystems or to the organization in general. However, to achieve successful scalability, organizations must adopt a dissemination framework that works within their structure and culture. Although IQ models vary in approach and methods, a basic underlying principle is that IQ is a continuous activity, not a one-time thing. When implementing changes, there will always be problems to address and challenges to manage; things are never perfect.
You can learn from your experiences and then use those lessons to change your strategy and test new interventions, as needed, so you can continuously move toward your improvement goals. The PDSA cycle involves all staff in evaluating problems and in suggesting and testing possible solutions. This bottom-up approach increases the likelihood that staff will accept changes, a key requirement for a successful IQ. You can repeat this cycle several times, first implementing one or more small-scale interventions and then expanding them to larger actions based on lessons from previous cycles. The team's first task is to set an objective or goal for improvement work.
By setting this objective, you will be able to better communicate your objectives clearly to all sectors of your organization that may need to support or help implement the intervention. The goal should reflect the specific aspects of performance related to CAHPS that the team is targeting. It must also be measurable and feasible. One of the limitations of an annual CAHPS survey as a measurement tool is the time elapsed between the implementation of the changes, the impact on people's experiences and the evaluation of that impact. For that reason, the team needs to define both final goals and incremental objectives that can be used to measure short-term progress.
After defining your final objectives, ask What is the gap between our current state and our goals? Make a list of those gaps and use them to set incremental SMART goals (specific, measurable, achievable, realistic and time-limited).For example, a team concerned with improving performance in the composite measure to obtain timely appointments, care and information from the 26% group survey for doctors can set a 1-year goal of increasing their composite score by two percent. At the same time, you could specify targets for the number of days needed to get an appointment for non-urgent and urgent visits. Similarly, a team that focuses on overall ratings can set goals for complaint rates for the health plan as a whole or for individual medical groups and then review those rates on a monthly basis. Once the objectives have been established, the team's next task is to identify possible interventions and select one that seems promising. Keep in mind that every improvement requires making a change but not all changes lead to an improvement.
These sources of ideas for improvement offer an excellent starting point but they must be evaluated carefully before implementation. To ensure successful monitoring and evaluation of process improvement initiatives it is important for healthcare organizations to prioritize communication with stakeholders affected by QI processes; start implementing improvements with small-scale demonstrations; think of organization as a system; define smallest measurable group activities; set SMART goals; identify possible interventions; evaluate ideas carefully before implementation; use PDSA cycle; monitor progress; learn from experiences; adjust strategy accordingly.
