The United States Department of Health and Human Services states quality improvement (QI) uses continuous and systematic approaches leading to improvements in the health status of targeted patient group and health care services that are measurable (HRSA, 2014). There is a direct correlation between the health outcomes of populations and the individuals within them and how well health services are improved. The systems of care and the delivery approach used by an organization is the focus of improvements in quality.
The Baldridge Award Criteria evaluate companies in seven divisions for consideration (Bushbinder and Shanks, 2007). These criteria set the standards of excellence in the field of improvement and recognize superior company performance. They are also a basis for any organization to structure quality evaluation and strategies for improvement.
Some of the responsibilities the leaders in healthcare organizations have are to evaluate possible improvement projects, implement the ones they feel will be effective, and determine the results after a period of time. The executives in charge of finance work with management to prioritize projects based on available resources and objectives of the corporation. The finance executives are concerned with the profitability of specific projects, but sometimes there are quality improvements that do not manifest in increased revenue (Brooks and Krupka, 2012)/
Caldwell (2006) advocates the use of Lean-Six Sigma in identifying waste for cost reduction and improved services. However, a review of critical research on nine references to Six Sigma met the criteria for Vest and Gamm (2009). They stated that, although all the strategy systems reviewed required some degree of improvement, their implementation will guide management toward successful organizational transformation. Even with some limitations, Six Sigma is nationally recognized as a system with steps guiding a specific project for improvement. In addition, Six Sigma incorporates a focus on training personnel. Employees are rated from the CEO down as their ability to contribute to quality improvement in the organization; the goal is to bring employees from lower levels to higher ones.
Focus on Patients, and Other Customers, Markets
Focus on the satisfaction of patients increases retention of the customer base. Conversely, dissatisfaction results in loss of patients. Retaining existing patients by improving service is less expensive than attracting new ones through marketing. As long ago as 1993, D.J. Voel (Vogel, 1993) acknowledged a shift in focus away from departments and toward perceived patient satisfaction in hospitals. Patient-focused care attempts to use clinical and nonclinical staff more effectively through changes in cross-training of personnel, some organizational restructuring, simplification through redesign of processes to save time and effort, and decentralizing services.
Strategies such as Pay-For-Performance systems may prove beneficial for improvement of heath care services. Unützer et al (2012) conducted an experiment with depressed patients and found a significant reduction in measurements of depression and patient reliability for follow-up treatment.
Measurement, Analysis, and Knowledge Management
The importance of teamwork has become a critical element in focusing on improvement in staff efficiency. Berg et al (2011) delineate the steps toward building an effective team and the impact on patient safety and performance improvement. Components to constructing the team include deciding on define goals and parameters, communication between the members using a common language, and sharing understanding.
Building an effective staff is a complex process. Issues in health care organizations are so complicated, no single person knows every aspect of an issue and more than one work area will be involved. Creativity is required to find solutions to problems and the commitment of the staff is crucial.
It is necessary for processes to be innovative in order to develop performance improvement that is effective. Components of evaluating a process include gathering data to test metrics, mapping the steps involved in the process, and presenting the information in a way that clearly communicates the success of the process and potential areas of improvement.
Process variation refers to different results a metric being tested can take dependent on various causes. Every step of a process can be mapped through the use of flowcharts. They demonstrate major steps, their substeps, and the flow of information between people. A way to analyze a process is through the use of cause-and-effect diagram. The problem under investigation is at the top of the diagram with possible causes (and secondary causes under each) responsible. A Pareto chart diagrams incidences on an x- and y axis; it is useful in the analysis of data.
The public, the government, and organizations today pay special attention to developments concerning America’s health care. cost reform, possible solutions to health insurance problems, and constant scrutiny of the quality of patient care play important roles in quality assessment and improvement. Providers of health care across the United States strive to maintain and accelerate successful outcomes while staying within financial and legal guidelines.
Betterevaluation.org,. (2014). Evaluating the Performance of an Organization | Better Evaluation. Retrieved 21 December 2014, from
Brooks, K., & Krupka, D. (2012). Performance Improvement in the Perioperative System. Healthcare Financial Management, 68-76.
Buchbinder, S., & Shanks, N. (2007). Introduction to Health Care Management. Sudbury, Mass.: Jones and Bartlett Publishers.
Caldwell, C. (2006). Lean-Six Sigma: Tools for Rapid Cycle Cost Reduction. Healthcare Financial Management, 60(10), 96-98.
Fendya, D., Snow, S., & Weik, T. (2010). Using System Change as a Method of Performance/Quality Improvement for Emergency and Trauma Care of Severely Injured
Children. Journal Of Trauma Nursing, 17(1), 28-33. doi:10.1097/jtn.0b013e3181d9155c
Hrsa.gov. (2014). Quality Improvement. Retrieved 20 December 2014, from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/
James, C. (2005). Manufacturing's Prescription for Improving Healthcare Quality. Hospital Topics, 83(1), 2-8. doi:10.3200/htps.83.1.2-8
Unützer, J., Chan, Y., Hafer, E., Knaster, J., Shields, A., Powers, D., & Veith, R. (2012). Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care.
Vest, J., & Gamm, L. (2009). A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare. Implementation Sci, 4(1), 35. doi:10.1186/1748-5908-4-35
Vogel, D. (1993). Patient-focused care. American Journal Of Hospital Pharmacy, 50(11), 2321-9.