Introduction To Continuous Quality Improvement
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GaddafiIntroduction To Continuous Quality Improvement
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GaddafiSession 3: Introduction to
Continuous Quality
Improvement
Overview of Continuous Quality Improvement
In this session you will learn about:
1. Operational Definition of Terminologies
2. Quality improvement structure
3. PQE implementation structure
Learning Outcomes
By the end of this session you will be able to;
1. Distinguish between Quality Improvement and Continuous Quality
Improvement
2. Explain how to apply the basic structural elements of quality
improvement for a given set up
3. Outline a strategy on how to advocate for PQE in Active Case Finding
Operational Definition of Terms
Quality The degree to which health services for individuals & populations increase the
likelihood of desired health outcomes & are consistent with current professional
knowledge – IoM (STEEEP)
Quality A systematic approach that uses specific techniques/methodologies to improve
Improvement quality
(QI)
Continuous Improvement A systematic approach of progressively applying improvement
Quality methodologies and techniques to improve quality
Improvement
(CQI)
Process A set of interrelated or interacting activities which transforms inputs into
outputs
Process Owner A person who is given the responsibility and authority for managing a particular
process.
Basic Requirements for an effective QI Program
Effective organisation-wide QI programs consist of four basic/key
structural elements:
Element Role
Leadership & Governance Visible & focused leadership, and effective governance /
Structures management processes aligns QI program with the
(CHMT/SCHMT/FHMT/CTLC/SC organisation’s vision and strategic plan
TLC)
Infrastructure & Resources Provides teams with the data, equipment, resources and
permission needed to plan and deliver sustained improvement.
Workforce Capacity Building/ Up- Builds QI skills and capability of staff to enable them lead and
skilling facilitate improvement work. (expertise in quality improvement
approaches and tools).
Culture & Environment Provides a supportive, collaborative and inclusive workplace
culture and a learning climate. (enables teams to have
time/space for reflective thinking and psychologically safety in
driving improvement work).
Leadership & Governance Structures
Structure Role Rationale
CHMT/SCHMT/Facilit Avail: Provide enabling environment
y Health Infrastructure for QI
Management Team Human Resource
Equipment + Supplies
Provide Leadership
QI Vision/Plan
QIT Plan & Coordinate QI activities Provide anchorage for QI
implementation
Quality Circles (WIT) Continuously Plan + implement QI Cog in the wheel for QI
activities activities
Structure: Program Quality & Efficiency (PQE)
Implementation Handbook
• Section I: Problem Identification – details the guide on how a QI team
narrows down to a particular practice area for intervention
• Section II: QI Project Goal Setting – provides a guide on setting
appropriate and actionable goals for an intervention
• Section III: Activity Planning – provides the ‘how to’ approach QI tasks
when implementing interventions; implementation models for use, task
schedules and team management
• Section IV: Performance measurement – a guide developing and
tracking performance measures during the implementation cycle
Section I – Problem Identification
Rationale Key Aspects Tools Output
Identify a Gap Analysis Brainstorming Understand the
problem and Situation Process Map PROBLEM,
critical Analysis Ishikawa Prevent the
underlying Root Cause Diagram problem
reasons for the Analysis 5 Why’s
occurrence of Pareto Chart
effect Tree Diagram
Strategies for Success:
Team approach
Relevant Data
Objective Analysis
Section II – Goal Setting
Objective
Set specific improvement goal clear to all
Rationale Key Aspects Tools Output
Enable a team What is the Aim statement Actionable
to develop focus of guide change idea for
appropriate aim improvement Driver diagram implementation
statement and Define Prioritization
plan for an population matrix
intervention Set the Multi-voting
measure & guide
timeline
Section III – Activity Implementation
Rationale Key Aspects Tools Output
Enables a team to • Agree on a • 6S An executable
adopt an change idea to • Plan Do Study small test of
implementation test Act (PDSA) change
framework, • Establish Cycle
develop a plan, measurements • PDSA
test & implement a • Prepare for the planning
change idea test template
• Assign roles • QI Activity
planning
template
Section III – Activity Implementation Cont…
Tips for Success:
• Plan use multiple test cycles for every idea
• Test on the smallest scale possible
• Test it with persons who believe in the improvement idea
• Implement the idea once all possible angles tested and confident of
the change idea
Section IV – Performance Measurement
Enable a team to develop and tracking performance measures during
the implementation cycle
Rationale Key Aspects Key Tools Output
Enables us to • Define Measure Feedback on
understand • Define Data elements • Run test
whether we • Define Data collection Chart implemented
have tools • SPC Chart
reached our • Data abstraction • TB **Desired –
improvement • Collect, Display & Registers/ Improvement
aims Analyze Data Reporting change
tools
Section IV – Performance Measurement Cont…
Strategies for Success:
• Multiple Measures – Structure, Outcome, Process & Balancing
• Chart relevant & appropriate Statistics
• Integration into daily routine – sample where necessary
• Populate data and chart over time
• Use of visual displays for results
Implementation Phases – TB QI Framework (1/2)
Phase Rationale Activities Time Frame
Preparatory Generate organization- Training – Management 3months
wide buy-in for QI in level Staffs
management tool box Situation Analysis
Work-Planning
Est. QIT
Introductory Introduce adopted PQE Train all staffs 3months
methodology & Est. WITs
Implementation guides Facility level situation
analysis
Develop action plans
Implementation Phases – TB QI Framework (2/2)
Phase Rationale Activities Time Frame
Implementation Initiate workplace QI Collaboratives 2 years
improvement & QI Dev. Standards Manual
practice for ACF – (6S Dev. SOPs
+ PDSAs) Dev. Dept. Guidelines –
IPC
Continuous Capacity
Building
Maintenance Ensure people follow Periodic Ongoing
work habits, keep trainings/refreshers
workplace rules & Periodic M&E
regulations Awards and
celebrations
Summary
The other three basic requirements:
Infrastructure & Resources
Workforce Capacity Building/ Upskilling
Culture & Environment
Summary
• Operational Definition of commonly used terminologies in Quality
Improvement
• Leadership and Governance structure for Quality improvement
• Basic Requirements of an affective QI program
• Implementation steps of PQE implementation
The other three basic requirements are they covered in the references.
References and Further Reading
1. Quality Improvement Framework accessed on https://www.nltp.co.ke/wp-
content/uploads/2022/05/QUALITY-IMPROVEMENT-FRAMEWORK.pdf
2. Program Quality and Efficiency Implementation Handbook accessed on
https://www.nltp.co.ke/wp-content/uploads/2022/05/PQE-HANDBOOK.pdf
The End
You have come to the end of Session 3: Introduction to Continuous
Quality Improvement, kindly proceed to Session 4: Contact Management
Asante