Quality Assurance or Quality Quality Assurance or Quality Improvement:Improvement:

What’s the Difference?What’s the Difference?

Johanna Buck*Johanna Buck*Title I Mental Health ProvidersTitle I Mental Health Providers

Quality Learning NetworkQuality Learning NetworkOctober 3rd, 2005October 3rd, 2005

*With thanks to Lori DeLorenzo, Susan Weigl and others*With thanks to Lori DeLorenzo, Susan Weigl and others

Quality Alphabet SoupQuality Alphabet Soup

Quality AssuranceQuality Assurance

““The planned and The planned and systematic activities systematic activities implemented in a quality implemented in a quality system so that quality system so that quality requirements for a product requirements for a product or service will be fulfilled.”or service will be fulfilled.”

American Society for QualityAmerican Society for Quality

Examples of Quality Assurance Examples of Quality Assurance ActivitiesActivities

Annual child abuse and domestic violence Annual child abuse and domestic violence trainingtraining

Chart review for patient's signature on consent Chart review for patient's signature on consent formsforms

Utilization Review processUtilization Review process

Activities that are based on public health standards, Activities that are based on public health standards, licensing standards, institutional policies, etc. licensing standards, institutional policies, etc.

Can help identify a problem, but are more often Can help identify a problem, but are more often used to comply with the standards.used to comply with the standards.

Quality ImprovementQuality Improvement

““Continuous improvement is Continuous improvement is an ongoing effort to improve an ongoing effort to improve products, services or products, services or processes. These efforts can processes. These efforts can seek “incremental” seek “incremental” improvement over time or improvement over time or “breakthrough” improvement “breakthrough” improvement all at once.”all at once.”

American Society for QualityAmerican Society for Quality

Goals of Quality Goals of Quality ImprovementImprovement

The goals of QI are to understand the The goals of QI are to understand the process, reduce the unintended process, reduce the unintended variation in care, eliminate errors, variation in care, eliminate errors, remove unnecessary steps, and remove unnecessary steps, and improve communication and improve communication and accountability. accountability.

The process is designed toward The process is designed toward outcomes. Quality improvement outcomes. Quality improvement depends on measurement. depends on measurement.

Core Concepts of CQICore Concepts of CQI Quality is defined as meeting and/or Quality is defined as meeting and/or

exceeding the expectations of our exceeding the expectations of our customers.customers.

Success is achieved through meeting Success is achieved through meeting the needs of those we serve.the needs of those we serve.

Most problems are found in Most problems are found in processes, not in people.  CQI does processes, not in people.  CQI does not seek to blame, but rather to not seek to blame, but rather to improve processes. improve processes. 

CORE CONCEPTS OF CQICORE CONCEPTS OF CQI

Unintended variation in Unintended variation in processes can lead to unwanted processes can lead to unwanted variation in outcomes, and variation in outcomes, and therefore we seek to reduce or therefore we seek to reduce or eliminate unwanted variation.eliminate unwanted variation.

It is possible to achieve It is possible to achieve continual improvement through continual improvement through small, incremental changes small, incremental changes using the scientific method. using the scientific method. 

Continuous improvement is Continuous improvement is most effective when it becomes most effective when it becomes a natural part of the way a natural part of the way everyday work is done.everyday work is done.

Comparison of QA & QIComparison of QA & QIQAQA QIQI

MotivationMotivation Measuring Measuring compliance with compliance with standardsstandards

Continuously improving Continuously improving processes to meet processes to meet standardsstandards

MeansMeans InspectionInspection Prevention, monitor Prevention, monitor over timeover time

AttitudeAttitude Required, Required, defensivedefensive

Chosen, proactiveChosen, proactive

FocusFocus Outliers or “bad Outliers or “bad apples”, apples”, individualsindividuals

Processes, systems, Processes, systems, majoritymajority

PlayersPlayers Selected Selected departmentsdepartments

Organization wide, Organization wide, benchmarkingbenchmarking

DisciplinesDisciplines Within professionWithin profession Multidisciplinary Multidisciplinary approachapproach

Scope Scope Medical Medical profession profession focusedfocused

Patient care focusedPatient care focused

ResponsibiliResponsibilityty

FewFew AllAll

QA versus QIQA versus QI

CQI vs. RESEARCHCQI vs. RESEARCH

Quality ImprovementQuality Improvement Aim: make changes that Aim: make changes that

result in improvementresult in improvement Methods:Methods:

Test observableTest observable Stable biasStable bias Just enough dataJust enough data Adaptation of the Adaptation of the

changeschanges Sequential tests Sequential tests

ResearchResearch Aim: gain new Aim: gain new

knowledgeknowledge Methods:Methods:

Test blindedTest blinded Eliminate biasEliminate bias More data, just in caseMore data, just in case Fixed hypothesesFixed hypotheses One large testOne large test

What is Quality?What is Quality?

Quality is a Quality is a never-ending never-ending

cycle of cycle of continuous continuous

improvementimprovement.. -Deming

Final Thought…Final Thought…

If you don’t have If you don’t have time to do it right, time to do it right, when will you when will you have time to do it have time to do it over?over?