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136 unit 2 | Working Within the Organization CikguOnline
Using CQI to Monitor and Evaluate Quality Assign Responsibilities
of Care
Continuous quality improvement (CQI) is a
process of identifying areas of concern (indicators),
continuously collecting data on these indicators, Identify Vital Areas
analyzing and evaluating the data, and implement-
ing needed changes. When one indicator is no
longer a concern, another indicator is selected.
Define Scope of Care
Common indicators include, for example, number
of falls, medication errors, and infection rates.
Indicators can be identified by the accrediting
agency or by the facility itself.The purpose of CQI Analyze Area in Terms of:
is to improve the capability continuously of every-
Aspects
one involved in providing care, including the Standards
organization itself. CQI aims to avoid a blaming Indicators
environment and attempts to provide a means to Criteria
improve the entire system.
CQI relies on collecting information and analyz-
ing it. The time frame used in a CQI program can
be retrospective (evaluating past performance, often Measure Actual Performance
and
called quality assurance), concurrent (evaluating cur- Measure Patient Outcomes
rent performance), or prospective (future-oriented,
collecting data as they come in). The procedures
used to collect data depend on the purpose of the
program. Data may be obtained by observation, per- Evaluate Performance and Outcomes
formance appraisals, patient satisfaction surveys,
statistical analyses of length-of-stay and costs, sur-
veys, peer reviews, and chart audits (Huber, 2000).
Recommend and Implement Actions
In the CQI framework, data collection is every-
one’s responsibility. Collecting comprehensive, accu-
rate, and representative data is the first step in the
CQI process. You may be asked to brainstorm your Evaluate Degree of Improvement
ideas with other nurses or members of the interdis-
ciplinary team, complete surveys or checklists, or Figure 10.1 Unit level QI process. (Adapted from Hunt,
keep a log of your daily activities. How do you D.V. [1992]. Quality in America: How to Implement a
Competitive Quality Program. Homewood, IL: Business
administer medications to groups of patients? What
One Irwin; and Duquette, A.M. [1991]. Approaches to
steps are involved? Are the medications always avail- monitoring practice: Getting started. In Schroeder,
able at the right time and in the right dose,or do you P. [ed.]. Monitoring and Evaluation in Nursing.
have to wait for the pharmacy to bring them to the Gaithersburg, MD: Aspen.)
floor? Is the pharmacy technician delayed by emer-
gency orders that must be processed? Looking at the
entire process and mapping it out on paper in the unit level if the organization is not focusing on
form of a flowchart may be part of the CQI process quality issues. To stay on track, an organization
for your organization (Fig. 10.1). needs a strategic plan. A strategic plan is a short,
visionary, conceptual document that:
QI at the Organizational and Unit Levels
■ Serves as a framework for decisions or for secur-
Strategic Planning ing support/approval
Leaders and managers are so often preoccupied ■ Provides a basis for more detailed planning
with immediate issues that they lose sight of their ■ Explains the business to others in order to
ultimate objectives. Quality cannot be found at the inform, motivate, and involve