Innovation & Research Centre - Research, Knowledge Translation and Implementation Guide: Quality Improvement

Queensland Health framework

Different organisations use different methodologies, approaches and tools for implementing a quality management and programmes for continuous quality improvement. Queensland Health has adopted one of the most widely accepted healthcare improvement and simple quality improvement models, the Plan, Do, Check/Study, Act (PDSA) cycle. PDSA is a systematic series of steps for gaining valuable learning and knowledge for the continual improvement of a service or process. Each cycle starts with hunches, theories and ideas and helps them evolve into knowledge that can inform action and, ultimately, produce positive outcomes.

Other frameworks

The UK National Health Service Institute for Innovation and Improvement (NHS Institute for Innovation and Improvement, 2010) proposes a six-stage framework for service improvement projects (see below). It is an ongoing cycle of collecting data and using it to make decisions to gradually improve program processes.

1. Start Out - Establish a rationale for any improvement work and obtain support for this work from an appropriate sponsor.

2. Define and scope -  Ensure the project starts in the right areas and to develop a project structure to provide a solid foundation.

3. Measure and understand - Measure the current situation and understand the level of change required in these measures to achieve the defined aims and objectives.

4. Design and plan the activities required to achieve the objectives that have been established.

5. Pilot and implement -Test out proposed changes via pilots before the changes are fully implemented.

6. Sustain and share - ensure that changes which have been implemented are sustained and are shared to aid learning.

The key components of a QI activity are:

• Understand the problem - start with an in-depth understanding of the problem, but equally as important is to ensure there is widespread understanding and buy-in for the quality improvement initiative and the problem it targets.
• Target improvement - questions to ask for this component include ‘How does our proposed project tie into organisational wide strategic improvement objectives?’, ‘What will have the biggest impact on our clients/staff?’, ‘What will have the biggest impact on costs?’
• Create an aim statement - this breaks up the work of achieving the goal into manageable pieces.
• Measure improvement - measuring baselines is critical because it enables you to determine if there is an improvement; and if and how the improvement is correlated to intervention.

A wide range of education/training sessions on QI and research are available to all staff within Metro North Hospital and Health Service via videoconference and/or face to face sessions, and the intranet.

• The MNHHS Research education and events site is located at https://metronorth.health.qld.gov.au/research/education-and-events
• The Metro North Collaborative for Allied Health Research, Learning and Innovation (CAHRLI) offers a bi-monthly lunchtime video-conference workshop series on research and quality improvement topics. There are several pre-recorded presentations that cover Quality Improvement implementation and issues available at, https://qheps.health.qld.gov.au/metronorth/allied-health/cahrli/rqis/cahrli-research-and-qi-series-videos
• The Allied Health Translating Research Into Practice (AH-TRIP) initiative, accessible at https://www.health.qld.gov.au/clinical-practice/database-tools/translating-research-into-practice, is a training package designed to prepare clinicians to plan and undertake a translational research project in their practice.

For more details on the PDSA framework, including how to set up an improvement project, go to the Institute for Healthcare Improvement (IHI) website to access

• The IHI Quality Improvement Essentials Tool kit http://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx  includes the tools and templates needed to launch a successful quality improvement project and manage performance improvement.
• The Quality Improvement Project Charter http://www.ihi.org/resources/Pages/Tools/QI-Project-Charter.aspx provides a rationale and roadmap for improvement work that can be used to clarify thinking about what needs to be done and why.