Name of Manual - Blue Cross and Blue Shield of Minnesota

Quality Improvement
Leadership Rationale:
Quality Improvement
Projects
Leadership within an organization must support and embrace the
philosophy of Quality Improvement for it to succeed. Advising,
supporting, and actively participating in the development and
implementation of process improvement is a vital function of
leadership.
Improving processes within an organization promotes better care
and services to customers, creating a marketplace advantage.
Requirement:
• Designated QI Medical Director, who is a practicing physician
and is either a MD or DO.
Rationale:
Addressing problems or opportunities within your facility using
the QI process offers distinct advantages. Quality Improvement
projects employ systematic analysis of current practices to reveal
refined approaches to everyday operations. Using a defined model
means that changes can be tested and adopted effectively.
Requirements and changes regarding QI reporting are distributed
annually in the first quarter to all main site primary care providers.
Suggested project categories may include clinical guideline
implementation or improvement, administrative or processoriented
improvements, or improvements based on customer
feedback. Often providers choose to do one project that is clinical
and one that is service-related.
We encourage you to conduct a survey or focus group of
customers as you develop system changes. Blue Cross does not
routinely collect project information from providers however,
requirements remain the same. The requirements listed below
should be followed if your facility chooses to implement
improvement activities.
Requirements:
• Provide QI program description, contact information, or
project reports upon request.
• Clinical projects must be based on approved and established
guidelines [i.e., Institute for Clinical Systems Improvement
(ICSI)].
• Projects have completed a full PDCA Cycle or Seven-Step
process. Refer to the PDCA or Seven-Step Process
information.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11) 3-3