Food-Service-Manual-for-Health-Care-Institutions

Move to CQI in Health Care
The term continuous quality improvement, or CQI, has been selected by many to identify their
quality initiatives. For the purposes of this text, CQI is defined as “the base theory that quality
can be improved on a continuous, or never-ending basis,” a definition taken from An
Executive’s Pocket Guide to QI/TQM Terminology. The concept of CQI is based on the principle
that poor quality is the result of poorly functioning or poorly structured processes that
can be improved.
The person credited with moving CQI from the manufacturing arena to health care is
Donald Berwick, who was trained as a physician. Berwick was codesigner of the National
Demonstration Project on Quality Improvement in Healthcare, which was designed using the
TQM approach. The project was led by the Harvard Community Health Plan in Boston in the
late 1980s and ended in 1991. The demonstration project included twenty-one health care
organizations, many of which have become leaders in TQM. This demonstration project has
been credited with beginning the shift that brought more than 60 percent of the health care
organizations in this country to CQI.
The CQI concept was first introduced in the JCAHO Accreditation Manual for Healthcare
in 1992. The JCAHO’s position is that 95 percent of an organization’s problems can be solved
through process improvement, and the JCAHO encouraged all hospitals to have some type of
CQI process in place. The remaining 5 percent of problems should be handled through traditional
quality assessment and peer review.
The JCAHO had renamed the “Quality Assessment and Improvement” chapter as
“Organizational Performance Improvement.” Representatives for the JCAHO advise hospitals
to learn the concepts of CQI without abandoning traditional monitoring and evaluation of
quality assurance. This advice means that traditional quality assurance will continue to play a
major role in accreditation standards with the JCAHO.
The JCAHO concedes that many different approaches lead to CQI and that it endorses no
one method. However, elements of CQI have been incorporated into the standards for accreditation
as follows:
• The key role that leaders (individually and collectively) play in enabling the assessment
and improvement of performance
• The fact that most problems or opportunities for improvement derive from process
weaknesses, not from individual incompetence
• The need for careful coordination of work across departments and professional groups
• The importance of seeking judgments about quality from patients and other “customers”
and using such judgments to identify areas for improvement
• The importance of carefully setting priorities for improvement
• The need for both systematic improvement of the performance of important functions
and maintenance of the stability of these functions
Another standard addresses the education of health care executives about quality improvement.
The standard requires facilities to demonstrate that the executive team has acquired education
in the approaches and methods of quality improvement. A plan must be in place to
demonstrate how the organization will meet quality improvement standards for
• Setting priorities for quality improvement activities
• Allocating resources for improvement activities
• Training staff members regarding quality improvement
• Fostering better communication and coordination of quality improvement activities
• Determining how the effectiveness of their contributions to quality improvement is
analyzed
Quality Management
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