A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 17: Quality Improvement
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The regular, ongoing work of the QI Committee,
supported by the clinic’s leadership, constitutes the
backbone of the infrastructure that supports ongoing
QI activities. The committee oversees the dynamic
process of planning, implementation, and evaluation
that involves:
• Analysis of data from the QI projects
• Solicitation of feedback from participating staff
• Decision-making based on the information from its
analysis
These activities contribute to sustaining the QI Program
and its activities in the clinic.
Will improvements last?
Sustainability is probably the biggest challenge
that clinics face in the field of QI. All too often,
improvements do not last once initial projects are
completed, because the structure and culture to support
QI is not present or is not supported. The challenge
of sustainability is therefore two-fold – not only to
maintain the successes of QI work and its clinical
outcomes, but also to maintain the systems of QI and
to keep the QI program vital. By asking questions
about how care systems can be improved and how QI
activities are progressing, clinicians play an important
role in both catalyzing and supporting QI activities.
What are the key components of a
quality plan?
The key elements of a quality plan include a quality
statement that describes the purpose and goals of the
QI program, priorities of the program, a description of
the organizational systems needed to implement the
program, including committee structure and functions,
definitions of accountability, roles and responsibilities,
the process for obtaining consumer input, core
measures, data collection processes, and a description
of how the plan will be evaluated.
KEY POINTS
Providers play an active role in the
activities of QI and can lead these
efforts by asking questions to determine
how improvements can be made.
Although the QI program may require
extra work from busy providers, the
opportunities to systematically measure
clinical performance will provide useful
information that leads to better care for the
patients they serve.
QI includes regular measurement of
care processes, analysis of processes and
systems of care, and implementation of
solutions to improve care and monitor their
effectiveness. The goal of QI is to achieve
optimal health outcomes for patients.
QI teams identify areas of change,
implement pilots to test the change,
review data assessing the change, and
ultimately make recommendations about
improvements. When staff members from
the systems being assessed work together
in teams and are engaged in the QI process,
they are more likely to generate ideas and
to accept changes.
Indicators, measurable aspects of care
that evaluate the extent to which a facility
provides a certain element of care, should
be based on standards or guidelines,
meet the primary goals of QI, and reflect
priorities specific to the community and
the clinic.
Once data have been reviewed by the
team and the process for improvement
identified, the next step is to decide where
opportunities for improvement exist. This
process is described as the PDSA (Plan-
Do-Study-Act) process. The first step is
to investigate this care process in greater
detail. Once a change in a particular step of
the process has been selected, a pilot test
of the change can be quickly implemented
and evaluated. If the pilot is successful, the
change can be adopted widely. If the pilot
is not successful, another change can be
selected and tested.
Sustainability is probably the biggest
challenge that clinics face in the field of
QI. The key to sustaining QI in the clinic
is development of an infrastructure that
supports ongoing QI activities.
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U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau