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Quality Control: The Misunderstood Essential for Improvement

Why It Matters

When effectively used, quality control methods can help internally monitor performance, assess progress, and help systems to direct improvement resources to where they are needed most.
Quality Control The Misunderstood Essential for Improvement

Photo by Markus Winkler | Unsplash

In today’s health care environment, quality improvement (QI) alone is insufficient to manage the multitude of priorities and demands placed on our systems. Truly exceptional health care organizations go beyond QI and embed quality control (QC) methods and tools into daily work.

Many industries successfully use QC methods, but in health care, QC is often unfortunately misunderstood as synonymous with quality assurance (QA). While they do serve similar purposes in comparing performance to a goal, QC is an internally driven, real-time activity, and QA is external and often occurs with a considerable time lag. QC methods sustain improvements for the long-run and promote stable systems to produce reliable outcomes. When effectively used, QC methods internally monitor performance, assess progress towards goals, and allow systems to direct improvement resources to where they are needed most.

The Whole System Quality approach integrates quality planning, quality control, and quality improvement activities for key health care system stakeholder groups. High-performing health care organizations pursue Whole System Quality by embedding QI methods and tools in daily work at all levels of the system. Multidisciplinary leaders are engaged in setting organizational quality goals based on the needs of their patients, families, and staff. Experienced managers align department and unit level goals to system-wide priorities. Point-of-care staff have the capability and capacity to identify opportunities for improvement, act on them, and call on expert support when they need it. To quote from the Institute for Healthcare Improvement (IHI) Whole System Quality white paper, “These activities inform an organization-wide, interlinked, and customer-centric strategic approach to quality and promote learning across the organization toward the pursuit of whole system quality.”

Over the past few years, while teaching about the Whole System Quality approach, I have coached organizations to embed quality control methods into their workflows and want to share some of these ideas with you. 

  1. Standard work outlines the key steps, roles of relevant staff, and rationale for why each step is important. A pediatric hospital in the United States was experiencing flow delays transferring patients from the emergency department to general patient care units. Making the decision to admit a patient was the physician’s responsibility, but there was a lot of variation in the acuity of admitted patients based on which doctor was making the decision. They mapped and tested a standard process for admission from the ED to general patient care areas. This included medically ready for transition criteria and roles and responsibilities for team members in the ED and in the general units. Managers responsible for flow reduced the amount of time from ED presentation to patient admission and reduced the amount of time they spent managing the process itself.
  2. Visual management boards offer a simple means to ensure good team communication, establish and maintain discipline around measurement, and ensure tracking of problems that require resolution. As the IHI visual management board guide indicates, they offer “at-a-glance information about current process performance, both quantitative and qualitative data, to help clinical unit staff coordinate and guide their daily work and monitor ongoing improvement projects."
  3. Huddles help teams actively manage quality and safety, including creating an opportunity to review important standard work such as checklists. They give teams an opportunity to evaluate performance and to proactively flag concerns. An escalating huddle system empowers caregivers to tackle issues they identify on their own or escalate them for assistance. When used in coordination with visual management boards, they are a powerful organizational tool for safety and reliability. At a statewide hospital system in the United States leaders felt ineffective because they would not hear about quality issues until well after they happened. They struggled to monitor performance and improvement activities in service lines across the system. They created standard visual management boards in each unit (and electronically) that included key measures, safety concerns, celebrations, and ongoing improvement work. Each morning a unit-based team would huddle around the board for 10 minutes. They discussed measures, events of the previous shift, risks for the upcoming shift, celebrations, and anything appropriate for escalation. After the unit-based team huddle, the management team huddled to discuss and disseminate any quality and safety concerns or celebrations. And, finally, a leadership huddle convened the executive team to keep them informed and enable swift action to address what needed their attention. When the huddle process began again the next day, the unit-based teams closed communication loops on actionable items from the previous day’s huddle. 

Each of these QC practices engaged front-line staff, managers, and senior leaders by focusing on standards for communication and responsibilities. When we set and follow these standards it creates more space and time in our days to focus on what really matters to our patients, our organizations, and to us.

Jesse McCall, MBA, is a Senior Director and Improvement Advisor at the Institute for Healthcare Improvement.

You may also be interested in:

The IHI Whole System Quality white paper

Whole System Quality: A Holistic Approach to Quality Management

Before and After Whole System Quality