Quality Assurance or Quality Improvement: What

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Quality Assurance or Quality ImprovementWhats
the Difference?

• Johanna Buck
• Title I Mental Health Providers
• Quality Learning Network
• October 3rd, 2005
• With thanks to Lori DeLorenzo, Susan Weigl and
  others

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Quality Alphabet Soup
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Quality Assurance

• The planned and systematic activities
  implemented in a quality system so that quality
  requirements for a product or service will be
  fulfilled.
• American Society for Quality

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Examples of Quality Assurance Activities

• Annual child abuse and domestic violence training
• Chart review for patient's signature on consent
  forms
• Utilization Review process
• Activities that are based on public health
  standards, licensing standards, institutional
  policies, etc.
• Can help identify a problem, but are more often
  used to comply with the standards.

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Quality Improvement

• Continuous improvement is an ongoing effort to
  improve products, services or processes. These
  efforts can seek incremental improvement over
  time or breakthrough improvement all at once.
• American Society for Quality

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Goals of Quality Improvement

• The goals of QI are to understand the process,
  reduce the unintended variation in care,
  eliminate errors, remove unnecessary steps, and
  improve communication and accountability.
• The process is designed toward outcomes. Quality
  improvement depends on measurement.

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Core Concepts of CQI

• Quality is defined as meeting and/or exceeding
  the expectations of our customers.
• Success is achieved through meeting the needs of
  those we serve.
• Most problems are found in processes, not in
  people.  CQI does not seek to blame, but rather
  to improve processes. 

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CORE CONCEPTS OF CQI

• Unintended variation in processes can lead to
  unwanted variation in outcomes, and therefore we
  seek to reduce or eliminate unwanted variation.
• It is possible to achieve continual improvement
  through small, incremental changes using the
  scientific method. 
• Continuous improvement is most effective when it
  becomes a natural part of the way everyday work
  is done.

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Comparison of QA QI
QA QI
Motivation Measuring compliance with standards Continuously improving processes to meet standards
Means Inspection Prevention, monitor over time
Attitude Required, defensive Chosen, proactive
Focus Outliers or bad apples, individuals Processes, systems, majority
Players Selected departments Organization wide, benchmarking
Disciplines Within profession Multidisciplinary approach
Scope Medical profession focused Patient care focused
Responsibility Few All
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QA versus QI
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CQI vs. RESEARCH

• Research
• Aim gain new
• knowledge
• Methods
• Test blinded
• Eliminate bias
• More data, just in case
• Fixed hypotheses
• One large test

• Quality Improvement
• Aim make changes that result in improvement
• Methods
• Test observable
• Stable bias
• Just enough data
• Adaptation of the changes
• Sequential tests

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What is Quality?

• Quality is a never-ending cycle of continuous
  improvement.

-Deming
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Final Thought

• If you dont have time to do it right, when will
  you have time to do it over?