What Is Cqi In Healthcare? - 2023, Health Blog

What Is Cqi In Healthcare
Continuous Quality Improvement (CQI) – Continuous Quality Improvement (CQI) is a deliberate, defined process which is focused on activities that are responsive to community needs and improving population health. It is a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality for state and local program levels.

Establishing a culture of CQI, Building CQI infrastructure and, Applying CQI methods to daily practice

For more information about Minnesota’s FHV CQI efforts, contact [email protected],

What are the 3 goals of CQI?

Guide to Continuous Quality Improvement Quality improvement management developed in the twentieth century as an approach that sought to address procedural problems before errors could hurt products. The quality improvement philosophy expressed itself in methods such as and,

A particular expression of quality management called continuous quality improvement (CQI) arose to serve the needs of social services, healthcare, and education.
CQI provides a framework for organizations to aim for excellence and also quantify and document its accomplishments.
In this article, you’ll learn about the core principles, methods, and benefits of continuous quality improvement.

We’ll also explore reasons why employees and others may reject formal attempts to build improvement teams, and how teams can gain confidence in the CQI approach. Continuous quality improvement (CQI) is a quality management philosophy that encourages all team members, including board members, volunteers, and employees, to continuously ask what can be done better.

CQI builds on existing quality management approaches such as TQM, Lean, and, but emphasizes that internal and external customer satisfaction is paramount, and that problems are caused by processes, not people. Despite CQI’s focus on people, data drives the search for problems and captures improvements.

This process is sometimes also called performance and quality improvement (PQI), and involves three main steps: develop, implement, and reflect. Occasionally, CQI can be considered a part of performance management, which is the long-term evaluation of programs to ensure that they meet goals.

Performance management has two parts: CQI, which offers teams the opportunity to test and implement new strategies as they work, in shorter improvement cycles; and process evaluation, which an outside group may conduct by looking at key issues from a systemic perspective.
Organizations may also use performance management to encourage team members to participate in improvement efforts.

Origins and Brief History of CQI The formal pursuit and management of quality in the 20th century traces back to Walter Shewhart’s statistical process control models from the 1920’s and 1930’s. Shewhart demonstrated that employees could track variation in processes and product output on a chart, which allowed them to fine tune work as it was completed.

Such activities not only produced superior products, but also empowered employees to learn more about their work and be accountable for it. Shewhart’s student and colleague, W. Edwards Deming further refined the concepts, which eventually found their way into quality management philosophies such as TQM, and then to continuous quality improvement.

a 1994 interview with Dr. Deming on his thoughts about quality and innovation in the workplace. As one National Institutes of Health article, “Assessing the Impact of Continuous Quality Improvement/Total Quality Management: Concept versus Implementation,” explains: CQI/TQM differs from the traditional quality assurance in many ways; Among the most important is CQI/TQM’s focus on understanding and improving underlying work processes and systems versus the traditional quality assurance emphasis on correcting after-the-fact errors of individuals.

CQI was first used in manufacturing, and Joseph Juran, Brian Joiner, and Philip Crosby expanded the concept to other business areas.
By the 1970s, quality management began to move beyond factories to transactional and service fields.
According to Michael Decker, MD in “,” in health care, quality measurements were originally based on how well an organization followed given standards.

As Decker writes: When a standard was not met, the response was often to seek a miscreant who could be punished for the transaction. Attention was directed almost exclusively to the performance of physicians, with little recognition given to the roles of other participants in the process or to the organization of the process itself.

The definition of quality rarely encompassed such considerations as patient satisfaction or the needs of families, employers, or other healthcare providers. As insurers, government, and other agencies began to demand quantitative proof of quality based on set procedures, it was clear that a new approach was necessary.

CQI not only uses data to instruct changes, but also seeks change from within the system and likewise looks for answers from the people in the system. Additionally, in CQI, quality is defined by meeting or exceeding the needs of customers, whether internal or external.

Today, marketing programs teach CQI as part of their curriculum, while social service programs in healthcare, education, facilities management, construction, and transportation use the practice. In health care, the continuous quality improvement philosophy came to prominence as those in government and private insurance companies required more evidence of value for money.

CQI provides a means to measure consistency and success in private and public hospitals, health programs for specific ailments, and for specific demographics, such as children, seniors, teens, pregnant women, and prison populations. Beyond controlling costs and justifying expenses, continuous quality improvement in medicine can provide support for excellence in care.

For example, the pervasiveness of colorectal cancer demands sound cancer detection methods. Authors of the paper “” assert that “Continuous quality improvement is recommended as part of every colonoscopy program.” A continuous quality improvement program aims to ensure that all team members, employees, managers, and other stakeholders feel consistently empowered to improve efforts and results.

Organizations and researchers articulate the fundamentals of continuous quality improvement slightly differently, but it generally embodies five principles:

Look at the system and its processes, Most problems are found in processes, not in people. CQI seeks solutions to produce the best outcome, instead of blaming people for problems that arise. In CQI, problems occur because of poor design, unclear instructions, or poor leadership. Use statistical analysis to identify and detail problems and strengths, CQI employs serial experimentation, also called the scientific method. Under this framework, teams manipulate different variables to see what works best. These tests are structured so practitioners can capture results and the chosen course(s) of action. Employ cross-functional teams drawn from employees, management, volunteers, board members, and even customers, Quality improvement is the purview of the whole team, not just management. Empower all stakeholders to identify problems and opportunities for improvement, and to develop and present solutions, Focus on both internal and external customers. Fulfilling the requirements of the customer is paramount.

A commonly recognized problem in any process is variation. Variation in procedures causes variation in outcomes. CQI and all quality management philosophies seek to make processes consistent. When output is consistent, teams can begin to improve processes.

There are other principles that guide continuous quality improvement, as well. Improvement should be part of the culture of the organization and a natural part of how people perform their jobs. Improvement doesn’t only mean success in a one-off project; rather, it is an ongoing effort, concurrent with regular duties.

Ongoing efforts also test improvements as they happen, without waiting for a formal evaluation. It is often said that CQI doesn’t follow the adage: If it isn’t broken, don’t fix it, Instead, CQI team members should proactively search for ways to be more efficient and effective.

You can learn more about the core principles in the U.S. by contacting the,, and the, A continuous quality improvement approach offers various benefits to organizations. At a minimum, as social service entities and educational institutions shift to outcomes-based models, data-driven efforts that produce measurable results satisfy funding requirements.

However, CQI can also provide structural and procedural benefits. The benefits of CQI include the following:

Team member accountability Creativity and solution creation Heightened team member morale Improved processes, information management, and documentation Greater adaptability to changes Tools and methods to monitor program effectiveness Opportunities for additional programs and new program modules

Why Do Employees and Others Resist CQI? Although the principles of CQI may sound inviting, team members may reject improvement initiatives for many reasons. Habits are difficult to adjust, and people often don’t like change. A key word in quality improvement word is continuous.

To succeed, the effort must be ongoing and consistent, and that takes additional effort, which team members might resist.
Depending on the framework chosen, a team may have specific methodological skills.
For example, a Six Sigma implementation may require trained to guide and execute research and improvement designs.

However, a CQI team should consist of people from the entire organization who are directly involved in its mission. Team members may be administrators, volunteers, board members, customers, or staff members. CQI positions include a chairperson or facilitator, a secretary or scribe, and team members.

Champion: Selected from within the team, a CQI champion helps to ensure the program receives support within and without the team. Program Administrators: CQI administrators should have day-to-day insight into how their organization works. Program administrators should have a sensitivity to when the improvement effort has become a burden, but should also lead the change effort suggested by the CQI process. Community Stakeholders: Stakeholders may be internal or external clients who can guide prioritization of CQI program efforts. Data Specialist, Program Evaluators: The number crunchers can identify data sources, analyze data, and present results in consumable charts and reports. Management: An organization’s management must be committed to the improvement effort, advocate for it to the whole organization, and support efforts by providing time, training, and other necessary resources.

Organizations implementing CQI may choose an existing established quality management method, but effective CQI usually includes some variants of the following core steps:

Create a Team: Your CQI team should be comprehensive and representative of the organization. Team members need direct knowledge of the work, clients, and system. Team members can be volunteers, employees, directors, managers, or board members. Define a Goal: Not every aspect of your enterprise requires tracking and improvement. Consider high-risk or essential aspects of your organization’s activities and study those before you spend time and effort on other aspects. Define Customer or Client Needs: Regardless of if your enterprise outputs products or services, the satisfaction and success of customers is critical. While deciding how to serve customers best, also consider what quality means. Determine Baseline: What is your starting point? You need this information to help you know whether your efforts are improving the current situation. Determine What Success Looks Like: Identify when to stop working on a problem and when to move to the next problem. Consider Different Approaches to Reaching the Established Goal: Build your plan of action methodically. Don’t just choose the first idea the group considers. Gather and Analyze Data: Numbers and statistics can help with the decision making process and are essential for documenting improvements for certification or funding. Use the Scientific Method: Solutions should be tested, refined, implemented, and adjusted as necessary. Create Logic Models: Logic models help to connect what you want to achieve to how you’ll achieve it. Logic models work well for demonstrating impact to funders. Foster a Learning Culture: Use peer teaching to help individuals build skills and sponsor group classes. Sustain Effort: Continuous improvement is not the success of a single project. You can sustain momentum by ensuring that data, evaluations, and procedures are well documented for times of staff transition so they can iterate.

What Is Cqi In Healthcare Process Studies and Outcome Studies In some organizations, improvements are analyzed and tracked through regular process and outcome studies.

Process Study: Look at the effectiveness of existing processes and ask: How can we improve the facility or processes or procedures? How do we make it more efficient? Outcome Study: Evaluate the outcomes of changes. For example, are patients getting the right care? Are they worsening after treatment?

Frameworks In pursuing improvements, organizations may use an assortment of existing quality assurance methods. Some frameworks are specific to social and health services, while others were developed in manufacturing and have been adopted by different industries and the service sector. Here are a few frameworks to help you accomplish CQI in your organization:

Getting to Outcomes (GTO): The RAND Corporation, along with the help of the Center for Disease Control, developed this trademarked model to help communities fight assorted addictions among young people. It includes 10 phases: focus, target, adopt, adapt, resources, plan, monitor, evaluate, improve, and sustain. GTO is ideal for both experienced teams and those new to working with quality improvement and outcome evaluation. PDSA/PDCA: Developed by W. Edwards Deming, plan, do, study, act (PDSA) became plan, do, check, act (PDCA), and presents a cyclical model for problem solving. PCSA is an essential element of and TQM methodologies.

Model for Improvement: The Institute for Healthcare Improvement Collective created this framework for collaborating across business, government, philanthropy, and social services to address entrenched social problems. Suited to larger organizations, the Improvement Model employs PDSA, plan do study act What Is Cqi In Healthcare Lean: This method focuses on eliminating waste and redundancy in existing processes, and works well in large organizations. Six Sigma: Often employed after a pass with Lean, Six Sigma seeks to find and remove the causes of defects or problems, and variations in process and output. A data-driven methodology, Six Sigma consists of five iterative phases: define, measure, analyze, improve, and control. Six Sigma adapts well to improving processes, such as client intake. The quantitative approach suits situations where you must rigorously document safety and quality. Malcolm Baldrige Quality Award Methodology : Organizations often follow Baldrige Award criteria to pursue quality. The Baldrige criteria aim to make strategic changes to an entire organization. Baldrige is a holistic approach and works well for introducing CQI concepts and encouraging a culture of improvement.

As with other quality improvement philosophies and methods, tools provide ways to gather information and data, make decisions, track progress, and visualize processes and results. The following are some of the tools you can use through the steps of an improvement effort, sometimes called IADT, which stands for identify, analyze, develop, and track. Identifying

allows groups to creatively discover problems and solutions. Ishikawa diagram, also called a fishbone diagram, allows you to graphically display all possible causes of a problem and then group them.

What Is Cqi In Healthcare Analyzing

Flowcharts represent how different elements join and relate to each other in a process. What Is Cqi In Healthcare Histogram shows how often a problem occurs, and how and where results cluster. Check sheets offer a basic way to create and use devices for collecting data. Pareto or 80/20 analysis charts are based on the assumption that 80 percent of problems are linked to 20 percent of causes. Group discussions often use the questioning method to discover root causes. You pose a question, and then continue asking why to each successive response.

What Is Cqi In Healthcare Download 5 Whys Template | | Developing

Storyboards graphically tell a story. In this case, they can explain how and why improvement is necessary and can provide a reminder for team members of the goal and steps to achieving the goal. A storyboard should be clear and detailed enough to stand on its own without interpretation. Benchmarking uses the information and statistics about comparable organizations to establish standards or benchmarks for attaining quality.

Testing and Implementing

help to track progress over time and help you visualize the effort applied to individual tasks. Storyboards are also useful for mapping the new process and its progress. Statistical process charts allow you to track results over time to see if and where outliers appear. These variations may indicate processes that require tuning.

Best Practices for CQI

Ensure that you have the correct data to address the chosen problem. Data must be accurate, timely, and focussed. Measure more than the outcome. It is important to also understand the composition and organization of an entity to understand where problems arise. Aggregate data so you and the teams that follow you can understand patterns of input and results. Review data collection tools and process for relevance. Make time and financial resources available to implement the effort properly. Consider devoting a dedicated team to the initiative. Break a large project into smaller ones to maximize opportunities for success and build enthusiasm. Define success for a project and understand when it will end so that you can start new projects.

Non-profit special interest organizations such as offer specific training in continual quality improvement. Training is also available through universities, with online material, workbooks, and via in-person workshops. Other supplementary studies can support the practice of CQI, such as general quality management principle training, problem solving, and,

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What is CQI and its purpose?

Continuous Quality Improvement (CQI), sometimes referred to as Performance and Quality Improvement (PQI), is a process of creating an environment in which management and workers strive to create constantly improving quality. Continuous Quality Improvement (CQI) is:

A theory-based management system that looks at processes/outcomes
Culture change
Client-centered philosophy
Tools to help quantify what we do
A search for common causes of variation
Driven by data
System, process and client feedback
Shared success
Long-term approach

What are the key elements of Continuous Quality Improvement?

Accountability
Driven by good management.not crisis
Driven by input from all levels of staff and stakeholders
Teamwork
Continuous review of progress

What are the internal and external benefits of Continuous Quality Improvement?

Improved accountability
Improved staff morale
Refined service delivery process
Flexibility to meet service need changes
Enhances information management, client tracking & documentation
Means to determine & track program integrity and effectiveness
Lends itself to design of new programs & program components
Allows creative/innovative solutions

What are the goals of Continuous Quality Improvement?

Guide quality operations
Ensure safe environment & high quality of services
Meet external standards and regulations
Assist agency programs and services to meet annual goals & objectives

Who is involved in Continuous Quality Improvement?

Persons & families served
Employees, volunteers & consultants
Members of advisory boards
Consumer advocates
All levels of agency staff

What is the Continuous Quality Improvement team structure? The Department of Children & Family Services/Office of Community Services’ Continuous Quality Improvement process involves two levels of teams. There is a state level Continuous Quality Improvement team and a Continuous Quality Improvement team in each region statewide.

Chair/Facilitator – facilitates Continuous Quality Improvement meetings, champions the Continuous Quality Improvement process and coordinates input and feedback to staff.
Scribe – takes detailed meeting minutes, schedules meeting room.
Member – participates in review of issues referred to the Continuous Quality Improvement team; provides feedback to peers, stakeholders and consumers.

What are the steps in the Continuous Quality Improvement process?

Step 1 Identify a need/issue/problem and develop a problem statement
Step 2 Define the current situation – break down problem into component parts, identify major problem areas, develop a target improvement goal
Step 3 Analyze the problem – identify the root causes of the problem and use charts and diagrams as needed.
Step 4 Develop an action plan – outline ways to correct the root causes of the problem, specific actions to be taken, identify who, what, when and where
Step 5 Look at the results – confirm that the problem and its root causes have decreased, identify if the target has been met and display results in graphic format before and after the change
Step 6 Start over – go back to the first step and use the same process for the next problem

Who is the Council on Accreditation (COA)? The Council on Accreditation is an international, independent, not-for-profit, child and family service and behavioral healthcare accrediting organization. It was founded in 1977 by the Child Welfare League of America and Family Service (now the Alliance for Children and Families).

Originally known as an accrediting body for family and children’s agencies, the Council On Accreditation currently accredits 38 different service areas and over 60 types of programs.
Among the service areas are substance abuse treatment, adult day care, services for the homeless, foster care, and inter-country adoption.

In addition to standards for private social service and behavioral health care organizations, the Council on Accreditation has developed separate business lines for public agencies, networks and lead management entities, opioid treatment programs, employee assistance programs, and financial management/debt counseling services.

The organization’s leadership promotes a culture that values service quality and continual efforts by the full agency, its partners, and contractors to achieve strong performance, program goals, and positive results for service recipients.

2: THE FOUNDATION FOR BROAD USE OF PERFORMANCE and QUALITY IMPROVEMENT

The infrastructure that supports performance and quality improvement is sufficient to identify organization-wide issues, implement solutions that improve overall productivity and promote accessible, effective services in all regions and sites.

3: SUPPORT FOR PERFORMANCE AND OUTCOMES MEASUREMENT

An inclusive approach to establishing measured performance goals and client outcomes, indicators, and sources of data ensures broad-based support for useful performance and outcomes measurement.

4: ANALYZING AND REPORTING INFORMATION The Performance and Quality Improvement plan describes how valid, reliable data will be obtained and used on a regular basis to advance monitoring of actual versus desired:

functioning of operations, that influence the organization’s capacity to deliver services;
quality of service delivery;
program results;
client satisfaction; and
client outcomes.

5: USE AND COMMUNICATION OF QUALITY INFORMATION TO MAKE IMPROVEMENTS

Reports, with findings based on improvement efforts, are issued periodically to personnel throughout the agency and provide information useful for improving programs and practice.

6: STAFF TRAINING AND SUPPORT

Staff and stakeholders receive training and support that increases their capacity to participate in, conduct, and sustain performance and quality improvement activities.

For more information on the Public Agency-Performance and Quality Improvement Standards or any other Council on Accreditation 8th edition standards, please visit their website at http://www.coastandards.org/ Customer Satisfaction surveys

Customer Satisfaction Survey (Mail to your DCFS Child Welfare Parish Office )

Questions?

E-mail the DCFS Webmaster,

Continuous Quality Improvement Reports

Customer Satisfaction Survey Reports
Peer Case Review Reports
Continuous Quality Improvement Reports
CQI Stakeholder Information Packet
2008 Employee Satisfaction Survey Results
2008 Employee Satisfaction Survey Analysis of Comments

What are examples of CQI?

Types of quality improvement initiatives – A CQI project may be at the individual level, meaning the goal is to improve the care for one specific client. An example of this is decreasing the number of episodes of incontinence or decreasing pain levels for one client through collaboration between nursing, occupational therapy, and medical services.

At the group level, the focus is on improving the quality of care for one hospital unit or for client groups with a particular vulnerability or risk. This type of CQI initiative may involve assessment tools that assign clients to risk groups. One example is the Braden Risk Assessment Tool, which puts people into risk categories for developing pressure ulcers.5 Examples of CQI projects at the group level include reducing falls or decubitus ulcers by implementing a multicomponent, multidisciplinary program.

At the system level, CQI initiatives strive to improve quality of care in the facility or across the organization. Examples include projects to decrease length of stay in subacute rehabilitation or reduce the number of repeat hospitalizations. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323067768000153

What are the 4 phases of CQI?

Root Cause Continuous Quality Improvement (CQI) is a process of collecting, analyzing & using data to improve the quality of services or products on an ongoing basis. Put simply, CQI helps teams “get better at getting better.” The Continuous Quality Improvement Cycle is a series of steps – Plan, Do, Study, Act – for structuring a CQI practice.

– Develop specific plan for testing & include in creating a Capacity Improvement Plan
– Identify key roles & resource needs
– Define time frame & measures of success

– Prepare to implement the Capacity Improvement Plan
– Implement the Capacity Improvement Plan
– Collect documentation & data

– Track results & analyze impact
– Share results with team
– Identify possible adjustments
– Identify & celebrate learnings & successes

– Adopt successful practices
– Make adjustments where needed
– Determine what more needs to be done and/or learned
– Set up for next round

: Root Cause

What are CQI principles?

CQI Essentials – The MDH FHV Section is committed to the principles of CQI and supports efforts at both the state and local levels to improve the effectiveness and delivery of family home visiting services provided to families with young children. These guiding principles include:

A focus on improving services from the client’s perspective Meaningful engagement at all levels is required for success Recognition that all processes can be improved Continual learning using an “all teach, all learn” philosophy Decision-making is improved by using both data and team knowledge CQI data is used for learning and improvement, not for judgment or supervision

The Minnesota Department of Health uses many different resources to support CQI efforts, but several essentials will get you on the path to success when planning a CQI project. Family Home Visiting has created a CQI Toolkit, available on the FHV Toolkits page, with more information on CQI practice and essentials.

What are CQI tools?

CQI Tool Kit Continuous Quality Improvement (CQI) is an ongoing, structured process, carried out by site-level staff to identify problems in quality care delivery, take remedial actions to achieve improvement, and carry follow-up monitoring to ensure no new problems arise and corrective steps have been effective.

CQI aims to: understand the current level of quality of care; identify problems or gaps between actual quality and expected quality for that setting; introduce corrective actions into the care system; monitor high-risk, high-volume, or problem-prone aspects of health care; and frequently measure the effect of those changes on health outcomes and system performance.

This site-level CQI tool kit is intended to assist program staff throughout the entire continuous quality improvement cycle. This tool kit is meant to be an example of generic activities, processes, and tools to be adapted as necessary by CQI teams in various country contexts. What Is Cqi In Healthcare CQI Data Use SOP

How is CQI measured?

CQI Selection Without SINR Lookup Table – The function computes the CQI values by using the SINR values across all layers corresponding to the reported PMI. Based on the number of codewords, the function forms the combinations of CQI values and reports the one which satisfies the BLER condition.

What is a good value of CQI?

CQI – Channel Quality Indicator In the LTE system, the CQI is used by the mobile to indicate the channel quality to the eNB. The CQI reported value is between 0 and 15. This indicates the level of modulation and coding the UE could operate. If you enjoy using our glossary, here are some other useful resources you might like.

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How do I write a CQI plan?

Your CQI plan should succinctly describe your CQI goals and objectives for the year, which should align with your CQI mission and be informed by program data. Goals identify your general intentions, such as ‘Improve family retention.’ Objectives are clear and measurable targets set to meet the overall goal(s).

What are the 5 S in CQI?

Introduction – Quality of health care services is a key element of the right to health, and has been a major concern for many years in the context of universal health coverage.1 In Uganda, the provision of quality health care is one the top priorities at policy and program level.

The Second National Health Policy states the mission of Ministry of Health (MOH) is to enhance socioeconomic development through the provision of the highest possible level of health services to all people in Uganda, 2 while acceleration of quality and safety improvement is an objective of the Health Sector Strategic and Investment Plan 2010/11-2014/15 (HSSIP).3 MOH also launched the Health Sector Quality Improvement Framework and Strategic Plan 2010/11-2014/15 (QIF&SP) to provide a common framework for all stakeholders involved in quality improvement of health services including health development partners outside Uganda.

Today there are various types of intervention to quality improvement of services, but MOH recommends health facilities to start 5S, an initial component of 5S-CQI (or KA1ZEN)-TQM approach for improvement of the work environment, as the entry point of all quality improvement interventions.4, 5 It is an approach to ensuring quality of goods and services initially developed by Japanese manufacturers, and started to be applied to health services in Uganda since 2007 with support of Japanese government.5S is a sequence of activities of sort, set, shine, standardize and sustain to improvement of the work environment, CQI (continuous quality improvement) or KAIZEN is a step following 5S to continuously improve the business operation processes through repetition of the cycle of Plan-Do-Check-Act, and TQM (total quality management) is to implement systematic operation that enables to provide goods and services satisfactory for both consumers and employees.5, 6 According to a proposed logic tree of 5S-CQI (or KAIZEN)-TQM for hospitals in Africa, the approach enables the hospitals to reduce waste of goods, facilities and time for searching and clean work place as well as to raise awareness of staff, followed by improvement of job quality and efficiency, management of medicines and equipment, infection prevention and control and elimination of medical accidents through strengthening of organizational capacity including staff satisfaction.

Subsequently the hospitals can improve their management indicated by cost reduction and increase in patient satisfaction (see Figure 1 of JICA, 2013).7 Since launching of 5S-CQI-TQM approach in Uganda, it was practiced in a Regional Referral Hospital (RRH) and 8 General Hospitals (GHs) at eastern and central regions by 2010.

Subsequently, MOH implemented a project in 2011-2014 to expose nine more RRHs to the approach in early 2012 and to support two out of eight GHs practicing 5S. In line with a logic model of 5S-CQI (or KAIZEN)-TQM approach in hospitals in Africa, 7 the project pursued improvement of patient satisfaction with services as well as reduction of waiting time of patients (as a phenomenon of improvement of job efficiency) through higher staff motivation as a result of 5S.

MOH also recognizes patient (or client) satisfaction, waiting time and staff motivation (or attitude to work) as quality assessment indicators in QIF&SP.4 The project trained facilitators of 5S in 10 RRHs and two GHs and regularly supervised and evaluated their performance. It also developed guidelines and a handbook for 5S for their references.

Meanwhile, it is not yet clearly captured what effect is actually realized as a consequence of 5S practice in Uganda and when the effect is emerged as it is a new approach to quality improvement of health services in spite of expected outcomes of routine work at health facilities listed in 5S implementation guidelines.5 The stakeholders being involved in quality improvement in Uganda are now more interested in the outcomes of their intervention.

How do you conduct a CQI meeting?

Documenting CQI Meetings – There will be variation in what reporting platforms offer for documenting CQI meetings, so pharmacy managers must ensure the pharmacy meets the following requirements:

CQI meetings are documented and accessible for regulatory review including
- Date
- Staff present
- Topics of discussion
- Any resulting improvement plans
The pharmacy manager must declare the date the pharmacy’s formal annual CQI meeting is complete using the following steps:
1. Log into your Pharmacy Portal using the Registrant Login link at https://cphm.ca/
2. Click ‘Update Safety IQ Engagement Information’
3. Scroll down to the Safety IQ Engagement heading and fill in your CQI meeting completion date.
4. Scroll to the bottom of the page and click ‘Save.’

Note: Filling out the self-declarations in the pharmacy profile does not meet documentation requirements set out in the Medication Incident and Near-Miss Event Practice Direction for SSAs and CQI Meetings. How often should a CQI meeting occur? At least once per year, the pharmacy manager must conduct one formal CQI meeting with most pharmacy staff in attendance.

You may need to conduct additional meetings if an incident results in harm to a patient or after completion of your pharmacy’s SSA. A CQI meeting should give pharmacy staff a supportive environment to fully discuss incidents, contributing factors and develop recommendations. In regard to the SSA, your CQI meeting is an opportunity for staff to understand how the SSA was conducted and for staff to participate in developing improvement plans.

How do you conduct a CQI meeting? Try to schedule a meeting time when the majority of staff present. Preferably, give every staff member the opportunity to attend the CQI meeting, if possible. Each meeting should have a set agenda shared in advance, so staff are better prepared and ready to actively participate.

The agenda items may be determined by the amount of time you have or if your SSA has been completed recently.
A simple agenda and/or meeting form can help give structure to your meetings and may be useful for documenting discussions.
Please see the CPhM CQI Meeting Toolkit for a sample agenda.
Why is psychological safety important for an effective CQI meeting? Safety IQ aims to improve community pharmacy systems to reduce the chances that patients will be harmed by a medication incident.

One of the cornerstones of prevention and improvement is open discussion and team participation, but the fear of punishment or humiliation remains a prominent barrier to CQI across healthcare professions. Fostering a psychologically safe environment will encourage your pharmacy team to participate more fully in CQI and make meaningful contributions to the pharmacy’s CQI program.

Anyone can ask questions without looking or feeling incompetent
Anyone can ask for feedback or help without looking or feeling incompetent
Anyone can be respectfully critical without appearing negative
Anyone can suggest innovative ideas without being perceived as disruptive

Pharmacy team leaders and managers have a critical role to play in supporting psychological safety. The Community Pharmacy Safety Culture Toolkit offers several resources and strategies for modelling and promoting psychological safety to build a more robust safety culture. What can the pharmacy manager or CQI coordinator do to prepare for an effective CQI meeting?

Review recent medication incidents and near-miss events to decide which ones should be discussed during your CQI meeting. Limit the number incidents for discussion (1-3 incidents) because you want to have sufficient time to effectively discuss contributing factors and develop ideas for improvement. Prioritize incidents that have caused harm or had the potential to cause harm. If your pharmacy does not have any medication incidents to discuss, then consider near- miss events that may have resulted in harm or are being repeated.
Review the results of your SSA and decide which areas you think your pharmacy team should focus on to close safety gaps. Set your team up for success by focusing on one area and starting with a small improvement. Do not overwhelm yourself or your team with multiple, complex improvements at once. CQI, as the name implies, is an ongoing process that will get stronger over time with the commitment and perseverance of your team.
Review your pharmacy’s incident statistics. Reporting to an online platform provides you with valuable information at your fingertips. How is your pharmacy reporting each month? Is your pharmacy staff reporting all incidents and beneficial near misses? What trends do you see – are certain medications more prevalent in incidents or do they include high risk meds such as methadone or warfarin? Your review of pharmacy trends is also an opportunity to assess how engaged your team is with Safety IQ and if further training or encouragement is needed.
Review external sources for shared learning on medication safety and how your pharmacy may incorporate this learning. Examples of shared learning are available on the College of Pharmacists of Manitoba Safety IQ and Shared Learning Can your pharmacy incorporate some of the shared learning recommendations? Consider ISMP Canada Safety Bulletins as tools to educate your staff on medication safety issues and prompt safety improvements in your pharmacy.

What needs to be documented about a CQI meeting?

Date of meeting
Who attended
What was discussed (incidents, SSA items, pharmacy incident statistics, safety education)
Outcomes or action plans resulting from the meeting

Some reporting platforms may have CQI meetings tools available to document CQI meetings online. If your reporting platform does not offer a space to document your CQI meeting, you may want to use the CPhM CQI Meeting Toolkit or another format. The pharmacy manager must also log into the Pharmacy Portal at cphm.ca to declare the date the pharmacy’s CQI meeting was completed.

What resources are available to help pharmacy managers/CQI coordinators with a CQI meeting? Please see the CQI Meeting Toolkit for supporting materials for your CQI meeting.
Why do we need to assess how well the pharmacy engages with Safety IQ? Reporting of medication incidents and near-miss events as well as documentation of improvement plans are mandatory elements of Safety IQ.

Pharmacy managers and staff need to periodically reflect and assess how well they are using Safety IQ tools and processes to ensure they have an effective CQI program. What areas is the pharmacy team doing well and where are they struggling? CQI is an ongoing process, but engagement may lessen over time and open discussion is needed to address barriers and develop action plans to renew commitment and increase impact.

My pharmacy holds frequent safety huddles. Are we still required to have an annual CQI meeting? Yes, every community pharmacy must complete an document at least one formal CQI meeting per year. Safety huddles are short informal meetings (10 to 15 minutes) where your pharmacy team can quickly share information about safety issues or concerns in a non-punitive manner.

Safety huddles can be as frequent as your pharmacy needs them to be. A safety huddle should promptly occur following a medication incident, especially if the incident harmed a patient. Safety huddles support prompt communication of incidents and discussion of changes to prevent recurrence.

However, they are not a substitute for an annual CQI meeting whereby the pharmacy team can discuss multiple topics such as incidents and near-miss trends, enablers and barriers to reporting or open discussion, SSA results, or medication safety education.
I am the only person who works in my pharmacy.

Do I still need to conduct an annual CQI meeting? Yes, an annual CQI meeting is a requirement of Safety IQ. You can use your meeting time to complete meaningful reflection about improving your practice. Some suggestions include:

Review and reflect on medication incident and near-miss events you have reported to your incident reporting platform. Implementing and monitoring changes based on a single report can make your processes safer. See the Analyze and Act page for resources.
Review progress on existing improvement plans based on medication incidents and near-miss events or your SSA. This time is also an opportunity to create new action plans.
Review CPhM and ISMP Canada improvement resources to look for new opportunities to improve your pharmacy practice. The Safety IQ Academy Blog features short, actionable articles on safety improvement. ISMP Canada Safety Bulletins and SMART Medication Safety Agendas also offer actionable safety improvements that help reduce the chances of patient harm.
Engage in professional development activities that will build your knowledge and help you apply principles of continuous quality improvement.
Conduct a CQI meeting with your colleagues providing that you do not violate patient or staff confidentiality.

As a small or one-person team, it is even more important for you to engage in self-reflection because you do not have the benefit of team input when it comes to detecting and analyzing medication incidents. You must also follow the documentation requirements for CQI meetings.

What is KPI vs CQI?

KPIs are measurable values used by funding bodies and health services to report against the progress and outcomes of strategies and measure the success of programs over time. CQI refers to a process whereby a systematic and cyclical approach is used to improve health outcomes.

What are the elements of CQI?

In undertaking any CQI initiative, a practice must consider three components: (1) structure, (2) process, and (3) outcomes (Donabedian, 1980).

How is CQI different from QA?

CQI differs from QA because it is based on facts, data, and specifications, rather than on standards (Table I).

What are the 5 S in CQI?

Subsequently the hospitals can improve their management indicated by cost reduction and increase in patient satisfaction (see Figure 1 of JICA, 2013).7 Since launching of 5S-CQI-TQM approach in Uganda, it was practiced in a Regional Referral Hospital (RRH) and 8 General Hospitals (GHs) at eastern and central regions by 2010.

MOH also recognizes patient (or client) satisfaction, waiting time and staff motivation (or attitude to work) as quality assessment indicators in QIF&SP.4 The project trained facilitators of 5S in 10 RRHs and two GHs and regularly supervised and evaluated their performance.
It also developed guidelines and a handbook for 5S for their references.

What are the goals of quality improvement?

Quality Measurement and Quality Improvement | CMS Quality is defined by the National Academy of Medicine as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

What are the elements of CQI?

In undertaking any CQI initiative, a practice must consider three components: (1) structure, (2) process, and (3) outcomes (Donabedian, 1980).