Definitions

Quality improvement in healthcare is the science of improving healthcare through the joint and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and a more engaged and fulfilled workforce. – Bataldeen, 2007

Patient safety is a practice that emphasizes safety in healthcare through the prevention, reduction, reporting and analysis of medical errors that lead to adverse events.

Approach

We live out our values of humility, collaboration and commitment to results.  As a result, we do not think we have all the answers.  Our goal is to build, connect and enable an active, self-directed community of people passionate about improving the healthcare in the Caribbean.

Continuous improvement

There are many approaches to quality improvement.  However, the most prominent are iterations or expansions of the Deming Wheel proposed by the W. Edwards Deming, a father of quality improvement.   The Deming Wheel defines a process for improvement work. The improvement steps are plan, do, study and act (PDSA). Each step has several tools and techniques.  PDSA emphasizes an experimental approach and a learning posture to improvement work.

CARIHI believes that improvement should take the deliberate iterative approach that the PDSA cycle facilitates.  However, the PDSA cycle must rely on worker expertise, and an established body of knowledge.  The lean approach to improvement offers significant insight into how to improve organizations.  In addition, literature on patient safety provides a good guide to practitioners.

The lean philosophy is a standout approach to improvement.  It adds an organizational culture context, contributes tools like error proofing and ideas like respect for the worker.   Lean is all about defining value from the angle of the client and being relentless in quest for perfect delivery of that value.  It emphasizes involving the front line staff.

Current patient safety research relies on disciplines such as human factors and ergonomics.  The field emphasizes whole system approaches in addition to culture modification. Therefore, the principles found in lean and PDSA are relevant to safety.

Current improvement and patient safety literature is almost all agreed that sub optimal system design is at the root of most of the issues in healthcare.   The principles that undergird systems improvement are stable across industries and areas of concern. This means they can and have been throughout healthcare with slight modification.  We favor using the PDSA cycle as the framework for improvement and drawing from lean healthcare and patient safety best practices as knowledge bases.

Organizational Improvement

We believe organizations should progress along a continuum of improvement.  It is crucial not to be hasty. For that reason, we propose the following order:

  1. Small sub-process improvement within units (start with a single unit).  E.g. improving prescription refill process.
  2. Department wide improvement effort (start with a single unit). E.g. reducing waiting time in the emergency room.
    1. Start with larger process improvement here
    2. Ramp up to changing the way a unit works.  This involves end-to-end process improvements, lean/improvement management system in place, multiple planned improvement projects and most of all, culture change.
  3. Value stream improvement effort. E.g. improving the value stream for hip replacement surgeries.
    1. Ideally focusing on value streams where most of the involved departments are in stage two.
  4. Organization wide improvement.
    1. This involves setting strategic goals with supporting funding and human development.  Based on a commitment to an improvement approach and established targets. Must have hands on executive involvement and an executive level champion.
    2. Should be able to set up an improvement coordination unit.