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Quality Improvement in Healthcare

“The combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, planners, payers and educators – to make the changes that will lead to better health outcomes (health), better system performance (care) and better professional development (learning).” (Batalden and Davidoff, 2007)

This resource has been developed to assist you with understanding quality improvement principles, techniques, skills and tools for effective service design within mental health and AOD services in Aotearoa New Zealand.

Here you will find a range of Quality Improvement tools, templates, links to helpful videos and other resources to help you and your service identify and learn from your service challenges, recognise inefficiencies and find ways to improve systems and processes by doing the right thing, with the right people, at the right time.

Please note new content is regularly being uploaded. 

What is Quality Improvement?

Quality Improvement (QI) is based on understanding the system in which we function, the complexities of working with people, the variation of outcomes created by a system and the use of knowledge to influence those outcomes.  QI is about problem solving so we can be doing the right thing, right, every time. QI is a proven, effective way to improve practice and processes in healthcare settings by taking opportunities to optimise, develop and streamline to improve practice.

Why is it important?

QI provides a way to improve how we do things so we reduce barriers, mistakes and system flaws, creating more time and resources to instead focus on effective and engaging care with service users.

What does QI mean for our services?

We often hear “change is the only constant” and that we need to be able to respond and adapt to change in our communities as it occurs.

Infant, Child and Adolescent Mental Health and Addiction Services (ICAMHS) aim to engage effectively with young people and their families/whānau, yet teams are continually faced with challenges and unpredictability requiring rapid responses and adaption as different people and situations present.  This can impact negatively on the health and wellbeing of people working within the system and the services ability to provide effective support to young people and their family/whānau.

QI provides a way to help us identify and learn from these challenges, recognise inefficiencies and find ways to improve by doing the right thing, with the right people, at the right time.

How do we use it?

Quality Improvement offers a proven methodology for improving processes and care.  QI provides the methods and processes to test incremental change before full scale implementation.  Once a goal is defined, changes can then be made and monitored by gathering and reviewing measures, developing and testing further change before implementing successful improvements.  QI is a continuous process requiring leadership from senior management and should become an integral part of everyone’s work regardless of their role to ensure an effective and inclusive culture.  All components need to be aligned within organisational strategic objectives and the quality management systems in order to engage effectively in Quality Improvement.

There are a range of QI tools we can use in our services to improve outcomes for whānau, staff and system performance. Within each project, a number of tools and techniques may be useful on their own or in combination with others. No two projects will be identical in their tests of change or the tools and techniques they use, but there will be common situations in which specific tools might be useful.

Learning to understand what and how to use these tools routinely will help to build practical improvement capability within your team and services to support the right thing, with the right people being done at the right time.

Three components to implementing successful and sustainable change

1.  Determine if the change will ease the workload for those providing care

Successful change should make the workload more manageable for staff.  When staff are able to see what is in it for them as a result of a change, it helps generate buy in and commitment for change.  When considering whether a project will save time and make work easier, consider:

  • What aspects of the daily work cause frustration to staff?
  • What are staff doing that seems unnecessary or counterproductive?
  • What are the identified areas of care delivery with poor results?

2.  Determine that the change will improve the service user experience

For example eliminating repetition or duplication in processes or increasing efficiency and convenience will translate into improvements for service users.  It’s valuable to understand and remember what service users' value; better quality of care through timely screening, easy transitions to and between appointments and an ability to be seen within an appropriate timeframe.   Creating a survey or engaging with consumer advisory groups may help your service align with the needs of service users. 

3.  Confirm the support for change

If the benefits of dedicating resource to a QI initiative will not outweigh the cost of preparing for change and implementation, then it is important to consider whether a change should really be made. Committing to change is easier when the costs of change are clearly understood. If change requires leadership approval, create watertight proposals and business plans that show the financial benefits of the change. Be ready to show the work your team has done and have the knowledge and understanding of the revenue impacts and results such as increased efficiency, improved quality of care and reduced levels of work load burdens.   

Quality Improvement Tools

Affinity ToolsBrainstormingCheck SheetsCo-designFishbone DiagramsHow to QIPDSA CyclePrioritisation MatricesProcess & Stream MapsRun ChartsSWOT Analysis

 
 
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