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The ABCDE’s of Quality Improvement

What is Quality Improvement (QI)?

You have all heard the latest buzzword in healthcare: “quality improvement”, or QI. Yet many healthcare professionals still only have a vague idea of what that truly means, and likely an even poorer understanding of how it might apply to their frontline practice. Conceptually, QI can be defined as the “combined 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 better professional development (learning)”1. 
Practically, QI now often refers to a proven structured methodology to assist any healthcare team in developing and implementing interventions that continuously improves clinical care. Borrowing from the ABC’s of ATLS, some of the key elements in QI are explored below.

ABCDE: A Structured Approach to QI

A - Aim

The first step in any QI effort involves identifying what exactly are you trying to achieve. Do you want to increase the proportion of blunt trauma patients receiving tranexamic acid in a timely manner? Are you trying to decrease post-operative wound infections rates? Perhaps your team wishes to improve appropriateness of trauma code activations? Be as concise and specific as you can. What is the magnitude of the improvement you seek; 15% or 30%? Over what period of time; 6 months, or 2 years? Try and articulate your Aim in as concrete and clinically relevant terms as possible, with clear goals and targets in mind.

B - Background

Once you’ve fleshed out what your team wants to improve, it is important to do some background research and data collection. How do you know how well/poorly you are currently performing? It can be very helpful to have baseline data to support the targets set in your Aim. A quick literature scan may review similar problems experienced by other centres - in fact, there may even be proven solutions and strategies published, that you can easily adopt!

C - Change

With your knowledge of the current state, you and your team can start developing potential change ideas and interventions to help move closer to your Aim. Gather all the relevant stakeholders and brainstorm; there are many QI tools (e.g. process mapping) that are freely available to assist your team in this process. Once you’ve got a reasonable idea, get started and actually put it into place as a test! Many QI efforts start with small scale interventions and tests of change - this is not a randomized controlled trial, it’s okay to take little baby steps.

D - Discover

As you start trialing different potential interventions, make sure your team is keeping track of what effects those little changes are having on different outcomes. Is your main Aim outcome changing the way you want? Are the interventions actually being implemented and working as expected in theory? How are your providers and patients feeling about the new changes? And are you noticing any unexpected consequences as a result of your changes?

E - Edit & Evolve

Armed with the learnings you gathered from these small tests of change, your team can go back and revise your interventions as needed. Perhaps a certain process would work better if done differently, or by different people. Maybe that paper-based checklist turned out to be too time-consuming, and an electronic solution needs to be developed. One of the key pillars of good QI work is a commitment to continuous evaluation and evolution of these small tests of change, as you march steadily towards improving that ultimate Aim.

How do I get started?

Getting a formal QI initiative up and running can sound like a daunting task - but it doesn’t have to be! There are many resources and supports available to help you along the way. There is a very good YouTube video by Dr. Mike Evans and the institute for Healthcare Improvement (IHI) that summarizes the key concepts of QI in a fun way
Health Quality Ontario (HQO) also provides a number of easy to use introductory materials for anyone interested in the topic.
Finally, there are numerous QI courses available such as the IDEAS course for those of you looking for a more formal training program. The most important step is to just get started!
Post by: Dr. Edmund SH Kwok, MD MHA MSc FRCPC, Director of Quality Improvement Unit, TOH 

Courtesy of The Ottawa Hospital Trauma Newsletter - Spring/Summer  

1 Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? (Editorial) Qual Saf Health Care 2007;16:2-3


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