The overall goal of quality management is performance improvement. If quality indicators show that a problem exists, then an action plan should be implemented to resolve the problem or improve care. For greatest effect, performance improvement activities should be data-driven and evidence-based. They should also involve all appropriate disciplines and departments. Typically, the action plan is designed to either improve an existing process or create a new one that will enhance care. Once the action plan is implemented, data should be collected to determine whether the intervention was successful, met reasonable needs and expectations of patients and their families, and was sustained over time.
Aside from being a response to quality assessment findings, performance improvement activities may also be selected and designed based on the following considerations (Kaiser, 2002):
Important data sources for performance improvement include utilization data, quality indicators, the OASIS minimum data set for home health patients, and the performance measurement (ORYX) indicators established by the Joint Commission on Accreditation of Healthcare Organizations.
The Home Health Department at KP uses a research method known as the Plan-Do-Check-Act (PDCA) cycle to implement interventions aimed at improving care processes and performance. Below, excerpted from KP's "Home Health Quality Management Program Description (2002)," are key activities of the PDCA cycle for performance improvement.
In the Plan phase the process to be improved is defined, stakeholders and their needs are identified and assessed, and the goal of the improvement effort is defined. With the use of performance improvement tools, contributing factors to performance are identified, measures and operational definitions are developed, and baseline measures are taken. Based on findings, an action plan is developed to decrease the difference between customer needs and the current process performance.
In the Do phase, the change is carried out and implemented as a pilot study. This is important so that problems can be identified, removed, and refinements made prior to large-scale rollout of the change in the Act phase. Baseline performance measures are taken during this phase and results summarized.
Here the baseline findings from the new process (Do phase) are evaluated. Impact on stakeholders and related functions (e.g., processes and departments) are analyzed. The types and causes of poor performance are identified along with solutions to fine-tune the change initiative and performance improvement program.
In this phase, implement modifications to the performance improvement work plan based on the findings from the Check phase. Plan and schedule ongoing measurements to monitor progress of the change. Ongoing monitoring should result in activities to narrow the gap between customer/stakeholder needs and the performance of the process(es). To continuously improve, it will be necessary to begin again with the Plan phase above.
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For more information about the TriCentral Palliative Care Toolkit visit www.growthhouse.org/palliative/. All content is Copyright © 2002, 2003 by Richard D. Brumley, M.D. All rights reserved. No part of this toolkit may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publishers. This guide to developing home-based outpatient palliative care services was developed through a grant to the Kaiser Permanente TriCentral Service Area from The Project on Death In America. The Kaiser Permanente TriCentral Palliative Care Program is a Sustaining Member of the Inter-Institutional Collaborating Network On End-of-life Care (IICN) which links major organizations internationally.
