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Foundational Frameworks of Quality Improvement


There are several foundational frameworks for quality improvement in healthcare. The major ones include continuous quality improvement (CQI), total quality management (TQM), and structure, process, and outcome (SPO). CQI is based on the notion that all aspects of the organization can be improved to enhance the satisfaction levels of stakeholders and clients. It, therefore, proposes changing the way things are done and doing different things rather than doing the same things in a different manner. TQM on the other hand is based on the notion that the same things can be done differently and in better ways. TQM, therefore, seeks creative and new ways of doing the same things. SPO is a framework that is used to measure the quality of care provided to patients. The three elements are interdependent and interact with one another and the environment in which they exist (Ralston & Larson, 2005).

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Different Definitions of Quality of Care by Stakeholders

Different stakeholders define the quality of care differently depending on their motives. For instance, shareholders of an organization will define quality in terms of cost minimization and profit maximization because their major interest is to get the highest returns on their investments. An organization’s management on the other hand will define the quality of care in terms of the reputation they receive which in turn affects their performance and survival in the healthcare industry. Patients define the quality of care in terms of the outcomes of the care they receive because their main motive is to get well and carry on with their daily activities.

The Roles of Clinicians and Patients in Quality Improvement

Clinicians are of different types and include physicians, nurses, and support staff to mention but a few. Each clinician has an important role to play in quality improvement. For instance, physicians need to ensure that they provide care to patients in a manner that conforms to quality and ethical standards set by their governing bodies. Physicians should also engage in continuous education and training processes that enable them to be better care providers. In quality management, the nurses play the greatest role because they are the closest to the patients in that they form the greatest bond with the patients in their day-to-day care. Nurses should act as advocates for the improvement of patient care. Nurses (particularly advanced nursing practitioners) engage in improving evidence-based practice for instance by carrying out a critical review of the nursing literature to identify the best course of actions that must be taken by all clinicians in different practice scenarios (Calomeni, Solberg & Conn, 1999). Patients also have a role to play in quality management. Patients should also advocate for quality care for instance by asking for information about the care they receive. This will help in minimizing adverse events resulting from medical errors.

The Need for Quality Management in the Healthcare Industry

Quality management is needed in the healthcare industry mainly so as to reduce the numerous medical errors that occur and that lead to adverse events on the patients. It is also required to enable the organization to maximize its scarce resources and avoid wastage (Ralston & Larson, 2005).

Areas that must be Monitored for Quality

The main areas that need to be monitored for quality include the structure, process, and outcomes of the organization. Structure refers to the particular organization responsible for providing care. It is characterized by elements such as “staffing patterns, programs, finances, facilities, and size of the organization,” (Wong & Chung, 2005, p. 360). The process entails “examining what must happen when, by whom, and in what sequence,” (Wong & Chung, 2005, p. 361). The processes for QI include planning, implementing, assessing, and revising the necessary changes. The process has a great impact on the outcomes of care provided by an organization and it should therefore be taken into great consideration. Outcomes refer to the end products of processes. Outcomes of an organization include employee turnover rate, employees’ morale level, teamwork spirit, and quality of patient care as gauged by patients’ opinions and health outcomes.

Accrediting and Regulatory Organizations Involved in Quality Improvement and their Roles

The National Committee of Quality Assurance (NCQA) plays an important role in quality assurance in healthcare organizations. The organization carries out accreditation plans and another performance measurement. The accreditation plans mainly involve the review of operations of healthcare organizations. It is usually done by NCQA reviewers including physicians and support staff who visit the organization and develop plan evaluations in the areas of medical records, the credentials of the physicians, quality management, the rights and responsibilities of the members, utilization management, and preventive health services (Noble & Klein, 2000). NCQA also develops performance measures such as the Health Employer Data and Information Set (HEDIS) most commonly applied. These measures include indicators covering the quality of care offered, level of access to it, satisfaction in the use of the care by customers and other stakeholders, the use of finances, management, and services. Other bodies involved in quality management and accreditation include the American Medical Association which plans on improving measures on the offices of the physicians, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in hospitals accreditation, the Foundation for Accountability, the Utilization Review Accreditation Commission, the Accreditation Association for Ambulatory Health Care and Medical Quality Commission among others. Accrediting bodies are faced with limitations of being effective to only large owned healthcare organizations, challenges of technology, and the element of competition which does not allow for an individual accrediting body (Noble & Klein, 2000).


Quality improvement in a healthcare organization is affected by both financial and human resources. The organization needs adequate financial resources to implement QI programs and equipment needed in the improvement of care to its patients. Qualified healthcare personnel is also required to ensure that the care provided is of high quality. Besides the financial and human resources, quality improvement is also affected by the accrediting and regulatory organizations mentioned above which govern the quality improvement efforts of any organization by setting standards that must be adhered to.

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Reference List

Calomeni, C., Solberg, L., & Conn, S. (1999). Nurses on quality improvement teams: How do they benefit? Journal of Nursing Care Quality, 13(5), 75-90.

Noble, E., & Klein, L. (2000). Quality assurance: the measure of quality culture in a managed care setting. Total Quality Management and Business Excellence, 11(2), 199-205.

Ralston, J., & Larson, E. (2005). Crossing to safety: Transforming healthcare organizations for patient safety. Journal of Postgraduate Medicine, 51(1), 61-7.

Wong, F., & Chung, L. (2005). Establishing a definition for a nurse-led clinic: structure, process, and outcome. Nursing and Healthcare Management and Policy, 53(3): 358-369.

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