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Quality Improvement and Measurement Tools in Healthcare

In recent years, the public has paid more attention to medical quality, and risk management has received increasing attention. The broad health risk is present in all types of the treatment session, resulting in damage or disability uncertainties, including all unsafe events, such as medical malpractice, accidents, concurrent Disease, and so on. In reality, the risks are often presented in specific events: medical risk-related events, that is, uncertain events that may cause losses. Many previous studies tend to reflect the number of risks through statistical risks related events. It can be considered that risk-related events are the explicit form of risk and risk content that can be precisely described and counted (Govindarajan et al., 2019). Quality tools are widely used to define and assess healthcare problems, especially in healthcare facilities that prioritize quality and safety problems.

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One of the quality improvement and measurement tools is Plan-Do-Study-Act Model (PDSA). It is widely used by the institutes that deal with healthcare improvement to impact and assess change. The primary aim of the PDSA is to create a functional tool between process changes and the outcomes (Hughes, 2016). The PDSA cycle begins by identifying the nature and the extent of the issue at hand, after which the changes to be made are analyzed. The next step is formulating a plan for a particular change that is required and identifying the specific people to be involved in the change process. The PDSA cycle also involves planning on what should be measured to identify the change’s impact and where the strategy will mostly be implemented. The change is then executed, and in the process, data is consistently collected (Hughes, 2016). The data collected is assessed and analyzed by reviewing various standard measurements that indicate success or failure. The last step of the PDSA cycle involves implementing the change or starting the whole process again. In general, the PDSA model is a great tool to measure quality in a healthcare organization by providing a step-by-step process of identifying what changes should be made and measuring the levels of success. For instance, physicians can apply a specific change in their communication process and then, through detailed discussions with staff can measure how it impacted the working process.

The Lean Production System is a quality improvement and measurement tool that physicians and nurses use to increase or improve patient care effectiveness and decrease costs revolving around healthcare (Johnson and Barach, 2017). The Lean Production System mainly focuses on the primary customer needs and strives to improve the processes by eliminating non-value-added activities. The Lean Production System focuses on maximizing the value-added activities in an organized manner to ensure smooth operations. It works by first identifying the root problem, which is done using the root-cause analysis. The Lean Production System process starts by formulating the goals, eliminating ambiguity, and defining various responsibilities. On healthcare matters, the professionals develop action plans to enhance, ease, and redesign the work processes. The Lean Production System’s success lies in completely removing unnecessary daily activities and those that do not add value (Johnson and Barach, 2017). For example, administrative healthcare professionals can use this system in order to encourage their team to follow the same goal while not engaging in distracting activities. This can be done through careful analysis of the work environment and strategic planning. Lastly, the Lean Production System can only be successful after identifying problems in the healthcare system and finding a way to work around them.

The third quality improvement and measurement tool that is used in the healthcare space is Root Cause Analysis. Root cause analysis (RCA) is one of the most commonly used qualitative assessment methods for medical risks in developed regions abroad. RCA focuses on the entire system, analyzes the whole process’s fault and responsibility rather than individual execution, finds out the cause and prevents similar risks from recurring by formulating preventive measures and execution plans. RCA analysis of related risk issues is divided into four main stages: incident investigation and problem confirmation, confirmation of near-end causes, confirmation of root causes, and improvement measures and actions. RCA is a retrospective medical adverse event analysis tool. This method focuses on improving the entire system and process rather than attributing the problem to individual behavior. The process involves scientific analyzing the proximal and root causes of risk formation, addressing the possible factors that cause medical risk-related events in the hospital, and correct understanding of the mechanism of high-risk factors. Improving self-management deficiencies and giving professional freedom to hospital management departments’ control capabilities greatly improve doctors’ work quality. By conducting detailed analysis and finding effective solutions, mid-level practitioners can contribute to the prevention of undesirable situations and add to their professional development and experience.

Moreover, improving the relationship between doctors and patients reduces the adverse consequences caused by medical risks and promotes specialist medical quality improvement. Root Cause Analysis is a useful technique mainly utilized in hospitals to pinpoint trends and assess risks when human error is suspected (Stevens, 2017). It is mostly based on the understanding that system failure rather than individual mistakes or negligence is among the leading causes of significant issues. The initial process begins with identifying and recording the sequence of events that led to the event under investigation, then determining the causal effects and the root cause of the main issue. The other major concern of Root Cause Analysis is identifying the enabling factors of an event. For example, in a hospital setting, an enabling factor to a human error could be not checking and counterchecking the patient’s identity band (Stevens, 2017). That would establish the root cause of the problem that emerged, and a clinical provider could be identified as guilty. In conclusion, Quality tools are widely used to define and assess healthcare problems, especially in healthcare facilities that prioritize quality and safety problems.


Govindarajan, R., Kaur, H., & Yelam, A. (2019). Tools and strategies for quality improvement and patient safety: A primer for healthcare providers. In R. Govindarajan, H. Kaur, & A. Yelam, Improving Patient Safety (263-273). Web.

Hughes., R. G. (2016). Chapter Ten: Evaluation of patient care based on standards, guidelines, and protocols. In J. V. Hickey, & C. Brosnan (Eds.), Evaluation of health care quality for DNPs. Web.

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Johnson, J. K., & Barach, P. (2017). Tools and strategies for continuous quality improvement and patient safety. In J. Sanchez, P. Barach, J. Johnson, & J. Jacobs (Eds), Surgical Patient Care (121-132). Cham. Web.

Stevens, K. R. (2017). Research and the mandate for evidence-based practice, quality, and patient safety. In M. P. Murphy, B. A. Staffileno, & M. D. Foreman, Research for Advanced Practice Nurses. Web.

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