|
Overcoming
the Challenges of Quality Improvement
All
methods of generating new knowledge have difficulties and
challenges. Those participating in quality improvement have
the dual responsibility of making changes and of providing
evidence that the changes they tried actually led to sustainable
improvement and thus warrant more general application. Discerning
how to meet this responsibility, while overcoming the learning
challenges discussed above, requires some approaches to
evaluating evidence that may seem unconventional to those
schooled in the research design and statistics of randomized
controlled trials. We believe these approaches not only
advance the field of quality improvement, but also provide
new ways for conducting health services research and for
integrating health services research with advanced quality
improvement. The following four elements are essential to
reliable learning through quality improvement and will help
to overcome the 6 learning challenges previously mentioned.
- A
description of the system
- Determining
the performance of the system over time
- A
trial and learning approach to improvement
- An
aggregation of the learning across a variety of conditions
Click
on the Elements below to learn more.
Table
2.1 Overcoming Learning Challenges
|
|---|
|
| Elements
to Aid Learning from Quality Improvement
|
|---|
| Learning
Challenges
| Description
of the System
| Performance
of the System
| Trial
and Learning
| Aggregation
of the Learning
|
|---|
| 1.
Imprecision of definitions | Very
Useful
| Very
Useful
|
| Somewhat
Useful
|
| 2.
Participants are advocates and investigators | Somewhat
Useful
|
| Very
Useful
| Very
Useful
|
| 3.
Intentional selection bias | Very
Useful
| Very
Useful
|
| Somewhat
Useful
|
| 4.
Threat of additional temporary resources to sustainability |
|
| Very
Useful
|
|
| 5.
Knowledge alone is insufficient |
|
| Very
Useful
| Very
Useful
|
| 6.
Difficulty of dissemination | Very
Useful
| Very
Useful
| Somewhat
Useful
| Very
Useful
|
|
|