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Efforts
to improve the quality of healthcare involve many challenges
during the design, testing, and implementation of new systems.
To overcome those challenges, an integrated system of learning
is needed. One such system, suggested in this chapter, is
based on the following four elements essential to
reliable learning through quality improvement:
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A description of the system;
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Determining the performance of the system over time;
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A trial and learning approach to improvement; and
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An aggregation of the learning across a variety of sites
or conditions.
These
elements give rise to the following set of factors that
researchers and clinicians can use to evaluate the rigor
of a proposed quality improvement project. Researchers can
use these factors as an outline for the methods section
of a proposal or, with slight variation, as a mechanism
to weigh the results from different quality improvement
projects when they perform systematic analysis:
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The aim of the project is focused on performance improvement;
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A balanced set of performance measures is included that
is sufficiently related to the aim;
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The description of the redesigned system is clear;
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The learning that took place during the evolution to the
new system is documented;
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Time series of the key measures annotated with the sequence
of the changes and other significant events are provided;
and
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The time series continue well after the changes have been
made to ensure sustainability.
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