CONTINUOUS QUALITY IMPROVEMENT" INEMERGENCY DEPARTMENT

The cost of care resumed an upward course . these costs, along with increased patient awareness, intersert . knowledge , and access to information have now, more than at the right time, at the right place, by the right provider the quality of their care. Continous quality improvement (CQI) applications, have been particularly relevant to the ED given the process foucss focus of quality improvement and the fact that the emergency department isa process – rich environment PHILOSOPHIC AND PRACTICAL TENETS OF CONTUOUS 1) COUSTOMER FOCUS The central focus of CQI philosophy is on through and statistical understanding of customers as an essential element to implementing a successful healthcare systems . in simplest terms a customer is any person excedding the customer'sexpectations 2) STATISTICAL APPLICATION OF KNOWLEDGE OF VARIATION Just as DNA is considered the "buildjng block" of life , statical process control (SPC) should be considered the bilding block of CQI .Reduction of variation through statistical means is an cssential compnnent of CQI and derives directly from scicnse of SPC . The movement toward more dearly defined clinical path ways (protocols) in ED will reduce variation which represenrs part of the success of CQI principles. 3)FOCUS ON PROCESS As Deming first noled , 85% of bad outcomes arise from the process itself, Whereas only 15% arise from faulty performance by the individual provider, Given this fact , CQI attempts to imprelve processes and systems rather than Focus on individual performance ,as was the the primary purpose of traditional management and quality assesment ( QA ) programs . 4) EMPHESIS ON DESIGN AND, REDESIGN In traditional QA, quality improvement is attempied by routing out " bad apple " rather than by improving processes and systems . The design and redesign concept in CQI focus on analyzing the system in such a way that " average performance "improves rather than placting omphesis primarily put liers with bad outcome. 5) LEAUEKSHIP REDEFINED AND EMPOVERMENT OF THE WORKEKS THE STRUCTURE OF CONTINUOUS QCJALlY IMPROVEMENT -THE BERWICK TRIAD : The Berwick triad consists of a strategy , a culture ,and a group of technique (augmented by specific tools) that constitute the foundation of quality improvement The techniques of quality improvement include the tradilionul aspects of qualiry planning .quality control, quality Improvement to which have been added more recently developed concepts of process management and benchmarking . The first step, tools blishiques of quality proveto be the I most difficult in the early 5 tages of implernencing a CQI program Juran trilogy. Oncc the project is identified, toole and techniques of quality improvement can be applied, including traditional oncs of qualily planning. Quality control,and quality improvement (collectively known as the Juran trilogy) as well as the enhancements of process anagement and benchmarking.