Quality Improvement

The flow diagram for this focus area is a bit different than the other focus areas we have explored thus far. This flow diagram is designed to help you build a deeper understanding of how your organization approaches quality improvement. However, unlike the previous focus areas, this is not the process that you will be trying to change or improve. The goal here is to develop a thorough understanding of the current QI process so that you can determine what elements can be leveraged to support pediatric quality improvement.

The questions in this flow diagram align with the environmental scan worksheet in the next section.

While in-depth knowledge of quality improvement (QI) methodology is not necessary to drive forth pediatric readiness, an effective PECC understands how to assess the current state of functioning, identify gaps, and formulate a plan for improvement.

As opposed to quality assurance—which tends to focus on human error and individual performance—QI is a dynamic process that examines system processes and protocols in order to limit errors, maximize benefits and/or improve system efficiency. As is commonly stated in QI, “every system is perfectly designed to get the results it gets”.[1] Using this mantra as a foundation, QI methodology seeks to create a culture of non-punitive continual improvement. Simply stated, QI approaches an error or adverse event seeking to determine how—not by whom—an error occurred and then identifying small iterative changes that can address the issue. While there are several well-known approaches to QI such as Lean and Six Sigma, the EIIC follows the Institute for Healthcare Improvement’s (IHI) Model for Improvement.[2] This framework includes identifying an opportunity, building a team, selecting measures strategizing on an approach, piloting the change, iterating, and expanding.

Central to QI methodology is identifying solid quality measures. So how do you measure quality? In 2001, the Institute of Medicine established the Six Domains of Health Care Quality which are: safe, effective, patient-centered, timely, efficient, and equitable.[3] Quality measures can then also fall into one of four types of measures: structural, process, outcome, and balance. During the accompanying learning session, we will delve into how to develop robust pediatric quality measures (we also recommend exploring a few of the free courses offered by the IHI’s Open School, https://education.ihi.org/topclass/). Meanwhile, there are several organizations that have identified validated metrics that can easily be adopted by your EMS agency, ED, or hospital. We will also explore strategies to measure and track your performance (such as annotated run charts) and how to introduce iterative changes through rapid plan-study-do-act (PDSA) cycles.

1. IHI Multimedia Team. Like Magic? ("Every System Is Perfectly Designed..."). 2015 [cited 2021 May 28]; Available from: http://www.ihi.org/communities/blogs/origin-of-every-system-is-perfectly-designed-quote.
2. Institute for Healthcare Improvement (IHI). How to Improve. 2021 [cited 2021 May 28]; Available from: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx.
3. Institute of Medicine. Crossing the Quality Chasm: The Iom Health Care Quality Initiative. 2019 [cited 2020 January 11]; Available from: http://www.nationalacademies.org/hmd/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx.