The Improvement Guide: A Practical Approach to Enhancing Organizational Performance
The Improvement Guide: A Practical Approach to Enhancing Organizational Performance
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DOI：
10.1080/10686967.1998.11919154
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发表时间：
1996-11
期刊：
影响因子：
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通讯作者：
Ronald D. Moen;L. Provost;Cliff Norman
中科院分区：
文献类型：
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作者：
Ronald D. Moen;L. Provost;Cliff Norman
505.925.7600传真505.925-7601 www.envisionnm.org SBHC质量改进在设想新墨西哥州设想新墨西哥州（ENM）是一个儿科质量改进（QI）计划，提供培训，发展和评估服务，以提高整个国家的儿童和青年的卫生服务质量。作为UNM儿科系的一部分，ENM拥有一支专家队伍，利用最新的信息技术，并利用UNM健康科学中心的资源来培训和支持SBHC提供者采用“最佳实践”，以确保有效和高效的护理健康服务。ENM是一个更大的运动的一部分，以国家为基础的组织致力于改善儿童和家庭的医疗保健，通过教学提供者如何使用质量改进方法在他们的实践。质量改进在这里被定义为一个过程，以影响提供者的做法，从而改善护理的变化。研究极大地提高了SBHC提供者对如何改善健康和减少疾病的理解，将这些知识转化为实践是质量改进的工作。换句话说，改善儿童健康结果需要缩小提供者所知与所做之间的差距。质量改进方法QI过程基于医疗保健改进研究所（IHI）、国家儿童医疗保健质量倡议（NICHQ）和Kaiser Permanente（北方加州）的Scott Gee博士开发的用于改进临床实践和交付系统的既定模型。从概念上讲，这些发展体现在改进模型中，这是一个简单而强大的工具，用于实施医疗质量的改进。“计划-实施-研究-行动”（PDSA）流程是一个既定的工具，为提供者和实践提供了一个结构化的流程，以计划，实施和评估变更的影响。改善质素的口号很简单，就是“所有改善都涉及改变，但并非所有改变都是改善”。ENM采用这种模式和方法，教供应商在SBHC确定实践的变化，这将导致改善病人的护理，并有助于降低医疗保健成本。QI的一个基本要素是制定适当的措施，以确定改进目标的进展情况，并测试所做的更改是否代表所需的改进。四个基本问题框架齐工作：1。我们想达到什么目的？2.我们可以想出什么办法来实现我们的目标。3.我们怎么知道计划是否有效？4.需要对计划进行哪些修改？确定并监测具体的进展衡量标准。这些措施允许每个SBHC站点衡量其自身实现目标的进度，允许ENM评估其QI对特定目标的有效性，并有助于全面评估QI对护理系统的影响。具体的倡议，沿着目标和相关措施，不断发展以满足SBHC方案的需要。持续的评估指导QI的过程，并评估质量改进对所涉及的计划和提供者的影响。所采用的措施来自“最佳做法”文献。ENM工作人员使用的一个常用工具是动机面试（MI）。MI是一套基于证据的技能，用于改善提供者和患者之间的沟通，以促进行为改变。初级保健和
505.925.7600 Fax 505.925-7601 www.envisionnm.org SBHC Quality Improvement at Envision New Mexico Envision New Mexico (ENM) is a pediatric quality improvement (QI) program that provides training, development and evaluation services to improve the quality of health services for children and youth throughout the state. As part of the Department of Pediatrics at UNM, ENM maintains an expert staff, utilizes up to date information technology, and draws upon the resources of the UNM Health Sciences Center to train and support SBHC providers in employing ‘best practices’ to ensure effective and efficient care health services. ENM is part of a larger movement of state‐based organizations working to improve the healthcare of children and families by teaching providers how to use quality improvement methods in their practices. Quality Improvement is defined here as a process to effect changes in provider practices that result in improvements in care. Research has dramatically improved SBHC providers’ understanding of how to improve health and decrease disease, and it is the job of quality improvement to translate this knowledge into practice. In other words, improving child health outcomes requires narrowing the gap between what providers know and what they do. Quality Improvement Methodology The QI process is based on established models for creating improvements in clinical practices and delivery systems developed by the Institute for Healthcare Improvement (IHI), the National Initiative for Children’s Healthcare Quality (NICHQ) and Dr. Scott Gee at Kaiser Permanente (Northern California). Conceptually, these developments are embodied in the Model for Improvement, a simple yet powerful tool for implementing improvement in health care quality. The “Plan‐ Do‐ Study‐ Act” (PDSA) process is an established tool that provides a structured process for providers and practices to plan, implement, and evaluate the impact of changes. The slogan for quality improvement is, simply, “all improvements involve changes but not all changes are improvements.” ENM employs this model and method to teach providers in SBHCs to identify practice changes that will lead to improved patient care and help reduce health care costs. An essential element of QI is developing appropriate measures to determine progress towards improvement objectives and to test if the changes made represent the improvements desired. Four basic questions frame QI work: 1. What do we want to achieve? 2. What ideas can we develop to achieve our goal. 3. How will we know if the plan is working? 4. What modifications to the plan are needed? Specific measures of progress are identified and monitored. These measures allow each SBHC site to gauge its own progress towards objectives, allow ENM to assess the effectiveness of its QI on particular objectives, and contribute to an overall assessment of the impact of QI on the system of care. The specific initiatives, along with objectives and related measures, evolve to meet the needs of SBHC programs. Ongoing evaluation guides the course of QI and assesses the impact of quality improvement on the programs and providers involved. The measures employed are derived from ‘best practices’ literature. A common tool used by ENM staff is Motivational Interviewing (MI). MI is an evidence‐based set of skills for improving communication between providers and patients for the purpose of enhancing behavior change. Primary care and