Project: Promoting Health Care Quality

Measuring and assessing quality provides a foundation for identifying needs for improvement, developing effective interventions, and then monitoring progress toward desired results.

In the Sadeghi, Barzi, Mikhail, and Shabot text, the authors assert that an effort to improve quality “calls for setting outcome and performance targets (goals and expectations) beginning with the end in mind, and then formulating initiatives and actions (processes) that can serve as a bridge to take the organization from its current performance to its desired performance” (p. 182).

Having this “end in mind” can provide justification for dedicating valuable resources toward the effort, and help to lay a clear, concrete path that takes the organization from uncovering gaps between current performance and evidence-based targets to actually achieving those goals.

In this section of the Course Project, you focus on what you would measure—and how you would measure it—relative to your previously identified quality improvement issue. Note: This section of the Course Project will serve as the Portfolio Assignment for this course.

To prepare:

• Review the Learning Resources. Also conduct a search of the literature related to your selected quality improvement issue and complete the Evidence Matrix (provided in this week’s Learning Resources).
• Evaluate the evidence presented in the research literature and the quality standards proposed by various organizations, including the IOM’s six aims for quality improvement.
• Based on this review and your knowledge of the organization that you have selected, determine appropriate measures and indicators of performance related to your identified quality improvement issue.
• Consider how you could gather and use historical evidence of the organization’s performance related to the quality improvement issue. Also consider methods for gathering and assessing current quantitative and qualitative data, including those currently in use by the organization (e.g., chart audit data, staff surveys, quality indicators that are monitored, observations). If possible, examine actual data to assess your selected organization’s performance related to the issue.
• Think about what, specifically, you would like to achieve related to this issue. Establish realistic, evidence-based quality performance targets.
• Analyze gap(s) between the organization’s current performance and the performance targets.
• As you do this, you may wish to create a graphic organizer/alignment chart for your own use that illustrates:
  • The measures and indicators that you would evaluate
  • Current and historical data related to this quality issue—either actual data or methods for how you would collect and analyze the data
  • Methods for collecting and analyzing data in the future (including when you would do this)
  • Realistic, evidence-based targets

Additional instructions for Section 3 are presented in Week 7. To complete this Assignment, you will write a paper introducing your quality improvement plan. This Assignment is due by Day 7 of Week 8

Through your work on Section 3 of the Course Project, you have examined the gap between current performance and evidence-based targets and considered how addressing this gap relates to organizational priorities and large-scale aims for quality improvement.

In this section of the Course Project, you begin to think about quality improvement strategies that could help to bridge this gap. As noted in the Sadeghi, Barzi, Mikhail, and Shabot text, this is referred to as performance-driven planning.

Since the publication of the Institute of Medicine’s report “Crossing the Quality Chasm,” a good deal of attention has been paid to the need to examine processes that contribute to outcomes (Ernst, Wooldridge, Conway, Dressman, Weiland, Tucker, and Seid). As the USAID has noted, interventions “will not create the desired outcome to improve the quality of care unless the overall process of care delivery is also improved.” Therefore, attention to process redesign is a central aspect of cultivating strategies for improvement.

To prepare:

• Refer to the modified Donabedian model (access, structure, process, outcome, and patient experience) presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text.
• Recall the performance targets that you identified for Section 3 (in Week 6). What does the recommendation that performance-driven planning should “begin with the end in mind” suggest given your established goals?
• Review the information presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text, and think about how you would assess the organization’s strengths and weaknesses related to the performance gaps you identified in Section 3 (Week 6).
• Based on the above, start to think of specific evidence-based strategies that could be implemented to close/minimize the performance gaps you have identified. Consider both interventions (what) and processes (how). Focus on strategies that are supported by the latest research and could create systems-level change. These may be tentative for now, but be sure to identify at least one that specifically lends itself to a change in process (i.e., practice, protocol, pathway, activity).

Additional instructions for Section 4 are presented next week. To complete this Assignment, you will create a process map and write a paper describing quality improvement strategies. This Assignment is due by Day 7 of Week 8

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