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Measurement Perspectives "As CQI philosophies and processes have evolved within health care, a series of broad-based approaches have evolved and proven to be successful across a range of health care settings" (Sollecito & Johnson, 2013, p. 36). In 1988, the U.S. Office of Technology Assessment (OTA) defined quality of care as "the degree to which the process of care increases the probability of outcomes desired by the patient, and reduces the probability of undesired outcomes, given the state of medical knowledge" (OTA, 1988). To measure outcome improvement, organizations identify and select measures.

Focusing on high-risk, high-volume, problem-prone areas is one way to maximize returns on organizational investment in performance improvement. These improvements generally focus on positively affecting large groups of patients, eliminating or reducing variability in processes, reducing risk, and avoiding serious problems within the organization (Sollecito & Johnson, 2013). Once the health care organization selects the indicators it wants to measure, such as proper hand washing, hospital acquired infection rates, readmissions, et cetera, it then collects data to measure the indicator and compare the organization's current performance to the desired performance level.

Critical elements when selecting a performance measure include:

• Relevance – Does the measure relate to the organization's improvement goals?

• Reliability – Does the measure accurately and consistently measure what it was intended to?

• Validity – Does the measure identify opportunities for improvement?

Tied with outcome measures are CQI methods and tools used for decision making, variation measuring, and process improvement. Walter Shewhart was the first to introduce the plan-do- check-act cycle. Later this was modified into the plan-do-study-act, or PDSA cycle. Health care organizations use this cycle to facilitate rapid change, putting improvement in the hands of those most directly responsible for the outcomes and processes in need of improvement: front line staff and managers. Lean and Six Sigma, two additional tools used by quality professionals, focus on reducing waste and eliminating defects. This in turn results in added value for the customer.

References Office of Technology Assessment. (1988). The quality of medical care: Information

for consumers (OTA-H 386). Retrieved from https://www.princeton.edu/~ota/disk2/1988/8832/8832.PDF

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care (4th ed.). Burlington, MA: Jones & Bartlett Learning.