Running head: RESEARCH PROJECT FINAL
Quality Improvement in Healthcare
Research Project Draft
BUSI 511
Group 2
Justin Conrad, Kristen Savage, Sam Monboe
Respectfully Submitted to:Dr. Pamela Kelly
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Table of Contents
Abstract............................................................................................................................................3
Introduction......................................................................................................................................4
Background......................................................................................................................................4
Importance of Quality Improvement in Healthcare.........................................................................5
Current Requirements......................................................................................................................6
Advantages of Implementing Quality Improvement Methodologies..............................................8
Disadvantages of Implementing Quality Improvement Methodologies..........................................9
Technology Impact on Health Care Quality Improvement.............................................................9
Quality Improvement on Nurse Training and Education..............................................................12
Reduced Medical Errors and Readmission Rates..........................................................................14
Conclusion/Recommendations......................................................................................................17
References......................................................................................................................................20
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Abstract
The core elements of quality improvement are equitable, reliable, timely, and patient-centered
care in healthcare systems. The training and education of quality improvement principles for
clinicians is key to enhancing the superiority of care patients receive. It also works to improve
the perception of investors or other key stakeholders towards the delivery of healthcare. Quality
improvement is focused on exploring best practices and evidence-based practice guidelines to
eliminate medical errors and avoid medical negligence when administering treatment to patients.
It should dictate how healthcare professionals administer care in terms of quality and
effectiveness. Also, quality improvement should evaluate patient feedback to ensure that care is
consistent with the expectations. Patient feedback will enable healthcare systems to improve how
care is offered and the influence that patient information has on the eventual outcome.
Keywords: Quality, improvement, education, clinicians, best practice
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Quality Improvement in Healthcare
Introduction
Quality improvement in healthcare is fundamental in shaping the perceptions of patients
and investors towards healthcare delivery. Patients and their families are pursuing quality and
effective medical care. The quality of care in healthcare systems is perhaps among the greatest
impediments for health care organizations because of the complexity involved (Brandrud et al.,
2017). An understanding of this need by healthcare facilities has necessitated the incorporation
of quality improvement techniques or aspects such as efficiency, patient-centeredness, timely,
reliable, and equitable healthcare. Healthcare systems seek to satisfy patient needs and maximize
positive outcomes through quality improvement (Allen, 2016). Improved quality in healthcare is
significant in fostering patient-centered and effective care. Patient safety is at the core of
healthcare delivery to ensure that care is administered in a manner consistent with patient
requirements that either meets or exceeds patient expectations (Brandrud et al., 2017).
Healthcare providers are required to pursue further education and training to enhance
their understanding of the evolving healthcare system requirements. Quality improvements seek
to address client needs and ensure that resources are optimally utilized (O'Rourke and Fraser,
2016). Technology has enhanced the delivery of healthcare and is a component of quality
improvement. Healthcare systems have since been transformed because diagnostics, records of
patient data, and charting a patient's progress have advanced (McHugh, Brown, Walunas, Liss
and Persell, 2020). Quality improvement plays a central role in eliminating medical errors and
reducing readmission rates (O'Rourke and Fraser, 2016).D
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Background
The necessity of safety and quality improvement initiatives pervade healthcare. Quality
healthcare is the extent to which people and communities obtain health services that enhance the
chances of anticipated health results and are aligned with the prevailing professional awareness
(Batalden, 2018). A majority of human errors are derived from flawed processes unlike people as
purported. Moreover, uneven and ineffective processes, shifting needs of patients, disparities in
provider practice and education, alongside health insurance contribute to the complexity of care
(Burstin, Leatherman and Goldmann, 2016). Today's healthcare systems are functioning at a
lower level than expected, which has necessitated the six aims, namely patient-centered,
equitable, efficient, timely, effective, and safe care (Brandrud et al., 2017). These aims are
intended to ensure healthcare professionals deliver healthcare that achieves the desired aims and
avoid processes that result in harm. Healthcare quality is meant to ascertain the effect of the
delivery of care on the anticipated patient outcomes and assess the extent that healthcare is
consistent with processes based on scientific evidence. Since errors are attributed to process or
system failures, it is significant to accommodate process improvement methods that recognize
inefficiencies, preventable errors, and ineffective care. Quality improvement in healthcare,
therefore, plays a crucial role in enhancing the efficiency and effectiveness of the healthcare
system (Burstin, Leatherman, and Goldmann, 2016).D
Importance of Quality Improvement in Healthcare
Quality improvement (QI) is the foundation of excellence in the care and services
provided to patients, staff, vendors, and customers. Quality is a description of how well an
organization meets the needs and expectations of its customers (Shi and Singh, 2010). Without
QI, essential resources will be wasted, and valued goals will be left unachieved. Over the past
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twenty years, QI has grown increasingly popular in practice and is now adopted mainly in a
variety of industries all over the world (McPhail-Bell et al., 2018).D
Quality improvement is a means to fulfill the regulatory requirement of increasing
customer satisfaction, productivity, profits, and teamwork (Thorlby, Jorgensen, Siegel, and
Ayanian, 2011). QI is a means of fulfilling regulatory requirements. Healthcare QI is now a
requirement for most certified and accredited healthcare institutions (Pflueger, 2015). The cost of
quality implies that insurance and government agencies reimburse based on the superiority of
care offered to patients. Patient outcomes are rated, and special incentives, including payment in
full as well as bonus reimbursement pay, may be used to reward the performance of the health
system. Programs such as Value-Based Purchasing and Pay for Performance are only a few that
have become increasingly popular for continued quality improvement efforts (Schroeder, Parisi
and Foster, 2019).D
Total Quality Management (TQM) is widely known as the philosophy of continuous
quality improvement beyond the initial goal (Waterman, Sutter, Burroughs, and Dunagan, 2014).
TQM is a tactical and all-inclusive management approach that involves management and its staff
besides using quantitative methods to improve incessantly. In healthcare, quality improvement
works effectively to enhance and drive desired clinical practice improvement (Waterman, Sutter,
Burroughs, and Dunagan, 2014).
Quality improvement measures are used to increase competence, effectiveness, and
advance patient outcomes. The Institute of Medicine has introduced six goals for healthcare
improvement: safety, efficacy, patient-centered, timely, efficiency, and equitable (Rosen et al.,
2011). Having valuable data to demonstrate performance opportunities supports quality
improvement efforts. There is also an emphasis on the needs of top-down leadership and
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participation for incessant improvement. The training and education of staff surrounding quality
improvement methods are instrumental in improving quality improvement (Rosen et al., 2011).
Current Requirements
DIt is essential to have an accumulation of data when implementing a quality or process
improvement program. The aggregation of data and information must be meaningful and useful
(Goodridge, Isinger, and Rotter, 2018). Data collection planning must include a design structure,
sampling method, and the right amount of data. For strategic planning, operational design, and
adherence to regulatory requirements, data collection should be the very foundation of all
improvement measures.DIt is not only necessary for health systems to maintain a steady flow of
data for quality improvement work, but also the gathering of data is required by regulatory and
government agencies to monitor a facility's performance (Goodridge, Isinger and Rotter, 2018).
Agencies routinely inspect health systems or compliance in monitoring and track adverse events.
For insurance reimbursement, health systems are required to prove that they operate safely and
effectively with minimal harm to patients (Rohrbasser, Harris, Mickan, Tal and Wong, 2018).
Value-Based Purchasing and Pay for Performance are just a few programs that provide financial
incentives to healthcare organizations that have proven they place the quality of care at the
forefront (Rohrbasser, Harris, Mickan, Tal and Wong, 2018).D
The inclusion of personnel and key stakeholders is a must for quality improvement to be
effective and influential in outcomes. Quality improvement teams must include frontline
caregivers and key stakeholders across disciplines (Batalden, 2018).DStrong facilitation is also
needed in the appropriate level to ensure quality improvement teams are focused and heading in
the right direction. Team cohesion and great team dynamics are also critical components of the
overall success of QI teams and the over improvement process. Quality Improvement teams have
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mainly become popular over the past several years (Aibar, Rabanaque, Mozas and Aibar, 2014).
It is essential to have team members that are both decision-makers and can do the work discussed
in the QI process. In comparison to process improvement, QI is a philosophy that seeks to
improve the way system processes are designed, and the outcomes realized (Aibar, Rabanaque,
Mozas and Aibar, 2014).D
Advantages of Implementing Quality Improvement Methodologies
D D D D D DImplementation of quality improvement methodologies creates many benefits for health
care organizations. The first advantage is that quality improvement methodologies assist in
improving safety within health care organizations (Thorlby, Jorgensen, Siegel and Ayanian,
2011). Research has shown that there are a high number of errors made by health care providers
in the United States. For example, "in 1999, the Institute of Medicine published statistics that an
estimate of 44,000 to 98,000 Americans died because of health care failures and errors" (Aibar,
Rabanaque, Mozas and Aibar, 2014, p. 945). Additionally, "large national reviews of patient
charts estimate that approximately nearly 10% of hospital admissions are associated with an
adverse event (defined as an injury resulting in prolonged hospitalization disability or death,
caused by health care management)" (Rafter et al., 2015, p. 273). Medical errors in the health
care setting contribute to higher health care costs in the United States, potentially due to the
extended hospital stays. Health care quality improvement can identify areas where improvements
can be made to make health care settings safer places (Rafter et al., 2015).DD
Additionally, health care organizations are more effective because of the advantages
developed from the implementation of quality improvement methodologies. According to
Bastian, Munoz and Ventura (2016), healthcare organizations must create a productive workflow
to improve healthcare value in the United States. Quality improvement is significant in
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enhancing the workflow within health care organizations. Health care administrators can utilize
quality improvement to make their organizations more effective by obtaining data from
information technology applications in their electronic health records system. The data identifies
areas needing improvement and then to monitor the effectiveness of changes made (Bastian,
Munoz and Ventura, 2016).D
Finally, quality improvement methodologies provide cost-effective measures for
healthcare organizations and ultimately allow them to be more efficient (Alhazme, Haque,
Wiggin and Rana, 2016). An estimated 99.3% of the healthcare entities and physician practices
in the study had executed at least a method of quality improvement. The goal was to improve the
healthcare organization to make the workflow process more efficient and cost-effective
(Alhazme, Haque, Wiggin and Rana, 2016).DD
Disadvantages of Implementing Quality Improvement Methodologies
D D D D D DImplementation of quality improvement methodologies creates several problems for
health care organizations. First off, what works for one health care organization may not work
for all health care organizations (Allen, 2016). Health care administrators lead healthcare
organizations with different agendas due to varying missions, visions, and goals of their health
care organizations. Quality improvement methodologies may find that implementing an
electronic checklist helps decrease medical errors for a certain amount of health care
organizations. Nonetheless, the solution may not work for every health care organization in the
United States (Allen, 2016).D
D D D D D DAdditionally, there is limited infrastructure to support large scale quality improvement
(Brandrud et al., 2017). Information technology is needed to help improve areas in the health
care industry through quality improvement. The cost of upgrading the technology is costly and
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not affordable to many health care organizations. As such, health care organizations need to find
new and improved ways to grow as a company because, after an initial investment, technological
advances become cost-effective (Brandrud et al., 2017).DD
Technology Impact on Health Care Quality Improvement
D D D D D DThe United States health care system is dependent upon medical research and innovation
in medical technology (Shi and Singh, 2010). Technology has positively impacted health care
systems using quality improvement. The United States leads the pack globally regarding the
progress and advancement of technology due to cultural viewpoint and principles, medical
instruction and practice, insurance availability, and contest among health care providers. First
off, technological advances have improved healthcare quality improvement through better
communication in the healthcare field. For example, the digitalization of patient care charting is
a significant quality improvement that has occurred recently. The American Recovery and
Reinvestment Act of 2009 required that medical facilities transition from paper charting to
electronic documentation for patient charting (Steffens, Gunser and Saviello, 2015, p. 237).
Electronic health records (EHRs) are information technology applications that have replaced
paper charting within the healthcare industry. Shi and Singh (2010, p. 105-106) discuss four
critical mechanisms of an electronic health records system as "collection and storage of health
information on individual patients over time, immediate electronic access to individual and
population-level information by authorized users, provision of knowledge and decision support
that enhance the quality, safety, efficiency of patient care, and support of efficient processes for
health care delivery" (Shi and Singh, 2010).D
According to Shi and Singh (2010), the United States health care system has limited
capabilities for electronic health records to be shared amongst medical providers. However, there
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are some advances with information technology applications to share patient charts with health
care organizations that utilize the same software applications, such as EPIC. More research is
needed to better implement the sharing of electronic health care records between medical
providers. Patient electronic medical records can share medical records with physicians through
software programs such as EPIC (Steffens, Gunser and Saviello, 2015). These records allow
physicians to view medications prescribed to a patient and whether they were filled at a
pharmacy. Medical providers can also view patient medical records from other healthcare
organizations through a records share feature. Finally, it is vital for health care providers to have
access to electronic medical records because this allows them access to immediate report of
critical lab values or notification for potential medical errors (Steffens, Gunser and Saviello,
2015).D
Federal care quality objectives typically characterize quality improvement in the context
of patient safety and avoidable health situations. Federal guidelines push for clinical
standardization among health care organizations (Allen, 2016). Health care organizations that
utilize health information technological applications, such as EPIC, can garner metrics and data
to identify and support areas needing improvement. Healthcare is constantly changing, and
something that works within a healthcare organization now, may not be effective five to ten
years later or even between two different health care organizations (Allen, 2016). Faster
turnaround times for patients in a health care setting have been enhanced because of
technological advances in the laboratory's diagnostic equipment through speedier provision of
treatment and interventions for infection control (Clark, Anderson-Cable and Diggle, 2016).D
One negative factor that technological advances have on quality improvement in the
United States health care system is the financial burden. Technological innovations are among
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the most expensive contributors to the high costs of health care (Shi and Singh, 2010).
Interestingly, technological advances in other industries result in a decrease in the labor force
and also a reduction of production costs. However, technological advances have a hefty price tag
in the health care industry, which contributes to inflation of health care in the United States (Shi
and Singh, 2019). The digitalization of medical records, as noted above, requires an extensive
upgrade of health care infrastructure, which is an example of a costly technological advancement
in health care that is needed for health care quality improvement (Shi and Singh, 2019).
Quality Improvement on Nurse Training and Education
Nurses play a considerable role in influencing the level or amount of care that is offered
to patients. Since they spend most of their time with the patients, nurses are trustworthy and
competent to handle multifaceted situations (Mannion and Davies, 2018). The ability to improve
patient care is centered on the duties of healthcare providers. There is increased demand for
better healthcare by keener competition, further healthcare regulations, and personnel
competence as ways that nurses can exercise the provision of care that is secure and efficient
(Zurlo and Zuliani, 2018). Nurse training is dictated by the quality of infrastructure, personnel
competence, and operational system efficiency. Having a patient-oriented system depends on the
extent of nurse training in addressing patient needs both efficiently and satisfactorily (Zurlo and
Zuliani, 2018).
Trained personnel deliver high-quality care to patients since these professionals
understand patient needs and the significance of satisfying them (Morley and Cashell, 2017). The
outcomes eventually become desirable because of the commitment and passion that trained
personnel have towards their duties. The challenge of hiring poorly trained personnel in
healthcare systems should be resolved by developing a clear recruitment plan (McHugh, Brown,
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Walunas, Liss and Persell, 2020).DAn increase in training programsand the improvement of
already existing programs should be prioritized. As such, having a consistent curriculum for all
trained nurses helps attain standardization that ensures the quality of care that is administered is
high and meets patient needs (Morley and Cashell, 2017).
Competent nurses are a valuable resource that ensures the improvement of quality
healthcare (World Health Organization, 2018). These nurses depend on the right instruments,
suitable medications, and new technologies. These three aspects are crucial in facilitating and
supporting the skills and knowledge of a nurse. The instruments for use in everyday operations
should be of good quality and available at low costs. Having proper inventory systems ensures
that healthcare systems can lower costs and attain better outcomes. The appropriate medications
help to achieve quality improvement because patients desire the best care at a low cost (World
Health Organization, 2018).
Telemedicine is dominating the healthcare sector today, and it is a vital component of
nurse training that ensures the administration of care to patients meets the high-quality criteria
(Greene, Farley, Amy and Hutcheson, 2018). Patient care is improved in a dynamic process that
should be at the core of the perceptions of medical care professionals. Patient sensitivity is
incorporated when designing healthcare delivery plans, so that patient expectations are
adequately addressed. The consideration of quality in every aspect of administering patient care
is helpful for improved quality in medical and non-medical fields (White, Butterworth and
Wells, 2017). Healthcare professionals, particularly nurses, must embrace autonomous practices
when serving client needs. In so doing, it simplifies the decision-making aspect of the best care
for a patient. Nurses thrive in environments that emphasize managerial support because of the
team building programs and awards for best performance. These programs boost employee
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morale and develop the superiority of care that they administer to patients (Greene, Farley, Amy,
and Hutcheson, 2018).
The medical industry is fast evolving, and patient satisfaction through constructive care
experiences is placed at the core of healthcare systems (Aase, Schibevaag and Waring, 2017). An
understanding of the roles of various clinicians is crucial in determining the extent to which
quality care is administered. Nurse training influences these outcomes because of the
preparedness and willingness to deliver the required care. Nurses spend most of the time with
patients, which imply they are highly influential in the patient's recovery process. The training
encompasses better care quality as well as experiences that define their role in healthcare
systems. Nurses have the power to transform patient experiences, mainly through empathic and
effective communication (Morley and Cashell, 2017). The time that nurses spend with patients
indicates their commitment to ensuring that patients are entitled to the best care. The nurses
engage patients in education programs about the best ways to maintain good health and their
safety. The patients can also establish confidence to deal with their illnesses, especially in
situations of despair. They build a rapport with patients, which most nurses agree is the best
approach to solve patient needs and obtain sensitive information for better delivery of care.
Notably, nurses establish relationships at personal levels, which enhance patient satisfaction
(Aase, Schibevaag and Waring, 2017).
Nurses are responsible for safeguarding patient safety, which is crucial in achieving
quality improvement in healthcare (Dandoy, Hilden, Billett and Mueller, 2017). Increased patient
satisfaction indicates the increasing role of nurses in building relationships with patients that aim
to address their needs. Nurses play a critically significant role compared to any other healthcare
professionals, as they monitor patients, detect errors, and understand care processes, all of which
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are components of their training (Mannion and Davies, 2018). Well-trained nurses are competent
and understand their role in delivering patient-centered care. Nurses are attentive to patient needs
and are focused on ensuring the recordings are usually positive scores. These indicate a patient's
progress and the commitment and qualification of a nurse to administer quality healthcare
(Dandoy, Hilden, Billett and Mueller, 2017).
Reduced Medical Errors and Readmission Rates
Healthcare facilities have had to withstand the challenge of elevated medical errors and
readmission rates. These aspects are costly to operations and tend to interfere with the roles of
those medical professionals that guarantee the best care is available or accessible to patients
(Upadhyay, Stephenson and Smith, 2019). The quality of patient care can decline due to
medication errors, the use of medical devices, and data reporting. Healthcare professionals must
demonstrate their abilities, skill, and experience to effectively manage an illness (Upadhyay,
Stephenson and Smith, 2019).
Quality improvement defines the standards of care that should be administered to patients
to attain positive outcomes (Zurlo and Zuliani, 2018). However, these standards are usually not
met because of incompetent professionals in healthcare systems. Readmissions are reduced by
improved discharge processes and ensuring they are patient-centered (Ruggiero, Smith,
Copeland and Boxer, 2015). The particular concern of medical professionals is to provide
medical reconciliation, enhanced coordination of the patient with providers in the community as
well as self-management capabilities (Ruggiero, Smith, Copeland and Boxer, 2015). These are
effective strategies aimed at eliminating readmission rates, which have, in recent times, increased
because of limited attention that is given to patients following discharge (Zurlo and Zuliani,
2018).
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Quality improvements guarantee an improved procedure that ensures discharge is not the
need for interacting or assessing the patient (Ruggiero, Smith, Copeland and Boxer, 2015).
Discharge processes should only be the beginning of presuming full recovery among patients.
Healthcare personnel, especially nurses, should portray dedication to follow up a patient's
progress and determine any need for further care or declare a recovery (Allen, 2016). Medical
errors occur because healthcare personnel do not consider it as their responsibility to routinely
monitor a patient after discharge. Quality improvement in healthcare requires overhauling
prevailing systems and introducing systematic approaches and procedures that work towards a
specific goal (Ruggiero, Smith, Copeland and Boxer, 2015).
Medical errors and readmission rates are a challenge to quality improvement initiatives in
healthcare (Yousef and Yousef, 2017). A lack of integration in healthcare organizations entails
interference among hospital and community-based providers regarding how well care is
administered. Healthcare systems that do not commit resources to lengths of patient stay in
hospitals and lack properly coordinated care hinder service delivery. Healthcare facilities that
invest adequately in inpatient care through prolonging hospital stays are more likely to obtain
favorable outcomes (Yousef and Yousef, 2017).
Quality improvement projects in healthcare facilities help to curb increased readmission
rates and medical errors (Montreuil, Martineau and Racine, 2019). Medical professionals ought
to have guidelines that inform their decisions whenever they serve clients. These decisions
should be consistent with the standards of practice and care. Notably, the decisions that medical
professionals make have a significant effect on a patient's process of recovery after or before
discharge. Patient-centered care involves placing the patient at the core of care and assessing the
extent to which it is effective (Batalden, 2018). Most patients are usually unaware of their illness
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or condition during discharge. As such, they mistakenly discontinue essential medications and
fail to attend to appointments and referrals. As such, every decision should be thoroughly
evaluated to ascertain its suitability treatment contexts (Montreuil, Martineau and Racine, 2019).D
Quality improvement projects also seek to improve the process of discharge and enhance
the coordination of care besides encouraging patients to maintain self-management (Jones, Vaux,
and Olsson-Brown, 2019). Patients that obtain quality healthcare are less likely to be readmitted
or complain of medical errors and negligence. The patients in such categories are difficult to
monitor and determine whether the medication was effective or not. These patients end up with
the intervention of community providers. As a result of high self-management expectations,
reduced length of stay in the hospital, and increased awareness, more patients become highly
susceptible to readmission (Mannion and Davies, 2018). As such, the healthcare team should be
committed to reducing readmissions by monitoring patients for a month besides availing the
necessary information for medications. These strategies guarantee the quality of care that is
administered and the effectiveness it will have on the patient as the recovery is monitored (Jones,
Vaux, and Olsson-Brown, 2019).
Conclusion/Recommendations
D D D D D DHealthcare is fast evolving, and quality improvement is enhancing patient protection and
effectiveness. Quality improvement has improved the delivery of healthcare by ensuring the
standards of care are within or surpass the anticipated limits. Technology has improved how care
is administered by facilitating the process of accessing treatment and influenced patient
outcomes. Quality improvement is instrumental in attaining patient safety and enhancing
effectiveness in the delivery of care. The widespread readmission rates and medical errors in
healthcare systems have reduced because of quality improvement. Healthcare professionals have
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become more cautious when delivering healthcare to patients. As such, the quality of healthcare
is becoming better because it is consistent with patient needs.
The core elements of quality improvement are equitable, reliable, timely, and patient-
centered care in healthcare systems. Training and education for nurses develop the superiority of
care and improves the perception of investors towards the delivery of healthcare. Quality
improvement should explore the best ways to eliminate medical errors and avoid medical
negligence when administering treatment to patients. It should dictate how healthcare
professionals deliver care in terms of quality and effectiveness. Also, quality improvement
should evaluate patient feedback to ensure that care is consistent with the expectations. Patient
feedback will enable healthcare systems to improve how care is offered and the influence that
patient information has on the eventual outcome.
It is also essential for healthcare organizations to have quality improvement teams
established to do the improvement work. Alongside the QI work, data collection and monitoring
is a necessary step and often a requirement of government and regulatory agencies. It is essential
to have an accumulation of data when implementing a process improvement program. The
aggregation of data and information must be meaningful and useful. Data collection planning
must include a design structure, sampling method, and ensure that the right amount of data is
collected. Strategic planning, operational design, and the adherence to regulatory requirements,
data collection should be the very foundation of all improvement measures. Under the
consideration of establishing a QI team, key stakeholders, and team members who are both
decision-makers and have a direct hand in the improvement work is another essential for teams.
Every member of the team is viewed as a subject matter expert, who brings a unique vantage
point to the group.
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The inclusion of personnel and key stakeholders is a must for quality improvement to be
effective and influential in outcomes. Quality improvement teams must include frontline
caregivers and key stakeholders across disciplines.DStrong facilitation is also needed in
appropriate levels to ensure quality improvement teams are focused and heading in the right
direction. Team cohesion and great team dynamics are also critical components of the overall
success of QI teams and the over improvement process.
Quality improvement practices are becoming the norm of how healthcare systems
enhance their patient care pathways and internal operations. Health systems are relying on
quality to lead their success in the achievement of goals, fulfill their mission, vision, and meet
the expectations of the governing board. It is essential to have an established quality
improvement program. Efforts for improvement are continuous and ongoing to seek
improvement in processes and systems. Quality improvement is the very essence of total quality
management and serves as the backbone for fulfilling organizational change, goals, and mission.
D
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