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Running head: UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE
Utilizing Quality Improvement (QI) in Healthcare
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UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 2
Abstract
Quality improvement involves all practices and interventions in healthcare
processes that seek to improve the process of healthcare delivery, hence the quality of healthcare
(Batalden, 2018). However, the process of healthcare delivery usually involves the interaction of
numerous sub-processes that are as diverse as they are intricate. The process of healthcare
delivery is based on the principles of process management that are more conscious of these
complexities. The guiding principles, basic concepts, as well as approaches to quality
improvement, generally follow the subtle example of process management principles. However,
further exploration of these principles, concepts, and approaches reveal an underlying need for
specificity in the application of process management (quality improvement) practices in
healthcare.
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 3
Introduction: Overview of Quality Improvement
Healthcare, in its entirety, is unique because it essentially involves all processes
and practices that seek to improve and maintain health among individuals. All the processes of
healthcare (prevention, diagnosis, and treatment of diseases) are complex in their own right. The
sophistication and advancements of these processes, more so through the incorporation of
technology in healthcare, has resulted in the denomination of the healthcare industry in a manner
that mimics almost all other types of industries (Young, Roberts & Holden, 2017). Indeed, the
healthcare industry incorporates aspects such as record keeping, sharing of health information
among relevant stakeholders, processing payments and salaries as well as interactions with other
institutions like insurance companies and the government.
As such, these immense and complex interlocking processes create the need for
efficiency within the healthcare sector. Although healthcare largely involves the practical
application of scientific processes in promoting healthcare, this application is not possible
without the management of the fore stated processes. As such, pioneers of the modern concepts
of quality improvement like Dr. Edwards Deming sought to improve these processes for a more
holistic and seemingly effective intricate healthcare system (Young, 2015).
Indeed, these revolutionary individuals initially tasked themselves with improving
the healthcare process. Their work, stemming from as early as the 1940s, did not necessarily
revolve around quality improvement. The latter stages of the exploration of process improvement
synonymized process improvement with quality improvement. These pioneers base their
justifications for this synonymous association since most processes can be subjected to
measurement, analysis, improvements, and control. They advocated for continuous efforts in
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 4
exploring methods of achieving practice results that are predictable, stable and result in the best
possible results in healthcare: efficient prevention, diagnosis, and treatment of diseases.
As such, quality improvement (QI) in healthcare may be defined as the
amalgamated framework and strategies implemented to improve the methodologies of healthcare
delivery through monitoring and controlling all processes involved in healthcare delivery
(Zoutman & Ford, 2017).
Why Quality Improvement in Healthcare Is Important
As already stated, the constant evolution and changes to the processes involved in
healthcare warrant the continuous analysis, monitoring, control and improvement of these
processes. Hence, quality improvement is not necessarily alien to healthcare. It is established as
an industry requirement. However, this need for the same is not necessarily the underlying
benefit of quality improvement. There are several other benefits associated with quality
improvement. Such benefits include:
Improving the level of performance of the healthcare system. One of the
main aspects of quality improvement is the changes the same has on the
overall processes involved in healthcare. Through quality improvement
practices, the healthcare sector can effectively implement enhancements
that are deemed to offer the best possible results (Aghaei Hashjin et al.,
2014). As a result, quality improvement helps to achieve a new level of
performance in a manner that aligns with better performance. A perfect
example of the same is the incorporation of various Electronic Health
Records soft wares. These soft wares were developed for the sole purpose
of improving the storage, retrieval, and exchange of health records. As
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 5
such, it improves the quality of health services offered through
significantly reducing the bulkiness of paperwork as well as the time
needed to retrieve and exchange patient information.
Reduced errors in healthcare. Indeed, the initial healthcare system was
marred by problems of misdiagnosis, misplacement of patient information
among other process-based errors. However, continuous improvements
made through quality improvement endeavors have helped to reduce cases
that result from both human and process error (Aghaei Hashjin et al.,
2014). As such, quality improvement is an important factor in significantly
improving healthcare in general since it aims at creating a seamless
industry. For example, diseases having an almost similar symptom pattern
(like water-borne diseases) were traditionally problematic for physicians
to diagnose and treat effectively. Educators and relevant stakeholders took
notice of this difficulty in both the process of diagnosis and the persons
responsible for the same. As such, a diagnosis such as eClinicalWorks and
Prime Suite were developed as measures to improve the process of
diagnosis for the sole purpose of improving healthcare. These soft wares
eliminate the probability of misdiagnosis in the case of such diseases. As
such, the process of diagnosis becomes fast, accurate and efficient as a
result of these soft wares.
Improved patient experience and efficiency of healthcare. The
complexities of healthcare processes affect the most important stakeholder
in healthcare, the patient. One of the major principles of quality
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 6
improvement is the improvement of the patient experience through
enhanced practices that strive to reduce the time, money and energy spent
with healthcare providers(Singer, Benzer & Hamdan, 2015). If the
improvement practices are patient-focused, all quality improvement
activities will be geared towards improving the patient experience. As
already established, quality improvement practices are not centered on the
clinical needs of the patients. Most of the quality improvement practices
concerning the patient experience are based on this fact. As Aine Cryts
writes, the most significant component of the patient experience is, well,
just that, their experience in hospitals and other healthcare providers. For
example, she writes of how Danville, a large healthcare system in
Southern New Jersey and Pennsylvania implemented in the two areas
implements ‘leadership rounds’- exercises where the upper echelon of the
healthcare system in the regions visit hospitals to identify pertinent issues
affecting patients. In one of those rounds, they discovered how patients
were losing sleep in hospitals in the area because the said hospitals
frequently purchased plastic pillows that were uncomfortable for the
patients (Cryts, 2019). The program, incorporated to the areas’ healthcare
system identified this problem that directly relates to the patient
experience and not necessarily the clinical needs of the patient. A simple
adjustment to the system like changing pillow suppliers helped to improve
the patient experience significantly and as a result, the healthcare system
in general in the area.
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 7
Improving performance and motivation of healthcare providers. If it
were not for quality improvement practices, failures within the system
were primarily blamed on the healthcare providers. Difficulties in record
keeping, which have the potential to cause misdiagnosis among other
faults already mentioned would be traditionally blamed on healthcare
providers. However, these faults within the system, if improved help to
dilute this notion, more so within the patient population.
Reduce the cost of healthcare. Perhaps the second most important aspect
of quality improvement, significantly reducing the cost of operations and
cost of healthcare through enhanced cheaper processes is an improvement
to the processes involved in healthcare (Shi & Singh, 2017, pg 285). For
example, psychooncology is an improvement to the general process of
cancer diagnosis since it helps to diagnose patients with cancer without the
expensive diagnosis methods like CT scans and the like. Photooncology
strives to accurately diagnose cancer by analyzing their psychological
distress as a result of the disease. Stress measurement tools such as DT
screening help to sieve patients suspected of cancer, with the hope of
preventing patients without cancer from going through the expensive,
time-consuming and potentially harmful diagnosis practices.
Psychooncology is in rapid expansion, and the mandatory incorporation of
the same in cancer diagnosis is becoming a reality. Stakeholders are
pushing for the successful implementation of the same for the sole purpose
of improving patient experience through reducing the time, and more
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 8
importantly, the money spent during a cancer diagnosis. The incorporation
of psychooncology in cancer diagnosis is an attempt by stakeholders to
alter (improve) the quality of the process of cancer diagnosis.
Defining and Guiding Principles in Quality Improvement (QI)
After the definition and benefits of quality improvement are established, the most
probable aspect of exploration of quality improvement as a major aspect of healthcare, further
exploration of the guiding principles surrounding quality improvement is necessary. Indeed,
these principles are significant because they are the main philosophical and methodological
aspects of the same, which form the basis of efficient and beneficial quality improvement
practices. The following are some of the principles that guide the development and
implementation of quality improvement:
Quality Improvement Is a Function of Process Management
Deming and fellow pioneers of what we know today as quality improvement
formed the skeleton of this important concept on the need for healthcare organizations and
institutions to deal with and respond to the growing complexities and challenges faced by a
rapidly expanding healthcare system (Young, 2015). Their approach, as simple as it was, was
remarkably efficient. The remarkable efficiency of their approach was based on the principle that
all quality improvement practices should be based on process management. As such, quality
improvement is the science that helps to improve the processes involved in healthcare delivery
significantly. The principles of process management are applicable in almost all other industries
in the world. However, the most significant success story of process management is in
healthcare. Through the improvements made through the application of principles of process
management, lives are made better (directly) through the incorporation of the aid principles. The
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 9
need for basing quality improvement practices on process management stems from the
complexities and intricacies of the healthcare system. Healthcare involves a lot of interlocking
processes, each dependent on the other.
Measurable Information Is Key
Indeed, for meaningful quality improvement to be achieved, data is the most
important component. Process management principles reiterate the importance of data, as
quantifiable information is the true measure of relative discrepancies and loopholes ineffective
and efficient performance. Variables that dictate these loopholes should be quantified to
understand the severity and urgency of the problem. For an industry as intellectually sensitive as
healthcare, improvements should be dictated by quantifiable data. Deming is famous in the world
of healthcare because of one of his statements, ‘In God we trust, but all others must bring data.’
Through this statement, Deming tried to reiterate that reliable data is the most important factor
that either arrant, merit or demerit suggestions for quality improvement (Young, 2015).
Most quality improvement practices start with research and investigation. For
example, in the leadership rounds scheme stated above, the members of the leadership board
conducted their said rounds through hospitals to gather information (data) on patient experience
(Cryts, 2019). If a single patient failed to fall asleep due to the plastic pillow, the patients’ case
would be deemed unique and somewhat not warranting of the intervention implemented.
However, the fact that a majority of the patients complained of difficulty in falling asleep due to
the uncomfortable nature of the pillows prompted the intervention (Cryts, 2019). As such, the
quality improvement practice was almost entirely based and justified on the data gathered.
The importance of reliable data also stems from the fact that the quality
improvement interventions have a direct impact on the stakeholders (more so if the intervention
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 10
is patient-focused) and incurs cost on the implementers of the same. As such, because of the
potential good (or harm) posed by the intervention, as well as the stated underlying cost of
implementing the intervention, there needs to be the justification of the need for the intervention
(Cantiello, Kitsantas, Moncada & Abdul, 2016). The best possible convincing element in the
case of sensitive intellectual situations is data.
Quality Improvement Does Not Necessarily Translate To Management of
Healthcare Professionals
Propagators of the modern concepts of quality improvements in the 1990s made
the ultimate mistake of altering the performance of healthcare professionals by constantly telling
them what to do. To these proponents, they associated quality improvement practices to
coercively directing the work patterns of healthcare professionals (Mensah Abrampah et al.,
2018). However, their attempts failed because the underlying principles behind the quality
improvement are managing the process and not necessarily managing the professional.
As such, there needs to be a separation between quality management as a function
of process management and managing healthcare professionals. Coercively altering the work
patterns of healthcare professionals has the potential to reduce motivation, moral and therefore
the performance of the healthcare professional. A workforce that is not motivated is a loophole to
the process of the said entity, which creates the further exponential need for quality
improvement. Therefore, this guiding principle of quality improvement was developed to focus
improvement practices on the process and not necessarily the workforce.
However, if the quality improvement practice should involve necessary
involvement of healthcare professionals, the principles of process management dictate that active
and proactive engagement of the professionals is necessary to get the best possible results of the
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 11
intervention (White, Butterworth & Wells, 2017). Making use of adequate communication skills
and additional training are elements of process management in interventions that require the
involvement of the stakeholders.
Involvement of Necessary Stakeholders
Similarly, another underlying principle of quality improvement is the need to
create cohesion between the relevant stakeholders. Process management principles dictate the
need for the relevant stakeholder to be in professional and execution agreement of the
intervention (White, Butterworth & Wells, 2017). As such, there needs to be active and proactive
communication between the relevant stakeholders before the implementation of the process. For
example, the incorporation of Electronic Health Records (EHR) made it easier to store, retrieve
and exchange patient health records. However, the incorporation of the same created the problem
of patient privacy. In this regard, the process of exchanging patient information was regulated, in
a manner that seeks to improve the security of patient information, due to the vulnerability of
digital health records to hacking. In this regard, authorities enacted policies such as the HIPAA
Act (Health Insurance Portability and Accountability Act), which offered guiding principles
surrounding the process of exchanging patient information (Cohen & Mello, 2018). The Act was
enacted as a result of continuous breaches of patient privacies within the healthcare system.
These breaches were both intentional and unintentional. However, the enactment of the Act
offered guiding principles and mandatory requirements for healthcare providers in the US as they
relate to safeguarding patient information. However, before the Act was enacted, the authorities
had an ethical and professional responsibility to engage the relevant stakeholders, like the
healthcare providers, insurance companies and developers of EHS systems (Shaw, 2013). They
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 12
engaged these stakeholders to determine whether the said policies would either positively or
negatively impact the processes involved in the delivery of healthcare.
Also, engaging these stakeholders is also important because it helps to collect the
relevant data needed to validate the enactment of the law. Such information was collected from
patient experiences and perceptions regarding the need to safeguard patient information. Also,
the authorities obtained such information from the healthcare providers and developers of EHS
to discover the causes and methods of breaches as well as the best approaches towards mitigating
breaches(Shi & Singh, 2017, pg 218). Through active and proactive engagement, interventions to
the processes involved in exchanging and storing patient information were significantly
improved.
Basic Methodological Concepts of Quality Improvements
The process of quality improvement is, apart from the guiding principles, based
on several methodological concepts. Indeed, any practice involved in real life situations needs to
have an amalgamation between the stated guiding principles or philosophical constraints of the
practice and methodological principles that form the methodological constraints to the process.
This amalgamation is necessary because it aligns the application of the practice with the desired
outcomes of the same. As such, the major methodological concepts that are involved in quality
improvement practices include:
Establishment of a Culture of Quality in Practice
The first step in implementing quality improvement practices is a culture that is
geared towards improving the quality of the practice. All practices, procedures, and processes
within the organization in question should be grounded on the desire for quality. This desire
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 13
should inspire a culture (behaviors, attitudes, and actions) that are geared towards improving the
quality of services offered by healthcare professionals as well as improved performance. As a
result, the upper echelon and relevant stakeholders of the said organization will conduct relevant
meetings and create relevant policies that are geared towards the main objectives and goals of
quality improvement.
The Determination and Prioritization of Potential Areas for Improvement
Practical application of the forementioned methodological principle should
involve all efforts that help to improve and further understand the complexities of the
organization. Determining and prioritizing areas in the organization that may affect the
performance and efficiency in delivering healthcare is conducted through thorough and rigorous
analysis of the systems in the healthcare system.
The analysis practices should be executed based on the guiding principles of
process management, which form the basis for quality improvement. As such, these efforts
should be centered on the processes involved in delivering healthcare, which is a direct mirror of
the effectiveness and efficiency of the healthcare provider in question. Aspects of the same, such
as the patient experience are explored by examining patient population via the lens of process-
centered practices like identifying barriers to the delivery of quality care, identifying high-risk
groups within the organization (Shi & Singh, 2017, pg 262), frequently diagnosed diseases
among others. For practice-centered investigations, issues that inhibit management practices such
as low morale, patient wait times, loopholes within policies, as well as poor communication
within the organization, should be explored. In so doing there is an increased tendency of
identifying areas within the healthcare organization process network that may need enhancement.
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 14
In essence, these practices are hoped to identify disparities within these process networks within
the organization.
Identification should have a direct datum for effective performance. As such, it is
encouraged that these determination efforts be centered on quality measures such as those from
government requirements, consultants and successful healthcare providers. Quality measures
could be obtained from entities like the Agency for Healthcare Research and Quality, National
Quality Forum and the Quality Payment Program.
Prioritization of areas of improvement should be based on the direct impact and
severity of the same on the performance of the healthcare entity. If an area to be improved has a
direct connotation with the patient experience or even patient welfare, then the same should be
considered a priority (Zavareh, 2017). Areas like communication within the healthcare entity
may not necessarily be considered a priority since the impact on the performance of the company
is indirect. After prioritization of these areas to be improved is established, the next prudent
action should be further exploration of the prioritized area.
Collection and Analysis of Data
The process of collecting and analyzing data begins during the determination and
prioritizing phase of the process. However, this stage only requires shallow investigation of the
problem, for the sole purpose of prioritizing. The real test of collecting and analyzing data comes
during the process of further exploration of the prioritized area. Often, qualitative and
quantitative exploration of this area, with the incorporation of meta-analysis is an accepted norm
(Ryu & Song, 2014). Indeed, the process of collecting and analyzing data is the most important
aspect of quality improvement. The data collected should be specific to the area explored,
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 15
measurable (because of already discussed reasons), realistic among other conventional data
requirements. If the data is not collected according to these guiding principles, the information
will not adequately represent the severity of the extent of the problem.
Also, the data analysis techniques, which mostly revolve around descriptive
statistics for both qualitative and quantitative data collected, should also be guided by the
principles of validity and relevance. Vulnerabilities such as bias by the quality improvement
team regarding the area under investigation should be mitigated (Siegel, 2013). Accurate
inferences from the data collected are the backbone and ultimate guiding principle surrounding
data analysis.
Data Presentation and Communicating Data Analysis Results
The communication of the results from data analysis should be conducted in a
transparent manner and inferences easily deduced. The data should be presented in a manner that
is easily understood since concerned stakeholders in the complex processes involved in
healthcare delivery stem from varied professional orientations. Often, process management
interventions in healthcare (quality improvement practices) do not necessarily revolve on clinical
practices involved in healthcare delivery. The main elements of this data analysis should be
conveying of relevant information such as the severity of the problem through descriptive
statistics, strategies for mitigating the problem such as project priorities, needs, expected results,
and relevant actions (Siegel, 2013). Such information should motivate the relevant stakeholders
to implement the said recommendations as to the practical aspect of the intervention.
Evaluation and Communication of Success
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 16
After the intervention is implemented, it is necessary and prudent for the people
tasked with implementation to investigate the success, or lack thereof, of the said intervention.
Evaluation criteria should be clearly defined, including measured determinants. If the project is
successful, based on the determinants of success, the project may be deemed to be successful,
and the success of the same can be communicated to other similar entities for the sole purpose of
transcending quality improvement within the industry.
The Applied Models in Quality Improvement
The models for quality improvement incorporate systematic and formal
frameworks for establishing relevant and prudent quality improvement practices. These models
are often centered on process management efforts and principles. As such, these methods are
conventionally accepted in other industries, even though they are essentially specific to
healthcare. As such, some of the models applied to quality improvement include:
The Model for Improvement or the PDSA (Plan Do Study Act) Approach
This approach is the most widely used model for quality improvement in
healthcare. The approach essentially combines two relatively popular quality improvement
models: the rapid-cycle improvement (RCI) and the total quality management (TQM) principle.
This approach was developed by the Institute of Healthcare Improvement in 1996. It essentially
makes use of a relatively rapid cycle process (the PDSA cycle). The main guiding principle of
the approach is using this rapid cycle process to investigate and determine the effects of small
changes in the processes on the overall performance of the healthcare system (Crowfoot &
Prasad, 2017).
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 17
The approach is intellectually initiated by asking three questions: what are the
problems of the current methods? How can these problems be mitigated? What are the
determinants of success when these mitigation efforts are implemented? Exploration of these
three questions should offer clarity on several pertinent issues regarding the mitigation effort
chosen. The first issue to be explored is the main aims and objectives of the intervention. The
desired outcomes should be specific and have a direct connotation with the problem. After a full
list of coherent and adequate interventions is made, the next pertinent issue should be the
exploration of the underlying methods and items of measurement. It is essential that the item of
measurement has a direct connotation with the aims and objectives. These items of measurement
should be directly formulated from the list of objectives. For example, if the objective of an
intervention is reducing errors in record keeping, the main item of measurement in response to
this objective should be an investigation of the number of reported cases of errors in record
keeping. After the items of measurement are established, the next prudent item of investigation
should be the adequate definition of the key changes that will be tested (Crowfoot & Prasad,
2017). In the example stated, the key aspect of change to be explored should be the significant
reduction of the number of reported errors in record keeping.
After these theoretical and conceptual bases of these interventions are developed
and adequately defined, the practical application of the identified intervention is executed via the
PDSA cycle. The first step of the cycle is the planning phase, which usually involves
determining logistical determinants, requirements, and details of the said intervention. The
resources required (budget and workforce required, as well as the skill set requirements of the
same) are usually the main aspect of the said intervention. Scheduling is also performed during
this phase. After planning, the actual execution of the intervention is carried out in the ‘do’ phase
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 18
of the cycle (Crowfoot & Prasad, 2017). This phase of the cycle should involve all practical
activities involved in the successful implementation of the intervention. It is vital for this phase
of the project to be grounded and guided by the planning phase of the intervention. However,
disparities may occur due to unforeseen uncertainties in the execution phase. After this phase is
complete, the next prudent phase is studying the intervention. Studying in this context is used to
describe the evaluation phase of the cycle effectively (Crowfoot & Prasad, 2017). The evaluation
usually involves research-based investigation of the intervention, based on success indicators
already discussed. After evaluation, the next phase in the cycle is action. The last phase of the
cycle involves the implementation of the recommendation of the evaluation phase. These
recommendations are based on the measured success rate of the intervention.
The Six Sigma Approach
This model, although not widely applied in quality improvement is still as
effective as the PDSA cycle approach. A model is a systematic approach that mainly aims to
reduce errors within healthcare processes (Ismyrlis & Moschidis, 2018). The approach mainly
incorporates statistical methods that are aimed at improving quality via minimization of variables
within the processes in healthcare that hurt the process.
In healthcare, the systematic methodology of this process revolves around the
DMAIC approach.
The first step in the implementation of this phase is a clear definition of
the problem in the process in question. This definition should be specific
and be measurable according to statistical standards. Also, in clearly
defining the problem, clear listing and exploration of the desired outcomes
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 19
in mitigating the problem, guided by the same requirements as the
problem statement should be developed (Ismyrlis & Moschidis, 2018).
After clear definitions of the problem and desired outcomes, investigation
of the current state of the process, more so on the severity of the problem
should be carried out. This investigation is carried out through
measurement of the quantifiable variables of the problem, which helps to
further develop inferences on the urgency and severity of the problem.
After the measurement, effective analysis of the data is necessary for
validation of the data, as well as determining the intensity and frequency
of the intervention that will adequately mitigate the problem.
After analysis, the next prudent step would be to develop interventions in
response to the analysis. These interventions are developed to improve the
process, by reducing the errors identified in the analysis and measurement
phase (Ismyrlis & Moschidis, 2018). This phase also involves all practices
and procedures that are necessary for successful implementation of the
intervention. The guiding principles of planning and implementation that
are applied in the PDSA cycle transcend to this method.
After improvement of the process is carried out (implementation) the last
step in the Six Sigma approach is controlling the intervention. Often, the
control process involves evaluation and response action to the intervention
(Ismyrlis & Moschidis, 2018). Evaluation, just like in the PDSA cycle, is
based on the measures of success of the intervention and adequate
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 20
responses to the success rate of the intervention are developed and further
implemented based on the same.
Conclusion
Indeed, quality improvement is a relatively old concept of healthcare delivery.
Active development and expansion of the same date back to as early as the 1940s. However, the
evolution of the same has transformed the conventional view and opinion regarding quality
improvement. General principles and concepts of quality improvements all stem from process
management in other industries. However, the actual application of quality improvement in
healthcare is specific due to the complexities of healthcare processes as well as the intellectual
requirements of the same (Grady, Redberg & O’Malley, 2018). As such, further development of
quality improvement approaches and models is necessary to improve further the quality of
healthcare delivered through quality improvements.
UTILIZING QUALITY IMPROVEMENT (QI) IN HEALYJCARE 21
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