Quality Improvement and Patient Safety
What to know
Quality improvement and patient safety tests frameworks for measuring and improving care. Candidates must know Donabedian's model - structure, process, and outcome - and the Institute for Healthcare Improvement (IHI) Model for Improvement using Plan-Do-Study-Act (PDSA) cycles. Understand Lean and Six Sigma basics, root cause analysis (RCA) for sentinel events, and failure mode and effects analysis (FMEA) for proactive risk assessment.
Know the difference between quality assurance (retrospective, compliance-focused) and quality improvement (prospective, systems-focused). Understand patient safety concepts: adverse events, near misses, never events, the Swiss cheese model, and a just culture. Be familiar with measures such as mortality, readmissions, hospital-acquired conditions, and patient experience (HCAHPS).
Traps
Questions often confuse RCA (reactive, after an event) with FMEA (proactive, before an event). Another trap is attributing outcomes to structure - structure is capacity (staffing, equipment), process is what is done, outcome is the result. Watch for just culture options that blame individuals for system failures.
Worked example / rule of thumb
Rule of thumb: RCA after, FMEA before. If a sentinel event occurs, conduct an RCA. If a new process is being designed, conduct an FMEA. For improvement, use PDSA: Plan a change, Do it on a small scale, Study the results, Act to adopt or adjust.