Quality Improvement and Patient Safety
Quality improvement and patient safety tests the methods used to measure, analyze, and improve care and to build safer systems. Questions ask you to choose a framework, interpret variation, and avoid blame-oriented responses to error.
Frameworks and measures
- The Model for Improvement sets an aim, measures, and changes, then tests with PDSA cycles.
- Donabedian's model classifies structure, process, and outcome measures. Use process measures to see whether the change is working before outcomes move.
- Run charts and control charts separate common-cause from special-cause variation. Do not tamper with common-cause variation.
- FMEA is proactive and scores severity, occurrence, and detection to prioritize risk. RCA is reactive. Trigger tools screen records for possible harm.
Safety culture
- Just culture distinguishes human error, at-risk behavior, and reckless behavior. Blame suppresses reporting.
- High reliability organizations show preoccupation with failure, reluctance to simplify, sensitivity to operations, resilience, and deference to expertise.
- Closed-loop communication, standardization, and checklists reduce reliance on memory.
Worked example
A team aims to cut CLABSI by 50% in six months. Reasoning: it tracks bundle compliance as a process measure and CLABSI rate as an outcome measure. A PDSA test adds a daily line checklist. A run chart shows a shift after eight points. The team checks balancing measures such as delays, then sustains with audit and feedback.
Traps
Measuring only outcomes; blaming individuals; using averages that hide variation; small samples; no balancing measures.