Chapter 17

At the end of the chapter, the reader will be able to:

1. Identify the key steps in a quality improvement process.

2. Apply the quality improvement process with real-world examples.

3. Assess the challenges in applying the quality improvement process in pharmacy settings.

Continuous Quality Improvement or CQI is a process improvement technique that focuses on improvement efforts by identifying root causes of problems, intervening to reduce or eliminate these causes, and reassessing the process. The never-ending CQI process recognizes that the majority of problems result from a failure in the process of providing the service (systems issues), as opposed to being attributable to the providers themselves. In this manner, CQI empowers health care providers to improve quality on a daily basis.

Many CQI models exist. Examples of specific models include the PDCA model that stands for plan, do, check, and act, and the FOCUS-PDCA model, which is a nine-step model that incorporates the words find, organize, clarify, understand, select, plan, do, check, and act. The Six Sigma model is also a well-known business management strategy whose use is widespread in many sectors of industry today. Suffice it to say that there are many CQI models and that all include elements that reflect the following core concepts: (1) plan, (2) design, (3) measure, (4) assess, and (5) improve. CQI has been described as a practical application of the scientific method since both processes are similar. With this being said, one can think of the steps in the CQI cycle as parallel to the information found in the sections of a scientific article: background, methods, results, conclusions, and recommendations. A visual representation of the sections of a scientific article can be seen in Figure 17-1.

###### Figure 17-1.

A visual representation of the steps in the CQI process.

This chapter will describe the CQI model and explore its use in pharmacy practice. The chapter will review examples of how pharmacists can use CQI to increase quality in pharmacy practice.

The following discussion of the CQI process is provided as a review; a more thorough discussion can be found in Chapter 5. A worksheet to guide you through the process is also found in Chapter 5.

When doing background work, it is important to investigate the issue to ensure you know and are able to define the following:

1. What is the problem? You need to be sure you are working on the right problem.

2. Why is the problem a problem? That is, why is the problem worthy of your attention?

3. What solutions have been tried? This is important and can be derived from the literature. If someone else has tried a solution and it has worked, the same solution may be able to be adapted for your practice setting.

4. State the global ...

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