You’ve probably been doing it your entire career: Aiming for the elusive but invaluable Quality Improvement. “When we implement a change to make our practice safer, smarter, more efficient, and better for our patients, we are really practicing quality improvement,” says Margo J. Reeder, M.D., assistant professor with the department of dermatology at the University of Wisconsin School of Medicine and Public Health.
Now, Quality Improvement, or QI, has a name and a bigger role in practices of all types. “The changing landscape of healthcare payment and reimbursement has brought quality improvement to the leading edge of our practice,” Dr. Reeder says. “As the country shifts to value-based healthcare, QI and outcomes will become a central part of what makes a ‘good’ dermatologist. By understanding the process for quality improvement, dermatologists can demonstrate their good work using valid quality improvement methods.”
Dr. Reeder and her co-presenter, Daniel D. Bennett, M.D., discussed QI in an interview with Dermatology Times before their presentation about the topic at the summer meeting of the American Academy of Dermatology in Boston.
QI may sound like a fuzzy buzzword or something that’s simply obvious—try to do a better job. But there’s more to it than that, says Dr. Bennett, vice chair of Clinical Affairs with the department of dermatology at the University of Wisconsin School of Medicine and Public Health. It even has a history.
The quality improvement movement largely arose in as a way to improve manufacturing processes, he says. “Patient care is obviously very different from manufacturing, but there are many elements in health care that are amenable to improvement through QI processes like PDSA” — Plan-Do-Study-Act.
Plan-Do-Study-Act, says Dr. Bennett, “is a tool to implement and study small changes which produces significant improvement in a system.”
Here are the four parts of PDSA:
Plan — What question are you trying to answer?
Do — What happened?
Study — How did what happened compare with the plan?
Act — What is the next step?
“These ‘small tests’ can help you try out several different possible options on the course to developing a new process,” Dr. Reeder says. “A PDSA cycle is a limited trial, and the process of quality improvement involves many PDSA cycles.”
For example, “a PDSA cycle can be as simple as placing exam gloves in a new corner of the room or testing out a new camera to take biopsy site photos,” Dr. Reeder says.
A PDSA cycle is also limited, meaning the trial may be a success and could lead to other creative solutions. Or it could reveal unseen consequences which must also be taken into account.
How can practices embrace QI overall?
It’s important to understand that “real QI work” is not simply a way to follow regulations, Dr. Bennett says. “There may be some overlap between QI work and regulatory requirements, but QI must be motivated by a desire to improve patient care, lower costs, and create a fulfilling work environment.”
In his academic center, he says, “we are using QI processes, for example, to create uniform processes to improve clinic efficiency and patient safety. In my experience, many private practices excel in these areas, but with decreasing payments and increased regulatory burden, all practices will be challenged to improve efficiency without sacrificing patient care.”
Disclosures: Dr. Reeder and Dr. Bennett report no relevant disclosures.