Continuous improvement evaluation process development

Most QI programs build upon an established quality assurance (QA) process. Quality assurance can be defined as a formal and systematic process in which problems in delivering health care are identified, solutions to the problems are developed and implemented, and follow-up monitoring then is carried out [30]. QA begins with problem identification. After possible sources of the problem are determined, solutions are developed and implemented. Then, the results of the intervention or solution are evaluated to determine whether or not the problem has been resolved. By incorporating a goal of continual improvement, a QA process can contribute to quality improvement activities. 

Efforts should be made to establish strategic alliances and to ensure joint development and the continuous improvement of products, processes, and systems. The company should ensure thorough review and evaluation of the performance of subcontractors in order to meet customer requirements. 

The management of process safety is many-faceted. The mitigation systems discussed in this book are only part of a total solution. Structured evaluation of chemical process safety is a process of continuous improvement that includes problem identification, development of proposed solutions, evaluation of solutions against established criteria, and, if appropriate, implementation of solutions. This approach is shown in Figure 1.1. 

Different metrics may be used to describe past performance, predict future performance, and encourage behavioral change. They are a means to evaluate the overall system performance and to develop a path toward superior process safety performance. This is accomplished by identifying where the current performance falls within a spectrum of excellent-to-poor performance. Such information will allow executives and site management to develop plans to address the specific improvement opportunities that could lead to measurable improvement in process safety. Good process safety metrics reinforce a process safety culture that promotes the belief that process safety incidents are preventable, that improvement is continuous, and that policies and procedures are necessary and will be followed. Continuous improvement is necessary and any improvement program will be based on measurable elements. Therefore, to continuously improve performance, organizations must develop and implement effective process safety metrics. 

In 1999, the Board of Commissions established an Oversight Task Force for the Accreditation Process Improvement (API) Initiative. The purpose is to oversee the continuous improvement in the accreditation process. The resulting changes are intended to enhance the evaluation of critical patient safety and patient care functions and to achieve an accreditation process that remains consultative and focused on performance improvement. A white paper was published outlining a future operational model that will continue to build and expand on technology, performance data, presurvey self-assessments, a fully automated interface with JCAHO, increased surveyor development, and a more continuous accreditation process. Instead of a once every 3 years site visit, two 18-month site visits would occur that evaluate select standards. In addition, since health care entities are so diverse, there is a desire to create a model that is more data driven, less predictable, and more customized to an individual organization. 

As mentioned earlier, the process of continuous improvement can incorporate a variety of activities designed to achieve even better safety. This process involves developing key elements from which performance can be measrrred. Work teams are encouraged to develop strategies which are time limited, to meet the given key elements. This process should be evaluated at frequent intervals and progress in continuous improvement fed back to the work team for strategy review. 

On the other hand, numbers that measure the quantity and quality of process activities related to safety performance provide the context needed to motivate individual and team responsibility. They direct continuous improvement of the process. Chapter 19 in Section 6 of this Handbook presents more details on developing a process-based evaluation system for continuously improving safety. The following chapters in Section 5 recommend a variety of additional strategies for cultivating a work culture that promotes actively caring behavior. 

The coaching process detailed in Chapter 12 also discussed how to develop and apply both generic and job-specific checklists for one-on-one observation and feedback sessions with coworkers (see Figures 12.9 and 12.10). As mentioned previously, using a behavioral checklist to observe and evaluate ongoing work practices is the type of performance appraisal that can lead to continuous improvement. 

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