A framework for improving quality. Using project study teams, Providence Health System tackles problem areas.

To identify issues for quality improvement and monitoring, an organization first articulates its service mission and objectives. The organization uses internal measurements and self-examination with external accountability and benchmarks to select a manageable number of projects for study. Supported by collected evidence, published data, and broad-based approval, projects focus on the process or outcomes of care, frequency of services, or patient populations. An accountable leader selects team members from the affected disciplines, who review evidence, agree on what and how to measure, determine implementation strategies, and develop an evaluation plan. The team meets established targets to track the project's progress and shares results with other teams. Providence Health System (PHS) his integrated its continuum of care through quality study groups (e.g., CORE) and improved communication systems. The Guideline Evaluation and Redesign (GEAR) projects compare PHS performance against outside standards, studying eight patient conditions (e.g., geriatric depression, hysterectomy) to decrease hospital days without compromising care. Each team is encouraged to develop guidelines for admission, discharge, and hospital care in their specialty areas. These projects are balanced between surgical and nonsurgical conditions and across clinical programs to engage different staffs. The PHS Population Health Improvement (PHI) teams used feasibility studies of eight patient populations to identify ways to improve quality of care based on internal and external evidence. The high-risk pregnancy team has redesigned staffing and implemented case management, and the Medicare and Medicaid projects have developed risk screens for new patient members.