Implementing a 4C Approach to Quality Improvement.

Designing a quality improvement activity can be labor intensive and intimidating to facilitators who have not been specially trained in process improvement methodologies. To simplify the process, a team was formed with the specific task of developing a basic model that addresses key concepts in change theory. The 2010 Institute of Medicine report stresses the importance of health care professionals working together, collaboratively, to use data to improve patient outcomes and improve care nationally. In addition, as noted in Quality and Safety Education for Nurses (2013), competencies have been developed to promote frontline problem solving including using data for quality improvement, providing safe care, functioning in collaborative teams, respecting and addressing patient and family concerns, applying evidence-based practice, and using informatics to make decisions. The team completed a search of the literature on change theory to identify the factors that are imperative to address when initiating a process improvement cycle. Kotter's Model of Change provided direction and guidance on the creation of the 4C model, which involves centering on issue, collaborating with team members, using the change process, and celebrating successes. This model has been implemented in a multihospital system as a framework for process improvement with such initiatives as preventing hospital-acquired infections, implementing patient safety initiatives, and addressing human resource concerns such as turnover and patient satisfaction.