Hogg Sandra, Roe Yvette, Mills Richard
Institute for Urban Indigenous Health, Bowen Hills, Queensland, Australia.
JBI Database System Rev Implement Rep. 2017 Jan;15(1):178-187. doi: 10.11124/JBISRIR-2016-003233.
The Institute for Urban Indigenous Health believes that continuous quality improvement (CQI) contributes to the delivery of high-quality care, thereby improving health outcomes for Aboriginal and Torres Strait Islander people. The opening of a new health service in 2015 provided an opportunity to implement best practice CQI strategies and apply them to a regional influenza vaccination campaign.
The aim of this project was to implement an evidence-based CQI process within one Aboriginal Community Controlled Health Service in South East Queensland and use staff engagement as a measure of success.
A CQI tool was selected from the Joanna Briggs Institute Practical Application of Clinical Evidence System (PACES) to be implemented in the study site. The study site was a newly established Aboriginal and Torres Strait Islander Community Controlled Health Service located in the northern suburbs of Brisbane. This project used the evidence-based information collected in PACES to develop a set of questions related to known variables resulting in proven CQI uptake. A pre implementation clinical audit, education and self-directed learning, using the Plan Do Study Act framework, included a total of seven staff and was conducted in April 2015. A post implementation audit was conducted in July 2015.
There were a total of 11 pre- and post-survey respondents which included representation from most of the clinical team and medical administration. The results of the pre implementation audit identified a number of possible areas to improve engagement with the CQI process including staff training and support, understanding CQI and its impacts on individual work areas, understanding clinical data extraction, clinical indicator benchmarking, strong internal leadership and having an external data extractor. There were improvements to all audit criteria in the post-survey, for example, knowledge regarding the importance of CQI activity, attendance at education and training sessions on CQI, active involvement with CQI activity and a multidisciplinary team approach to problem solving within the CQI process.
The study found that the implementation of regular, formally organized CQI strategies does have an immediate impact on clinical practice, in this case, by increasing staff awareness regarding the uptake of influenza vaccination against regional targets. The Plan Do Study Act cycle is an efficient tool to record and monitor the change and to guide discussions. For the CQI process to be effective, continued education and training on data interpretation is pivotal to improve staff confidence to engage in regular data discussions, and this should be incorporated into all future CQI sessions.
城市原住民健康研究所认为，持续质量改进（CQI）有助于提供高质量的医疗服务，从而改善原住民和托雷斯海峡岛民的健康状况。2015年一家新的健康服务机构开业，为实施最佳实践CQI策略并将其应用于区域流感疫苗接种活动提供了契机。
本项目的目的是在昆士兰州东南部的一家原住民社区控制健康服务机构内实施基于证据的CQI流程，并将员工参与度作为成功的衡量标准。
从乔安娜·布里格斯研究所临床证据系统实际应用（PACES）中选择了一个CQI工具在研究地点实施。研究地点是位于布里斯班北郊的一家新成立的原住民和托雷斯海峡岛民社区控制健康服务机构。本项目利用在PACES中收集的循证信息，针对已知变量提出了一系列问题，这些变量导致了经证实的CQI应用。采用计划-执行-研究-行动框架进行的实施前临床审计、教育和自主学习，共有7名工作人员参与，于2015年4月进行。2015年7月进行了实施后审计。
共有11名调查前后的受访者，包括来自大多数临床团队和医疗管理部门的代表。实施前审计的结果确定了一些可能需要改进的领域，以提高对CQI流程的参与度，包括员工培训和支持、理解CQI及其对各个工作领域的影响、理解临床数据提取、临床指标基准、强大的内部领导力以及有一名外部数据提取人员。调查后的所有审计标准都有改进，例如，关于CQI活动重要性的知识、参加CQI教育培训课程、积极参与CQI活动以及在CQI流程中采用多学科团队方法解决问题。
研究发现，定期、正式组织的CQI策略的实施确实会对临床实践产生直接影响，在本案例中，通过提高员工对针对区域目标接种流感疫苗的认识。计划-执行-研究-行动循环是记录和监测变化以及指导讨论的有效工具。为使CQI流程有效，关于数据解读的持续教育和培训对于提高员工参与定期数据讨论的信心至关重要，这应纳入所有未来的CQI会议。
