Rubenstein L V, Fink A, Yano E M, Simon B, Chernof B, Robbins A S
Center for the Study of Healthcare Provider Behavior, Sepulveda Veterans Affairs Medical Center (VAMC), CA, USA.
Jt Comm J Qual Improv. 1995 Aug;21(8):420-32. doi: 10.1016/s1070-3241(16)30170-5.
Successful implementation of modern ongoing quality improvement (QI) methods requires investment of institutional resources, but can produce significant improvements in medical care. A health care organization's goals and objectives for improving care are expressed in strategic plan documents, which could provide a framework for planning quality improvement initiatives. However, institutional strategic planning processes are often not well linked to QI staff and resources. We developed the Quality Action Program (QAP) to connect QI to strategic planning.
In 1991, Sepulveda VHAMC implemented a major primary care initiative, documented in a comprehensive strategic plan. The QAP was developed to enable the initiative to be evaluated within a QI context. THREE-ROUND EXPERT PANEL PROCESS: To carry out the QAP, members of an institution's quality council engage in a structured consensus process. The first round involves reading educational materials and filling out a quality action survey the second round includes participation in an expert panel meeting, and the third round involves making final priority rankings. EIGHT-STEP QAP IMPLEMENTATION PLAN: QI staff carry out activities to prepare for and carry out the three-round expert panel process.
QAP induced significant institutional QI activity directed toward achieving the top-ranked QI criterion--ensuring continuity of care. Continuity of care improved significantly over time between the pre- and post-QAP periods.
Expert panel methods can be used to link strategic plan goals and objectives to QI efforts.
成功实施现代持续质量改进（QI）方法需要投入机构资源，但能显著改善医疗服务。医疗保健组织改善护理的目标和目的在战略计划文件中有所体现，这些文件可为规划质量改进举措提供框架。然而，机构战略规划流程往往与QI人员和资源联系不佳。我们制定了质量行动计划（QAP），以将QI与战略规划相联系。
1991年，塞普尔韦达退伍军人医疗中心实施了一项重大初级保健举措，并记录在一份全面的战略计划中。QAP的制定是为了使该举措能够在QI背景下得到评估。三轮专家小组流程：为实施QAP，机构质量委员会成员参与结构化的共识流程。第一轮包括阅读教育材料并填写质量行动调查问卷；第二轮包括参加专家小组会议；第三轮包括进行最终的优先排序。八步QAP实施计划：QI人员开展活动，为三轮专家小组流程做准备并实施该流程。
QAP引发了显著的机构QI活动，旨在实现排名最高的QI标准——确保护理的连续性。在QAP实施前后的时间段内，护理连续性随时间显著改善。
专家小组方法可用于将战略计划目标与QI工作相联系。
