Continuous quality improvement: adaptation of the 10-step model with postanesthesia care unit application.

In the 1986 Agenda for Change the Joint Commission on Accreditation of Health Care Organizations (JCAHO) introduced a systematic conversion changing the blueprint for quality from quality assurance to continuous quality improvement (CQI). CQI is an evolutionary philosophy that incorporates leadership concepts from total quality management. It includes substantial changes regarding quality to be initiated by leaders of health care organizations. Ultimately, a commitment to quality and continuous improvement by all personnel is essential. The JCAHO is facilitating this transition through annual revisions in accreditation standards. CQI standards and indicators focusing on patient processes and outcomes are to be finalized in the 1994 Accreditation Manual for Hospitals. Monitoring and evaluation to assess quality and improvement remains intact as an integral part of CQI. Standards furnish the basis for measuring and assuring quality. The Marker Model provides clear, concise descriptions of all types of standards and their use in assuring quality. The 10-step model is an organized method developed by JCAHO to monitor compliance with standards and to evaluate improvement. The framework for this monitoring model uses a multidisciplinary approach achieved as a result of the effort and expertise of caregivers. The 10-step model, now in transition at Tri-City Medical Center, is described with application to the PACU.