Double loop learning and the quality of quality improvement.

BACKGROUND

Double loop learning, an attempt to question underlying organizational policies and goals, offers the possibility of making quality improvement (QI) efforts more productive. Joint Commission standards in the Improving Organizational Performance (PI) chapter of the Comprehensive Accreditation Manual for Hospitals regarding the measurement of important processes or outcomes related to patient care and organization functions seem to incorporate the principle of double loop learning.

IMPROVING PI PROCESSES

QI can be applied to five sets of PI processes: planning, designing, measuring, assessing, and improving. A composite case study is presented, in which a consultant used the PI framework to review a 300-bed state mental hospital's QI function. EXAMPLE--ASSESSING: When data are assessed, is the organization using tools such as run charts and process control charts correctly to understand sources of variation? Because QI and other hospital staff were unfamiliar with run and control charts, the consultant gave a brief introduction to variation and process control and helped them evaluate their data. The hospital's quality council voted to send two of its members, the directors of management information systems and QI, to a course on statistical process control and agreed to put in their QI plan and annual appraisal a reassessment of their needs for more staff to be familiar with statistical process control.

SUMMARY AND CONCLUSIONS

Taking an honest look at the value of QI within one's organization can lead to actual performance improvement instead of "paper" improvement. Indicators should be developed to assess and improve QI processes.