A Blueprint for Health Care Leaders to Implement Quality Improvement Efforts

Doctor in a face mask taking notes in a notebook

Women are dying in childbirth. Medication compliance is low among some populations. Hospital-acquired infections are on the rise in surgical units. People have long wait times to be seen in emergency departments.

This is just a sampling of the myriad of challenges facing health systems today. Health care leaders and providers who are well-versed on the science of improvement are best positioned to solve such problems effectively, says M. Rashad Massoud, MD, MPH, FACP, Harvard T.H. Chan School of Public Health visiting lecturer at the Department of Global Health and Population and the Francois-Xavier Bagnoud Center for Health and Human Rights, as well as Program Director of Health Care Quality Improvement: From Design to Implementation at the Center for Executive Education.

Yet, Massoud points out that many leaders who recognize the importance of providing quality care, struggle with bridging the gap between knowing about it and doing it in the most effective way.

Following Proven Quality Improvement Principles

Massoud suggests that health care leaders look to the science of improvement, which is an applied science that combines several elements together into a comprehensive approach to managing quality improvement efforts. This includes an appreciation of a system and an understanding of how the parts all relate to one another, recognition of the variation that is a natural part of the system’s processes, an understanding that theory is needed to apply scientific approaches into improvements, and an appreciation of psychology to understand how different characteristics impact the system. These elements can serve as a framework to help organizations improve their quality while, at the same time, reducing costs.

Massoud offers the following five practical steps that build on these key concepts and can help leaders improve their organization’s own efforts:

  1. Identify the problem. “All improvements start with an aim. You need to clarify that aim in an easy-to-understand way,” Massoud says.
  2. Consider measurable solutions. “Once you have an objective, you can ask yourself how to achieve it and how best to measure the results. For instance, we can look at an example of a patient who undergoes a specific procedure and gets an infection, or the proportion of women who deliver babies in your hospital and have a postpartum hemorrhage,” he explains. After you apply an intervention, how do the rates of affected people change?
  3. Focus on the process of implementing your solution. Massoud stresses that the “how” is as important as the “what,” in order to achieve measurable results that can be replicated. “What I have found over and over again is that health systems don’t have a lack of evidence, treatments, or interventions that can save lives and alleviate suffering; it’s a lack of implementing these approaches in a reliable way that can make them less effective. Consistency is needed to ensure that every patient gets the treatment or intervention every time it’s needed to improve the outcome,” he says.
  4. Utilize the Plan, Do, Study, Act Cycle. Massoud suggests that leaders look at implementing improvements using proven change models such as the Plan, Do, Study, Act (PDSA) cycle to get the best results. “When you try an improvement through the PDSA cycle, you can initially test each intervention on one patient, to figure out if it works or doesn’t work, and then figure out if it needs to be modified,” he says. If you find the approach is effective, then you can progress to scale it for more patients and test it again. If it still works, you can continue to move it from one unit to another unit to see if it works across locations and populations, then across the entire hospital. “It’s really about testing the changes and building the degrees of confidence that this change works and under what circumstances,” he says.
  5. Be flexible to adapt the details to fit different situations. It’s important to understand that not all changes will work equally. “We have to accept that in a real project, something that works in one place and one way may look slightly different in another place in order to get the same results,” he says. This means that leaders need to stay flexible so they can adapt to a change or intervention so it can work for each specific situation.

When health care leaders follow such proven quality improvement steps to address pressing problems, Massoud says that they can ultimately help their organizations improve patient outcomes and become more cost effective.

Harvard T.H. Chan School of Public Health offers Health Care Quality Improvement: From Design to Implementation, an online program that will take you through the journey of implementing an improvement project that leads to results.