National Standards Assessment Program
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Continuous Quality Improvement

Continuous quality improvement (CQI) is a planned way of improving quality of care for patients and carers, step by step and over time.

The National Standards Assessment Program (NSAP) uses the plan-do-study-act (PDSA) cycle to support improvement effort. In essence the PDSA cycle is an inductive learning model – the growth of knowledge through making changes and then reflecting on the consequences of those changes.

The science in PDSA is in the act of reflection, and learning from what one observed and did. 

There are 5 steps to the Continuous Quality Improvement (CQI) Phase of the NSAP Cycle

Step 13: Organise quality improvement (QI) planning meeting to create an outline of a QI action plan

  • Bring to this meeting SPECIALIST PALLIATIVE CARE SERVICE strategic plan, NSAP Interim report, relevant quality resources and latest research evidence relevant to KIAs

Step 14: Develop the QI action plan or integrate it into an existing service QI action plan, uploads to their NSAP Service web page and the Liaison Officer receives a NSAP CQI kit.

Step 15: Implement the QI action plan and discuss a peer mentor visit.

Step 16: Learn about how to implement change in your Service. Consider attending a CQI collaborative workshop or CQI webinar.

Step 17: Include the QI action plan as a regular agenda item at team meetings. 

Step 18: Continue to work on the activities in  the QI action plan until self assessment is due in 18 months.

Improvement methods

Langley, Nolan and Nolan developed a simple model for achieving changes that are improvements (figure 1). Nolan’s model comprises three basic questions and a fourth element that describes a cycle of testing innovation.
The improvements implied in Nolan’s model are not large, precisely designed tests and trials that take months or years. Rather they are rapid, small, clever informative cycles. Large scale improvements come as the small scale cycles are linked cumulatively to each other within and across organisations.
Model for Improvement
What are we trying to accomplish?
That is, what is the aim
How will we know that a change is an improvement?
That is, what do we need to measure
What change can we make that will result in an improvement?
 Figure 1: A model from improvement from Langley, Nolan and Nolan1
Quality improvement culture
There needs to be certain factors in place for an organisation to be able to optimally utilise the PDSA model in making changes. These contribute to the quality improvement culture and provide the frameworks and systems that are required to support NSAP. These factors are known to contribute to success.
Action plan implementation
To ensure that NSAP is part of a cycle of CQI it is important to act upon the opportunities for improvement that have been identified in the self assessment. This involves the development of a quality improvement action plan which contains the key components required to enable the key improvement to be implemented.
Breakthrough series (BTS) collaborative model
The BTS, developed by the Institute for Healthcare Improvement (IHI)2, is a learning system that brings together a large number of teams from different services to seek improvement in a focused topic area3 over a defined period of time. It is an effective means of capturing and rapidly spreading new ideas and best practice in health care. This is achieved by sharing ideas that work,  testing via PDSA rapid cycles and an organised approach, enabling improvements in outcomes for patient care through changes in practice. 
NSAP has piloted this model with 20 services from across Australia from May – December 2011 and completed the NSAP Collaborative Improvement Project – Assessment and Care Planning.
1. Langley, G.L., Nolan, K.M., Nolan, T.W. (1992) The foundation of improvement. Silver Spring MD. API Publishing.
2. Institute for Healthcare Improvement (2003) The Breakthrough Series – IHI’s Collaborative Model for Achieving Breakthrough Improvement. Innovation Series 2003.
3. Schouten, L.M.T., Hulscher, M.E.J.L., Everdingen.J.J.E., Huijsman,R., Grol,P.T.M. (2008) Evidence for the impact of quality improvement collaboratives: systematic review. British Medical Journal, 24 June: 1 – 9.


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