Researchers believe many quality improvement efforts don’t improve quality

Quality improvement (QI) is advocated as one way of addressing problems with healthcare. But this report from RAND researchers finds its effectiveness is still showing mixed results. The reasons for this, it explains, is that QI is done in isolation, or at a local level. Therefore, it fails to pool resources, develop collective solutions or introduce new hazards in the process. The research highlights four key challenges in implementing QI efforts.

1. QI work continues to be undertaken in the form of time-limited small-scale projects, perhaps conducted as part of professional accreditation requirements.
2. Multiple ill-coordinated small-scale QI projects may degrade rather than improve the ability to achieve improvements across healthcare as a whole. As attention shifts from one project to another, the gains achieved in the first project may attenuate.
3. Those who introduce local QI interventions are sometimes so convinced that the change introduced is positive that they may avoid an evaluation.
4. A further challenge lies in the emphasis on specific interventions as the keys to QI, particularly when interventions are considered to be magic bullets. Huddles, checklists and other tools risk overlooking the impact of context on implementation and more importantly, the critical role of context as generative of safety and quality.