From Our Print Archives

Continuous Quality Improvement

Using a systems approach

Vol. 27 • Issue 6 • Page 11


Continuous Quality Improvement (CQI) is an ongoing effort to improve services or processes. It seeks to obtain incremental improvement over time.

Considered the brainchild of W. Edward Deming, a statistician who worked in Japan following WWII, CQI is the business model that turned "Made in Japan" from a derisive label to one of high quality. Deming saw the model as a system whereby feedback from the process and customer were evaluated against organizational goals.

But the fact that it can be called a management process does not mean that CQI needs to be executed by management. It simplifies decisions about the design and implementation of the delivery process.

A systems approach to CQI can be adapted to almost everything we to as health care providers in terms of improving outcomes through teamwork and processes. The following outline simplifies the systems approach:

Quality of Care


The clinical/leadership teams ascertain what areas of clinical programming they believe fall short of the company's expectation.

For instance, Sunny Days Health Care Community provides rehab screens to its long-term care residents per protocol. However, we do not see the number of LTC residents receiving therapy services that we believe therapy should be seeing for the number of reported falls.

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ISC Application:

In order to validate the assumption, you need a method in place to retrieve data and trends. The inpatient coordinator implements the Rehab Screen Tracking Form. By consistently tracking referrals and rehab screens, the results will either support or negate the assumption. Innovative Senior Care (ISC) Rehab Screen results are monitored for 30 days. Outcome results show that 10 therapy rehab screens were provided in a one-month span secondary to falls. Of the 10 falls, two residents converted to services for a 20-percent conversion percentage. This statistic supports the assumption.

Set a New Benchmark/Goal

Collectively determine a reasonable goal.


The coordinator and therapists set a goal for a 50-percent conversion percentage. Collectively brainstorm and identify new strategies to achieve the desired goal.

The therapy team identifies the following clinical strategies:

• All rehab screen visits will be conducted by two clinicians /multidisciplinary for all falls (PT/OT).

• ISC will fully incorporate the falls screen form (timed scores yield greater sensitivity results than observation or subjective responses).

• The follow-up delivery of therapy services will specifically focus on the areas triggered from the rehab screen.

• Room modifications are implemented.

Educate All ISC Therapists


The therapy coordinator reviews the enhanced strategies with the health care administrator and other community stakeholders. During the next staff meeting, the enhanced strategies are reviewed and agreed upon.

Monitor, Document and Communicate Incoming Data


Through consistent monitoring of fall rehab screen requests and rehab screen outcomes, therapy successfully converted four residents of 10 fall rehab screens for a 40-percent conversion percentage. Although not at goal, therapy is moving closer to the target.

Re-engineer and Implement Additional Strategies as Identified


The therapy team identified and implemented an additional strategy:

• The therapy coordinator led additional team-building and role-playing.

• There was regular team review of Quality Indicator reports.

• Speech-language pathology will also screen fall-risk residents.

Report Updated Statistical Results and Trending


In the second month, therapy reports a 45-percent conversion percentage, and this is maintained for the balance of the year. The coordinator and team hold the 50-percent conversion goal for the next year.

A systems approach to CQI is systematic, logical and promotes clinician ownership. It offers opportunities for celebrating team successes while the ultimate benefit is appreciated by our resident population. 

Marlin G. Gatty, MPM, OTR/L, is regional director of Innovative Senior Care - Brookdale Senior Living, in Brentwood, TN.


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