Differences |
Differences |
Differences |
Inspiration for Change |
Top-down from administration often using
analyses of large datasets. |
Bottom-up from self-organizing
self-learning independent, but interconnected, agents. |
Selecting Measures of Success |
System administration or payers select
approved single-disease (often) outcome targets vetted by influential
organizations (National Quality Forum, e.g.) |
Single-disease measures
are often recognized as inappropriate for complex systems trying to
provide patient-centered care. Health services or health system
measures, such as better use of clinic vs. urgent/emergency facilities,
may be more meaningful. |
Setting Target Goals |
Administration selects numerical goals often
based on best practices or results reported by “centers of
excellence.” Six sigma level outcomes often expected. |
There is no
absolute numerical target to define success, only a sense of making the
current situation better. Front-line clinicians realize their efforts
could be influenced by numerous forces not in their immediate control,
making a single numerical target meaningless. |
Selecting Specific Processes to Improve |
Front-line personal are
expected to rigidly and consistently apply best practices that may
change slightly in subsequent PDSA* cycles. |
Agents that evolve in
their understanding of an issue could change every aspect of the
project, including who else is asked to help, the processes that are
changed, and even the ultimate goals of the project. |
Naming QI Priorities |
System administration or payers declare a list of
possible improvements and prioritizes QI projects based on practical,
financial, and political factors. |
Priorities are set by front-line
caregivers and their immediate working partners also based on numerous
factors, but largely driven by their own sense of what is most important
at that time. |
Organizational Buy-In and Reporting |
Regular organizational meetings
with all members expected to participate and receive regular reports of
the most recent analyses. |
The top levels of the organization may or
may not be asked to buy-in and participate in QI activities for a
particular project. Involved agents self-learn, self-organize, and
evolve in their understanding of the contributing agents and forces
influencing their goals. |
Recognition and Rewards |
Organizations and their subunits are
extrinsically recognized and rewarded to help motivate front-line
workers to improve processes. |
Successful projects may be rewarded post
hoc, but the motivation to improve systems is more
intrinsic. |
Similarities |
Similarities |
Similarities |
Data |
Data are needed at several times over the life of the project,
which will often require support from IT or financial personnel (billing
or encounter data). Traditional QI utilizes reports updated on a
regularly scheduled basis, complex QI perhaps less so. |
Data are needed
at several times over the life of the project, which will often require
support from IT or financial personnel (billing or encounter data).
Traditional QI utilizes reports updated on a regularly scheduled basis,
complex QI perhaps less so. |
Resources |
Except for the relatively rare and simple “low-hanging
fruit” successes, resources are required to enable people improving
care to have the time and space to work on the specific QI project
separate from direct patient care, often for both the immediate project
and its long-term stability. |
Except for the relatively rare and simple
“low-hanging fruit” successes, resources are required to enable people
improving care to have the time and space to work on the specific QI
project separate from direct patient care, often for both the immediate
project and its long-term stability. |
Multi-disciplinary |
Solutions most always include more than one type of
clinician on the healthcare team and often include non-clinicians. |
Solutions most always include more than one type of clinician on the
healthcare team and often include non-clinicians. |
Processes not People |
The classic Deming philosophy that poor quality
is almost always the result of poor processes, not bad employees, is
true for both traditional and complex QI work. |
The classic Deming
philosophy that poor quality is almost always the result of poor
processes, not bad employees, is true for both traditional and complex
QI work. |