Monday, 30 January 2012

Hemadri's Four Fundamental Questions for Clinical Quality Improvement

Hemadri's 4 fundamental questions for Clinical Quality Improvement

1) Do you have local clinicians' agreement on clinical healthcare delivery? (Doing the same thing by all professionals in the same manner for the same condition)

2) Are you measuring the right things in the right manner? (Measuring process and outcomes over time)

3) Do you have a human approach to leadership and management? (In other words do your staff love you, do your patients love you? Working with and enjoying ambiguity and limitations)

4) Can you prove meaningfully that you have shared to others and you have learned from others within your organisation? (Proof that every individual does whole system improvement)

To some of you these four questions might sound like cliches. To some of you these might be stating the blindingly obvious. The questions are not 'lay'; they are highly technical questions with strong theories and some practical examples behind them. There are specific and explicit frameworks, methods and techniques to explore these questions and then to make them happen.

There is a general impression that healthcare does all the four well; especially if you work in healthcare you may be tempted to answer 'Yes' to all the four questions. You may even proceed to argue and 'prove' it. There is much evidence that healthcare in general lacks all the above four. The chances are it will be surprising if many areas of healthcare delivery had even one of these. But once these questions can be answered with a real 'Yes' healthcare leaps into a bright better zone.

Success in Healthcare can be found only if the the answers to all the four questions can be a clearly demonstrated 'YES'.

We explore these at the CQI to some extent. I am hoping that over a period of time I should be able to blog about these things in specific detail rather than in broad general terms. Perhaps even write a book.

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chandu said...

You have raised very pertinent questions. The piece is also very well written. With patient-orientated approach that has been promulgated the answer to the first question cannot be a Yes. Although the conditions may be the same, the patients are different and so will be their management. We do have local and national guidelines in place but I have often found it difficult to translate them to each and every patient alike. Should patient's opinion be included in the assessment of CQI? Nice work Hemadri.

HEMADRI said...

Thanks Chandu.
Patients will be different of course, will all clinicians agree to manage those differences in the same way is the question. So patient generated differences - allowed; clinician generated differences - 'not allowed'.
I will write about local and national guidelines soon; I share your frustration.
Patients opinion is essential to CQI and is included in my 3rd question. If our patients don't 'love' us, it means we have work to do