Continuous Quality Improvement

Programs that encourage quality improvement are essential to all organizations, including those involved in health care. The principal is that each decision and task be undertaken correctly the first time and all of the time.

Perfection, however, is a largely unattainable goal in simple systems, let alone in complex biological systems modulated by considerable individual variability in observation and responses to treatment. The principle of continuous quality improvement in clinical medicine is to ensure that patients with defined clinical characteristics be managed according to clinical guidelines derived from the highest possible scientific evidence.

This process is an example of the scientific method:

    1. Ask questions about the quality of care
    2. Formulate a hypothesis
    3. Test the hypothesis with an experiment
    4. Collect Data
    5. Interpret the data
    6. Use the results to change care and behavior
    7. Use the observations made of the change to develop the next hypothesis

This process has been shown to imporove the utilization of appropriate treatments and avoid the utilization of ineffective or inappropriate treatments. Improvement in outcome is usually realized and, on occasion, costs can be reduced.

Quality Improvement programs, such as ACS-GAP, have shown a better application of proven therapies and greater adherence to clinical practice guidelines. In large studies this strategy is associated with improved outcomes, including a reduction in mortality. In our institution the initiation in the ACS-GAP program was followed by a reduction of re-admissions following cardiac events.

A project in quality improvement is required as part of the Cardiology Training Program, as it provides structure to achieve many of the goals outlined by CanMeds.