Essentials of Nursing Leadership and Management, 5th Edition

136 unit 2 | Working Within the Organization

Using CQI to Monitor and Evaluate Quality
of Care

Continuous quality improvement (CQI) is a
process of identifying areas of concern (indicators),
continuously collecting data on these indicators,
analyzing and evaluating the data, and implement-
ing needed changes. When one indicator is no
longer a concern, another indicator is selected.
Common indicators include, for example, number
of falls, medication errors, and infection rates.
Indicators can be identified by the accrediting
agency or by the facility itself. The purpose of CQI
is to improve the capability continuously of every-
one involved in providing care, including the
organization itself. CQI aims to avoid a blaming
environment and attempts to provide a means to
improve the entire system.
CQI relies on collecting information and analyz-
ing it. The time frame used in a CQI program can
be retrospective (evaluating past performance, often
called quality assurance), concurrent (evaluating cur-
rent performance), or prospective (future-oriented,
collecting data as they come in). The procedures
used to collect data depend on the purpose of the
program. Data may be obtained by observation, per-
formance appraisals, patient satisfaction surveys,
statistical analyses of length-of-stay and costs, sur-
veys, peer reviews, and chart audits (Huber, 2000).
In the CQI framework, data collection is every-
one’s responsibility. Collecting comprehensive, accu-
rate, and representative data is the first step in the
CQI process. You may be asked to brainstorm your
ideas with other nurses or members of the interdis-
ciplinary team, complete surveys or checklists, or
keep a log of your daily activities. How do you
administer medications to groups of patients? What
steps are involved? Are the medications always avail-
able at the right time and in the right dose, or do you
have to wait for the pharmacy to bring them to the
floor? Is the pharmacy technician delayed by emer-
gency orders that must be processed? Looking at the
entire process and mapping it out on paper in the
form of a flowchart may be part of the CQI process
for your organization (Fig. 10.1).

QI at the Organizational and Unit Levels

Strategic Planning

Leaders and managers are so often preoccupied
with immediate issues that they lose sight of their
ultimate objectives. Quality cannot be found at the

unit level if the organization is not focusing on

quality issues. To stay on track, an organization

needs a strategic plan. A strategic planis a short,

visionary, conceptual document that:

■Serves as a framework for decisions or for secur-

ing support/approval

■Provides a basis for more detailed planning

■Explains the business to others in order to

inform, motivate, and involve

Assign Responsibilities

Identify Vital Areas

Define Scope of Care

Evaluate Performance and Outcomes

Recommend and Implement Actions

Evaluate Degree of Improvement

Analyze Area in Terms of:

Aspects

Standards

Indicators

Criteria

Measure Actual Performance

and

Measure Patient Outcomes

Figure 10.1Unit level QI process. (Adapted from Hunt,

D.V. [1992].Quality in America: How to Implement a

Competitive Quality Program.Homewood, IL: Business

One Irwin; and Duquette, A.M. [1991]. Approaches to

monitoring practice: Getting started. In Schroeder,

P. [ed.].Monitoring and Evaluation in Nursing.

Gaithersburg, MD: Aspen.)