What is Quality Improvement in Nursing?

Continuous quality improvement (CQI) in healthcare is a systematic approach to improving patient safety and care. This process is essential to nursing practice, as it helps ensure patients receive the best possible care.

Quality improvement in nursing involves identifying and addressing problems in healthcare delivery to improve outcomes. CQI uses data to identify improvement areas, develop and implement interventions, and evaluate the results.

This article will define nursing quality improvement, its importance, various models, and real-world examples that illustrate its impact.

What Is Quality Improvement in Nursing?

At its core, quality improvement in nursing is the systematic approach to evaluating and enhancing healthcare practices. It involves identifying areas for improvement, creating strategies to address them, and measuring outcomes.

CQI is rooted in evidence-based practices and empowers nurses to actively contribute to improving healthcare services. 

What Are the Four Components of Quality Improvement?

The four components of quality improvement are:

1. Identify a Problem

The first step in CQI is to identify a healthcare delivery problem. You can do this by reviewing patient data, conducting surveys, or observing the care process.

2. Gather Data

Once you've identified a problem, the next step is to gather data about it. You can use this data to understand the scope of the dilemma and identify potential solutions.

3. Develop and Implement an Intervention

With sufficient data, you can develop and implement an intervention to address the issue. You should base your intervention on the best available evidence and tailor it to your problem.

4. Evaluate the Results

The final step in CQI is to evaluate the results of the intervention. This step involves collecting data to determine whether the intervention has effectively improved the problem.

Continuous Quality Improvement Definition for Nursing

Experts often use quality improvement and continuous quality improvement interchangeably. These terms emphasize the evaluation and enhancement of practices to ensure excellence in patient care. Different regulatory agencies use other models of CQI and have different definitions for what it means.

Centers for Medicare & Medicaid Quality Improvement Definition

Centers for Medicare & Medicaid Services (CMS) defines CQI as “…the framework used to improve care systematically. Quality improvement seeks to standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations.”

Joint Commission Quality Improvement Definition

The Joint Commission defines CQI as standards that “…are the basis of an objective evaluation process that can help health care organizations measure, assess, and improve performance. The standards focus on important patient, individual, or resident care and organization functions that are essential to providing safe, high-quality care.”

What Are the Different Quality Improvement Models?

You can use several models to implement CQI in your nursing practice. Some of the most prevalent models include the following:

Plan-Do-Study-Act (PDSA)

PDSA involves planning a change, implementing it on a small scale, studying its effects, and acting based on the results. This cyclic process facilitates gradual improvements while minimizing risks.

Six Sigma

Borrowed from the Motorola manufacturing industry, Six Sigma seeks to minimize defects and process variations. It emphasizes data-driven decision-making and aims for near-perfect results.

Lean Methodology

Also originating from manufacturing, Lean Methodology focuses on reducing waste and streamlining processes. In nursing, this translates to optimizing workflows and resource utilization.

The Model for Improvement

This model focuses on improving the quality of care by setting goals, measuring progress, and making data-informed changes. The model for improvement is the most popular CQI model in the healthcare industry. 

The model for improvement combines three fundamental questions with the PDSA model to better guide the improvement process.

Model For Improvement Three Fundamental Questions

You can address the three fundamental questions of the model for improvement in any order. However, answering them thoroughly will ensure your team understands the purpose behind the intervention.

These fundamental questions are as follows:

1. What are you trying to accomplish? Setting a goal can help you answer this question. You should create your objective using the  SMART format, which means your goal should be:

• Specific

• Measurable

• Achievable

• Relevant, and

• Time-bound

2. How will you know whether a change is an improvement? Creating metrics by which you can measure your intervention's success will help you answer this question. Your metrics will help you determine your intervention's efficacy by measuring its structure, process, outcome, and balance.

3. What changes can you make that will result in improvement? Perform a root cause analysis (RCA) to identify the cause of your problem. Understanding the root causes of your issue will help you create tailored, practical changes.

Using the PDSA Model

After answering the fundamental questions, you can complete the PDSA cycle. Remember, needing multiple PDSA cycles to achieve your desired results is okay.

• Plan: Create a plan for your intervention

• Do: Set your plan in motion

• Study: Study the results of your plan

• Act: Review your results, whether they worked or didn’t 

You can adapt the intervention into your framework if the results are helpful. If not, you can make improvements based on the pitfalls and try again.

6 Quality Improvement in Nursing Examples

Healthcare quality improvement projects implemented by nurses improve patient safety and healthcare delivery. Nurses must follow specific quality measures every day to ensure they're optimizing and advancing patient care.

Common quality improvement in nursing examples include the following:

1. Reducing the incidence of hospital-acquired infections
2. Improving patient satisfaction
3. Increasing the use of evidence-based practices
4. Decreasing falls in high-risk fall patients
5. Reducing medication errors
6. Improving communication between healthcare providers

Do you recognize how you implement some of these in your daily work? For example, you can implement “Decreasing falls in high-risk fall patients” by applying non-slip socks on a patient and turning on the bed alarm.

Additionally, you may implement “reducing medication errors” by scanning the patient’s wristband and the medication while verifying the correct dose, medication, time, and patient.

Why Does Quality Improvement in Nursing Matter?

Quality improvement in nursing is essential because it helps patients receive the best possible care. By identifying and addressing healthcare delivery problems, CQI improves patient outcomes, reduces costs, and increases satisfaction.

Quality improvement in nursing is an ongoing process that allows healthcare professionals to optimize their practices. Healthcare is a continuously evolving landscape, and CQI enhances its expansion.