Using the Plan, Do, Study, Act Model to Implement a Quality Improvement Program in Your Practice
by Michael S. Morelli , MD, CPE, FACG
Chair, ACG Practice Management Committee
This article appears in the September 2016 Issue of The American Journal of Gastroenterology
The secret of getting ahead is getting started. The secret of getting started is breaking your complex, overwhelming tasks into small, manageable tasks, and then starting on the first one. —Mark Twain
Understanding How Quality is Defined and Why Quality is Important
Working to improve the quality of care provided to our patients has become one of the cornerstones of modern health care. Yet, how healthcare quality is defined has changed over the years. Understanding how quality is defined and how to implement a quality improvement program in your practice using the Plan, Do, Study, Act (PDSA) model will help you develop methods to measure quality, enhance it, and report it in ways that will improve patient care and future reimbursement.
The traditional paradigm where quality could be demonstrated by the presence of good provider credentials, high caliber facilities or equipment, the style in which care was provided, or patient outcomes is now considered incomplete. This paradigm provided a basic framework from which to understand quality improvement, but it ignored the important concepts of cost and efficiency. A newer paradigm was put forth in the year 2000 when the Institute of Medicine (IOM) published a new definition of quality, describing it as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Essential elements for quality were suggested, including reducing unnecessary variation, applying evidence-based medicine and best practices, error reduction, process improvement, promoting a culture of safety, and creating a culture of accountability. In the document Crossing the Quality Chasm, published in 2001, the IOM more clearly defined quality, recommending that high-quality care should be safe, effective, efficient, timely, patient centered, and equitable.
As healthcare professionals are increasingly burdened with regulations and requirements, it is easy to be cynical when discussing the concept of quality in medicine. However, efforts to enhance quality can simultaneously improve the care we provide for our patients, reduce waste, and save money. With the advent of Medicare CHIP and Reauthorization Act (MACRA), it can also increase reimbursement and ultimately help differentiate your practice from the competition. The PDSA model can provide a solid foundation from which to start the process of quality improvement for your practice: plan what will be done, do it, study and analyze the results, and act on the results to make improvements in what you are doing.