Chat with us, powered by LiveChat Performance Improvement in Health Care? Assignment Content Now that you have reviewed resources related to quality tools and techniques, as I say they are the recipe to success, th | Writeden

 Performance Improvement in Health Care 

Assignment Content

Now that you have reviewed resources related to quality tools and techniques, as I say they are the recipe to success, think of an area in health care or an industry in which you are familiar with and indicate which tool you can use to assist in analyzing the information. Describe how this tool can be used to help and it's purpose. Have you ever used and PI/QI tools to assess/measure a process? If so, describe how and tell me about the situation.

1 Page APA Format.

(I work in the Emergency Medicine Department, as a Senior Admin Assistant)- handle all of the providers credentialing and make sure everything runs smooth. 



Chapter 3: Integrating Implementation Science Approaches into Continuous Quality Improvement



Implementation Science Defined

Integrating Implementation into QI: The Model for Improvement and Implementation

Implementing Well: Using Frameworks for Implementation


Most consistent challenges to continuous quality improvement (CQI) in health care:

Ensuring broadest adoption of evidence-based improvements in practice

Motivating research into further improvements of processes and outcomes

Implementation science represents a next step in the evolution of CQI in health care.

Implementation Science Defined


“(A) specified set of activities designed to put into practice, an activity, or program” (NIRN, 2018)

Implementation science

The “scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and hence, to improve the quality and effectiveness of health services and care … (this) field includes the study of influences on health care professional and organizational behavior.”

QI Methods

Use is well-established in improving systems and processes health care

Still much to debate about their effectiveness

Do not incorporate a systemic approach to the implementation of the improvement solution

Example: Six Sigma’s DMAIC process moves directly from the Improve step to the Control step without any mention of context-specific details

Six Sigma DMAIC Process

Six Sigma DMAIC process

Courtesy of Business Cherub.

Model for Improvement

Does not address implementation

Often neglects broader organizational changes necessary for success and sustainability

Model for Improvement

Reproduced from Langley, G.L., Nolan, K.M., Nolan, T.W., Norman, C.L. and Provost, L.P. (2009), The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd ed., Jossey Bass, San Francisco.

Key Ingredients for Achieving Outcomes

Key Ingredients for Achieving Outcomes

Modified from National Implementation Research Network

Integrating Improvement and Implementation

Integrating Improvement and Implementation

Integrating Implementation into QI

Model for Improvement and Implementation incorporates three implementation questions into the traditional model for improvement:

Implementation outcomes

Implementation determinants

Implementation strategies

Plan, Do, Study, Act

Tests and refines strategies to fit the implementation context

The Model for Improvement and Implementation

The Model for Improvement and Implementation

Modified from Langley, G.L., Nolan, K.M., Nolan, T.W., Norman, C.L. and Provost, L.P. (2009), The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd ed., Jossey Bass, San Francisco.

Implementation Outcomes

Measure how well the implementation process worked

Implementation Outcomes

Reproduced from E. Proctor, 2011. Adm Policy Ment Health. 2011 Mar;38(2):65–76. doi: 10.1007/s10488-010-0319-7. Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda.

Implementation Outcomes and Definitions

Implementation Outcomes and Definitions

Using Implementation Outcomes


Intervention relying on fast ambulance services to improve referral processes affecting the timeliness of care

Feasibility and cost may be most important outcomes

Hand-hygiene intervention

Adoption rates may be affected by differences in acceptability of the intervention

Integrating Implementation Outcomes into QI

Define change package to be implemented

Consider implementation questions in MFII

Determine implementation outcomes most relevant to successful implementation

Collect baseline measures and set targets

Measuring Implementation Outcomes

Perceptual measures

Feasibility, acceptability, appropriateness, or adoption

Measure through:


Semi-structured interviews

Routine measurement

Implementation Determinants

Factors that facilitate and impede achievement of the implementation aim

Depend on a variety of characteristics, such as:






Partial Listing of Contextual Factors Affecting Implementation

Selected List of Factors Affecting Implementation

Data from: Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes

and the factors affecting implementation. American Journal of Community Psychology, 41(3-4), 327–350. doi:10.1007/s10464-008-9165-0

Determinant Frameworks

Nilsen (2015) identified 13 frameworks in which the “aim is to understand and/or explain influences on implementation outcomes”

Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., 2009)

Widely accepted

Tested widely in many different contexts

Consolidated Framework for Implementation

Consolidated Framework for Implementation

Based on Laura J Damschroder, David C Aron, Rosalind E Keith, Susan R Kirsh, Jeffery A Alexander and Julie C Lowery, “Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science”, © Damschroder et al., licensee BioMed Central Ltd. 2009.

Active Implementation Frameworks

Five frameworks created by the National Implementation Research Network (NIRN):

Usable interventions

Implementation stages

Implementation drivers

Implementation teams

Improvement cycles

Active Implementation Frameworks and Definitions

Active Implementation Frameworks

Reproduced from: Blanchard et al, 2017. Res Social Adm Pharm. 2017 Sep – Oct;13(5):922–929. doi: 10.1016/j.sapharm.2017.05.006. Epub 2017 May 22. The Active Implementation Frameworks: A roadmap for advancing implementation of Comprehensive Medication Management in Primary care.

Implementation Drivers

Most directly related to factors affecting implementation

Categorized into competencies, leadership, and organization

Can be mapped onto the CFIR components of:

Inner setting

Outer setting

Individuals involved

Implementation process

Implementation Drivers

Implementation Drivers

Reproduced from: Bertram, R. M., Blase, K. A., & Fixsen, D. L. (2015). Improving programs and outcomes. Research on Social Work Practice, 25(4), 477–487. doi:10.1177/1049731514537687

Implementation Strategies

“(M)ethods or techniques used to enhance the adoption, implementation of the adoption, implementation, and sustainability” (Powell et al., 2015)

Different strategies may need to be combined depending on the context in which the QI initiative is implemented.

Implementation Strategies and Key Activities

Implementation Strategies and Key Activities

Mapping Implementation Outcomes to Strategies

Mapping Implementation Outcomes to Strategies

Mapping CFIR Domains to Strategies

Mapping CFIR Domains to Strategies

Stages of Implementation Framework

Implementation occurs through four stages



Initial implementation

Full implementation

Although presented in a linear progression, this is a nonlinear process.

Stages of Implementation

Stages of Implementation

Reproduced from Bertram, R. M., Blase, K. A., & Fixsen, D. L. (2015). Improving programs and outcomes. Research on Social Work Practice, 25(4), 477–487. doi:10.1177/1049731514537687

Interactive Systems Framework

Conceptualizes implementations occurring through interactions between three systems:

Synthesis and translation system

Support system

Delivery system

Distinguishes between general capacities and innovation-specific capacities

Interactive Systems Framework

Interactive Systems Framework

Reproduced from: Scaccia, 2015. J Community Psychol. Apr;43(4):484–501. Epub 2015 Apr 13.

A practical implementation science heuristic for organizational readiness: R = MC2.

Using These Frameworks in Practice

Framework strategies must be embedded in the implementation process.

Different strategies need to be used at different stages and in different systems.

Frameworks provide guidance on how to do this


QI methods have focused on the development of changes packages and interventions with the assumption that someone else will take care of implementation.

Implementation science has been concerned with the adaptation and implementation of evidence-based interventions, often without understanding what the intervention is and how it has been developed.


Improvement interventions are often poorly implemented.

Implementation science has failed to benefit from the wealth of practical knowledge about theories of systems, processes, and variation.

The intent of this chapter is to bridge this gap.





















Performance Improvement

Useful Tools and Techniques

Goal of PI

To continuously strive to improve performance in new and improved ways, resulting in improved patient and organization based outcomes.

PDSA Cycle

The steps in the PDSA cycle are:

Step 1: Plan—Plan the test or observation, including a plan for collecting data

Step 2: Do—Try out the test on a small scale

Step 3: Study—Set aside time to analyze the data and study the results

Step 4: Act—Refine the change, based on what was learned from the test


“Making it Happen with…. Who?”

Quality Action Team (QAT)

Departmental/Multidisciplinary QM Initiatives

Be creative and develop a new type of team

PI Tools and Techniques


Do you think PI Tools look like these?

Data, Data, Data

What is data?

Data are facts that have been collected but not yet interpreted.

Data needs to be aggregated and analyzed in order for it to be useful.

Aggregate Data

Combine data into a mass sum or whole.


Translation of data collected during the monitoring process.

Flow Chart

Shows all the steps in a given task.

Helps identify the most efficient procedure for completing a task.

Applied to a process that has a beginning or end.

Example: Medication Administration or Admissions Process.


Summarizes data from a process and presents its frequency distribution in a bar chart.

Example: Number of falls by participant, or number of new nosocomial pressure ulcers.

Bar Graph

A graph is a chart or graph that presents  categorical data with  rectangular bars with  heights or  lengths proportional to the values that they represent. The bars can be plotted vertically or horizontally. 

Line Graph

A line graph is commonly used to display change over time as a series of data points connected by straight line segments on two axes.

Pie Chart

A pie chart is a circle graph divided into pieces, each displaying the size of some related piece of information.

Example: Participant falls by sub-type (i.e., from bed during ambulation, etc.)

Cause and Effect Diagram- Also known as Fishbone (ishikawa)

Allows identification, explorations and graphic display of all possible causes related to a problem to discover its root causes.







Quality Problem