When to Escalate
Quality Improvement Turns a Safety Concern into a Tested Change
Quality improvement (QI) is the disciplined process of improving care by identifying a performance gap, testing a change, measuring its effect, and adjusting the plan.
Quality improvement (QI) is the disciplined process of improving care by identifying a performance gap, testing a change, measuring its effect, and adjusting the plan. It is not a declaration that care is “better” because a new policy was distributed. Improvement is demonstrated when data show that the desired result changed without creating a new safety problem. Start with a specific problem and a defined population. “Prevent falls” is too broad to guide measurement; “reduce unwitnessed inpatient falls on the medical unit over the next quarter” is actionable. A useful aim identifies what will improve, by how much, and by when. QI examines both the care process and the patient outcome. For example, a catheter-associated urinary tract infection initiative might measure: - Process: the proportion of urinary catheters with a documented ongoing indication each day. - Outcome: the rate of catheter-associated infection. - Balancing measure: urinary retention or emergency recatheterization after unnecessary catheters are removed. The balancing measure matters because a change can improve one result while causing another problem. A lower catheter rate is not a successful intervention if...