Participatory continuous improvement.

Abstract

There are a number of limitations to current models of risk-adjusted outcome, continuous quality improvement, the most important of which are the reliance on chart abstraction for data collection, the focus on a procedure rather than a disease with several treatment options, and the emphasis on outcomes--particularly the identification of care providers with high rates of adverse outcomes. In this article, I describe a paradigm that combines clinical information management with quality of care assessment and improvement and that emphasizes the participation of care providers. This participatory continuous improvement model is a synthesis of three existing concepts: (1) continuous quality improvement, (2) intellectually and altruistically motivated self-examination and self-improvement, and (3) a modern medical information system. Important design elements of the participatory continuous improvement model to overcome these limitations include (1) a patient population defined by a disease, or diseases, rather than by a treatment to allow for assessment of the appropriateness and access to care; (2) a database that includes all important patient-level risk, treatment (process), and outcome information; (3) data input by the care provider at the point of care; (4) timely information feedback to care providers in a nonadversarial environment; and (5) public accountability. I believe that participatory continuous improvement models can provide the framework for psychologically sound ways to positively influence practice behaviors, and that this will, in turn, result in improved access to care, quality of care, and cost-effectiveness of care.