Challenges aligned to the IHI Quality Improvement Competency Framework
| Donabedian model of quality | |||
|---|---|---|---|
| Practice-based learning and improvement competency | |||
| Domain | Structure (staffing/infrastructure) | Process (care processes/knowledge exchange) | Outcomes (clinical outcomes/sustainable change) |
| Customer knowledge—patients’ perspectives and needs | Effectively engaging patients in the implementation of the bundle | Ensuring the COPD care bundle meets the needs of the patients | Demonstrating the COPD care bundle improves outcomes aligned to the needs of the patients |
| Variation and measurement—collection and analysis of data | Connectedness of IT systems to collect data at the patient level | Accuracy and resource to collect data on care processes | Linkage of process data and outcome data at a patient level |
| Leading, following and making changes in healthcare—demonstration of change management skills | Engaging and training staff with the necessary skills for implementation and evaluation of complex interventions | Delivering required care processes to reduce variation | Sustaining change |
| Developing new, locally useful knowledge—demonstrating development and use of PDSA cycles/model for improvement | Staff capacity to develop skills required for iterative design and feedback | Understanding the connectivity between care processes | Linking data to behaviour change and demonstrating causal linkage |
| Systems-based practice competency | |||
| Healthcare as process/system—engaging all patients in the healthcare system | Representativeness of patient involved and engaged | Capturing all patients eligible for intervention | Demonstrating population level health benefits |
| Collaboration—networking, joint working and sharing knowledge and ideas within and across organisations and between similar services | Engagement between care providers and third sector organisations | Sharing information about patient care | Competition versus collaboration |
| Social context and accountability—understanding conditions from a social perspective linking with health and social care model | Range of issues affecting disease beyond the biomedical model of healthcare | Conflicting priorities between different health and social care organisations and third sector providers | Demonstrating and sustaining system wide changes |
IHI, Institute for Healthcare Improvement; PDSA, Plan-Do-Study-Act.