Implementing a 4C Approach to Quality Improvement

Abstract

Designing a quality improvement activity can be labor intensive and intimidating to facilitators who have not been specially trained in process improvement methodologies. To simplify the process, a team was formed with the specific task of developing a basic model that addresses key concepts in change theory. The 2010 Institute of Medicine report stresses the importance of health care professionals working together, collaboratively, to use data to improve patient outcomes and improve care nationally. In addition, as noted in Quality and Safety Education for Nurses (2013), competencies have been developed to promote frontline problem solving including using data for quality improvement, providing safe care, functioning in collaborative teams, respecting and addressing patient and family concerns, applying evidence-based practice, and using informatics to make decisions. The team completed a search of the literature on change theory to identify the factors that are imperative to address when initiating a process improvement cycle. Kotter's Model of Change provided direction and guidance on the creation of the 4C model, which involves centering on issue, collaborating with team members, using the change process, and celebrating successes. This model has been implemented in a multihospital system as a framework for process improvement with such initiatives as preventing hospital-acquired infections, implementing patient safety initiatives, and addressing human resource concerns such as turnover and patient satisfaction.

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“…Similar to previously published studies, staff engagement in this quality improvement initiative is essential to the program's success [26][27][28]. In our case, TEAM M e was well received by clinical providers.…”

How to optimise public health interventions: a scoping review of guidance from optimisation process frameworks

“…One stated optimisation to be achieved once a predefined question has been sufficiently answered [38]. Almost one third (n = 6) of the frameworks [20,34,[39][40][41][42] were identified as being modified, or incorporating components from a prior framework.…”

“…Symptomatology: the set of symptoms characteristic of a medical condition or exhibited by a patient. 1 (5%) part of the optimisation framework [39,41], or were related to the concept aiming to be improved [43,44].…”

“…Such groups should include all stakeholders who would be impacted by changes in the implementation of a targeted health intervention program or policy, for example, health managers, clinicians, patients or community representative, as well as researchers. McGonigal et al [41] state that it is important to get the right people involved before deciding the direction an approach will take. Redick et al [44] state team members should be from every discipline involved in the process and they should be chosen for their experience with the condition being studied/implemented rather than their job titles.…”