As we compare the various state programs, the research team determined that it would be useful to identify a standard for quality improvement that could be applied to the various state programs as a means by which to compare them. The following key principle and framework for quality improvement as described by Dr. M. Rashad Massoud was identified as such a standard. Dr. Massoud describes the following concepts:
- Fundamental principle of improvement--Systems need to change in order to achieve higher levels of performance. Quality improvement activity involves the examination of the various processes involved in the activity to determine any potential areas for change that may yield improvement.
- Principles of Quality Management--There are four main principles of quality improvement:
- Focus on the client
- Understanding work as systems and processes
- Focus on the use of data
As stated above, Dr. Rantz explained her vision for QIPMO as a program that would encourage nursing facility staff to look at the processes they currently use in a critical manner eliminating the standard, "this is the way we've always done it" approach. Her vision is very similar to Massoud's description of a fundamental principle for improvement. QIPMO focuses on data, as noted above and is highly focused on the needs of the client. Each facility visit agenda is determined by the particular needs of the nursing facility staff. QIPMO nurses work as a team, relying on each other's areas of expertise. They begin by attempting to understand the facility's systems for MDS completion as a first step to determining the accuracy of the data.
Massoud also describes a methodology for quality improvement, PDSA (Plan, Study, Do and Act) also referred to Shewhart's Cycle for Learning and Improvement. The QIPMO program was developed via this process as described above and the activities carried out by the QIPMO nurses in the nursing facilities also follow this standard process. Facility staff are encouraged to collect the baseline data from their "Show-Me" reports, work with the QIPMO nurses to determine the validity of the report and then develop a plan to change their care processes. They implement the change, monitor the results, study the effect as reported in subsequent "Show-Me" reports and either continue the change or modify it to achieve the desired results.