Case Studies from the Quality Improvement Support System

The Agency for Health Care Policy and Research funded the development of the Quality Improvement Support System (QISS) to facilitate information exchange on quality improvement in health care organizations. This funding was made available because, despite widespread interest and activity in continuous quality improvement (CQI) and related efforts, very little scientific research has been undertaken that provides guidance for quality improvement.

Background Information

The QISS was developed by researchers at the University of Wisconsin, as a network with over 40 member groups, organized to share information about quality improvement activities. Because many of these organizations were health systems that owned multiple hospitals and clinics, QISS members represented over 200 acute care facilities and over 100 outpatient clinics located throughout the United States.

The researchers solicited nominations for successful examples of clinical quality improvement teams from quality leaders in the network. Nominations were accepted from network members only if they could demonstrate measurable improvement in outcomes, health status, customer satisfaction, and/or economic value. After collecting data from the nominees (e.g., team reports, storyboards, charts, graphs, and bibliographies), the researchers developed a project report with 15 case studies. This report, after expert review, is now available to the public.

The Case Studies

For comparison purposes, the consortium applied Batalden's 10 principles of total quality management (TQM) to the 15 case studies:

• Constancy of purpose.
• Customer-mindedness.
• Quality-mindedness.
• Process-mindedness.
• Statistical-mindedness.
• Employee-mindedness.
• Management leadership.
• Benchmarking.
• Continuous improvement.
• Suppliers as partners.

The consortium found that Batalden's 10 principles were consistently confirmed across studies with the exception of "suppliers as partners." Only four of the case studies identified a partnership or customer/supplier relationship as part of the project which at least partially contributed to its success.

Many of the case studies describe attempts to reduce cost without degrading quality and represent a blend of CQI and reengineering or redesign. They support the importance of an interdisciplinary perspective, of an evaluation of the care provided across settings, and of the inclusion of patients' perceptions in adjusting the care process.

About the Project Report

The project report (AHCPR Publication No. 97-0022) consists of an introduction as well as a background section. It also contains 15 separate case studies:

• Acute Chest Pain Management.
• Applications of Pharmaceutical Clinical Algorithms Used in Conjunction with Critical Pathways.
• Asthma Self-Management Techniques in Home Health Care.
• Cardiac Surgery Clinical Pathway.
• Cardiac Surgery Rapid Recovery.
• Carotid Endarterectomy Length-of-Stay Project Team.
• Cesarean Section Utilization—Reducing Rates and Improving Appropriateness.
• Chronic Obstructive Pulmonary Disease Improvement Team.
• Coumadin Management.
• Myocardial Perfusion Study Team.
• Open Heart DRG Outcome Improvement Team.
• Partnership in Pregnancy and Parenting.
• Reducing Asthma Revisits to the Emergency Room.
• Surgical Preparedness.
• Total Hip Replacement Care Map.

The case studies contain sections on lessons learned, reviewer comments, and resources for additional information.

Ordering Information

While supplies last, single print copies are available free of charge from:

AHCPR Publications Clearinghouse
Attn: (97-0022)
P.O. Box 8547
Silver Spring, MD 20907
800-358-9295 (toll-free within the U.S.)
(703) 437-2078 (callers outside the U.S. only)
888-586-6340 (toll-free TDD service; hearing impaired only)

Current as of April 1, 1997

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