Table Of ContentMcLaughlin and Kaluzny’s
Continuous Quality
Improvement in
Health Care
FIFTH EDITION
Julie K. Johnson, PhD, MSPH
Professor, Department of Surgery
Center for Healthcare Studies
Institute for Public Health and Medicine
Feinberg School of Medicine, Northwestern University
Chicago, Illinois
William A. Sollecito, DrPH
Clinical Professor, Public Health Leadership Program
UNC Gillings School of Global Public Health
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
World Headquarters
Jones & Bartlett Learning
5 Wall Street
Burlington, MA 01803
978-443-5000
[email protected]
www.jblearning.com
Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett
Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com.
Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional
associations, and other qualified organizations. For details and specific discount information, contact the special sales department at
Jones & Bartlett Learning via the above contact information or send an email to [email protected].
Copyright © 2020 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical,
including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.
The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett
Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or
otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall
not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein.
McLaughlin and Kaluzny’s Continuous Quality Improvement in Health Care, Fifth Edition is an independent publication and has not been
authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product.
There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities
represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios
featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only.
This publication is designed to provide accurate and authoritative information in regard to the Subject Matter covered. It is sold with the
understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert
assistance is required, the service of a competent professional person should be sought.
Production Credits
VP, Product Management: David D. Cella Cover Design: Scott Moden
Director of Product Management: Michael Brown Text Design: Kristin E. Parker
Product Manager: Sophie Fleck Teague Director of Rights & Media: Joanna Gallant
Product Specialist: Carter McAlister Rights & Media Specialist: Merideth Tumasz
Production Manager: Carolyn Rogers Pershouse Media Development Editor: Shannon Sheehan
Production Editor: Brooke Haley Cover Image (Title Page, Chapter Opener):
Senior Marketing Manager: Susanne Walker © ALMAGAMI/Shutterstock
Manufacturing and Inventory Control Supervisor: Amy Bacus Printing and Binding: Command Robbinsville
Composition: codeMantra U.S. LLC Cover Printing: Command Robbinsville
Library of Congress Cataloging-in-Publication Data
Names: Sollecito, William A., author.
Title: Mclaughlin and Kaluzny’s continuous quality improvement in health care /
William A. Sollecito, DRPH, UNC, Chapel Hill, Julie Johnson, PhD, MSPH,
Northwestern University Medical School, Chicago, Illinois.
Other titles: Continuous quality improvement in health care
Description: Fifth edition. | Burlington, Massachusetts: Jones & Bartlett Learning, [2019] |
Includes bibliographical references.
Identifiers: LCCN 2018029625 | ISBN 9781284126594 (paperback)
Subjects: LCSH: Medical care—United States—Quality control. | Total quality management—United States.
Classification: LCC RA399.A3 C66 2019 | DDC 362.10973—dc23
LC record available at https://lccn.loc.gov/2018029625
6048
Printed in the United States of America
22 21 20 19 18 10 9 8 7 6 5 4 3 2 1
To my home team—Paul, Harrison, Tore, and Elijah.
–JJ
To my family for their loving support always and
especially to our newest addition, Mason, who
represents the future, which is what this book is
all about!
–WS
© ALMAGAMI/Shutterstock
Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Chapter 3 Integrating Implementation
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x Science Approaches
into Continuous Quality
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xii
Improvement . . . . . . . . . . . . . . .51
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Implementation Science Defined . . . . . . . . . . . . . . . .51
Chapter 1 The Global Evolution Integrating Implementation into QI: The Model
for Improvement and Implementation . . . . . . . .53
of Continuous Quality
Implementing Well: Using Frameworks for
Improvement: From
Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Japanese Manufacturing
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
to Global Health Services . . . . . . 1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Appendix 3.1: Definitions of CFIR Constructs . . . . .69
Appendix 3.2: Implementation Strategies
Rationale and Distinguishing
and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Appendix 3.3: Categories and Strategies . . . . . . . . .80
Elements of CQI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Appendix 3.4: List of Behavioral
Evolution of the Quality Movement . . . . . . . . . . . . . . .9
Change Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . .82
The Big Bang—The Quality Chasm . . . . . . . . . . . . . . .17
From Industrialization to Personalization . . . . . . . . .18 Chapter 4 Understanding Variation,
The Scientific Method of CQI . . . . . . . . . . . . . . . . . . . . .24 Tools, and Data Sources for
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 CQI in Health Care . . . . . . . . . .107
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Health Care Systems and Processes . . . . . . . . . . . . 108
Gaining Knowledge Through Measurement . . . . 112
Chapter 2 Factors Influencing the
Quality Improvement Tools . . . . . . . . . . . . . . . . . . . . 124
Application and Diffusion
Sources of Data for CQI . . . . . . . . . . . . . . . . . . . . . . . . 134
of CQI in Health Care . . . . . . . . .32
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
The Current State of CQI in Health Care . . . . . . . . . .33 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
CQI and the Science of Innovation . . . . . . . . . . . . . . .35
Chapter 5 Lean and Six Sigma
The Business Case for CQI . . . . . . . . . . . . . . . . . . . . . . . .37
Management: Building a
Factors Associated with Successful CQI
Foundation for Optimal
Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Patient Care Using Patient
Culture of Excellence . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Flow Physics . . . . . . . . . . . . . . .143
Kotter’s Change Model . . . . . . . . . . . . . . . . . . . . . . . . . .47
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Lean and Six Sigma Management Defined . . . . . 144
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Lean Management System (LMS) . . . . . . . . . . . . . . 157
v
vi Contents
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Chapter 6 Understanding and
Chapter 9 Assessing Risk and
Improving Team
Preventing Harm in the
Effectiveness in Quality
Clinical Microsystem . . . . . . . .235
Improvement . . . . . . . . . . . . . .175
Risk Management—Background and
Teams in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
High-Performance Teams and Quality Models of Risk Management . . . . . . . . . . . . . . . . . . . 240
Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Engineering a Culture of Safety . . . . . . . . . . . . . . . . 240
Understanding and Improving
Applying Risk Management Concepts to
the Performance of Quality
Improving Quality and Safety Within the
Improvement Teams . . . . . . . . . . . . . . . . . . . . . . . . 182
Clinical Microsystem . . . . . . . . . . . . . . . . . . . . . . . . 242
Resources and Support . . . . . . . . . . . . . . . . . . . . . . . . 189
Role of Risk Management and Patient
Team Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Chapter 7 The Role of the Patient
Chapter 10 Classification and
in Continuous Quality
the Reduction of Medical
Improvement . . . . . . . . . . . . . .201
Errors . . . . . . . . . . . . . . . . . . .253
Patient Involvement in Health Care
Improvement: A Brief Overview . . . . . . . . . . . . . 202 Why Classify Safety Events? . . . . . . . . . . . . . . . . . . . . 255
Rationale for Patient Involvement in CQI . . . . . . . 204 Skill-, Rule-, and Knowledge-Based
Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Methods for Involving Patients in CQI . . . . . . . . . . 205
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Factors Affecting Patient Involvement . . . . . . . . . . 207
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Measuring Patient Involvement in CQI . . . . . . . . . 207
The M-APR Model of Patient Involvement . . . . . . 208
Chapter 11 Continuous Quality
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Improvement in U.S. Public
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Health Organizations:
Chapter 8 A Social Marketing Approach Widespread Adoption and
to Increase Adoption Institutionalization . . . . . . .270
of Continuous Quality
Clarifying Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Improvement Initiatives . . . .217
History of Actions to Promote CQI
Hallmarks of Social Marketing . . . . . . . . . . . . . . . . . . 219 in Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Social Marketing Applications to CQI Factors Affecting the Ongoing Adoption and
in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Institutionalization of CQI in Public Health . . . 273
A Scenario for How to Apply Social Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Marketing to a Health Care CQI Initiative. . . . . 225 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Contents vii
Chapter 12 Health Service QI Frameworks and Methods . . . . . . . . . . . . . . . . . . 299
Accreditation: A Strategy Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
to Promote and Improve References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Safety and Quality . . . . . . . .282
Chapter 14 Future Trends and
An Overview of Accreditation . . . . . . . . . . . . . . . . . . 282 Challenges for Continuous
Accreditation: A Common Strategy Quality Improvement in
to Improve Health Organizations
Health Care . . . . . . . . . . . . . .311
and Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Accreditation: A Process Promoting Setting the Stage for CQI. . . . . . . . . . . . . . . . . . . . . . . 312
Continuous Quality Improvement . . . . . . . . . . . 285 Conceptual Frameworks for Improving Care . . . 312
Accreditation Agencies, Standards, and Road Map for the Future . . . . . . . . . . . . . . . . . . . . . . . 315
Surveyor Reliability . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Public Health Accreditation in the
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .333
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Chapter 13 Quality Improvement in
Low- and Middle-Income
Countries . . . . . . . . . . . . . . . 297
Variation in Health Outcomes . . . . . . . . . . . . . . . . . . 297
New Challenges and Opportunities for QI . . . . . . 298
© ALMAGAMI/Shutterstock
Acknowledgments
As we developed the fifth edition of Contin- the motivation to pursue them. Deep appre-
uous Quality Improvement in Health Care, we ciation is also given to the faculty and staff in
were inspired once again by Drs. McLaughlin the Public Health Leadership Program at the
and Kaluzny. While we are very appreciative of University of North Carolina and the Center
their contribution of the Preface, their contri- for Healthcare Studies and Surgical Outcomes
bution has been so much greater through the and Quality Improvement Center (SOQIC)
years, as mentors and as colleagues. at Northwestern University with whom we
We were also inspired by the thought shared ideas that led to a better product. We
provoking Foreword written by Dr. Paul especially thank Dr. Rohit Ramaswamy, who
B atalden where he outlined the model of CQI not only authored two chapters but also shared
in improving quality, safety, and value and his wisdom about the current and future
the model of coproduction in improving the trends in CQI globally. Finally, we appreciate
“value of the health care service contribution the feedback and guidance that we received
to better health.” from the readers of the Fourth Edition, which
We have benefited greatly from the feed- among other things led us to reduce the num-
back of students who have provided insight ber of chapters in this edition, but also gave us
and understanding of the importance of the incentive to go into greater depth on some
making this book a practical teaching tool of the new topics, such as implementation
that addresses the continuing challenges of science. While several chapters of the Fourth
improving quality and safety of health care Edition have been eliminated, we would like
in the future. We are most appreciative to our to acknowledge several of the authors of those
friends and colleagues around the globe who chapters here, as the concepts (listed below)
authored chapters. The coordination and inte- were integrated into this edition’s remaining
gration of the contributing authors was a tre- chapters. They include:
mendous undertaking and we were privileged
to work with excellent colleagues, who are ■ Vaughn Upshaw and David Steffen—the
truly expert practitioners of continuous qual- importance of the learning organization
ity improvement in health care. concepts in CQI
The production of the book required a ■ Anna Schenck, Jill McArdle, and Robert
team effort at all levels and in multiple loca- Weiser—the use of Medicare data in
tions. We would first like to acknowledge the CQI and the real-world example of the
assistance and guidance of the editorial team at Clemson Nursing Home Case Study
Jones & Bartlett Learning. In Chapel Hill, spe- ■ Curt McLaughlin and David Kibbe—the
cial appreciation goes to Dean Barbara Rimer, importance of health information tech-
of the UNC Gillings School of Global Public nology and understanding the strengths
Health, whose leadership inspires a learning and weaknesses of various data sources
environment that stimulates innovations and used in CQI
viii
Acknowledgments ix
Once again, as with CQI itself, the pro- role of all of our fellow team members, not the
duction of this book truly required teamwork least of which includes our families.
and we appreciate and acknowledge the vital
Julie K. Johnson, Chicago, IL
William A. Sollecito, Chapel Hill, NC
