Quality improvement

Copyright © 2006 Society of Hospital Medicine

Quality improvement (QI) is the process of continually evaluating existing processes of care and developing new standards of practice. QI is influenced by objective data and focuses on systems change, rather than individual performance, in order to optimize performance and appropriate resource utilization. Hospitalists may lead or participate in QI teams to optimize management of common inpatient conditions and improve clinical outcomes based on standardized evidence based practices. Hospitalists should use evidence based outcomes data whenever available to support their inpatient practices and QI initiatives.


Hospitalists should be able to:

  • Identify and categorize adverse outcomes that may include sentinel events, near misses, or other adverse events.

  • Describe QI requirements for hospital accreditation that are supported by regulatory organizations.

  • Describe outcome measurements currently studied by major payers and regulatory agencies.

  • Identify guidelines and protocols supported by outcomes data to shape and standardize clinical practice.

  • Describe and differentiate Root Cause Analysis (RCA) and Healthcare Failure Mode Effects Analysis (HFMEA) and their utility in quality improvement in the hospital setting.

  • Describe the differences between outcome and process measures.

  • List the characteristics of high‐reliability organizations.

  • Describe the elements of effective teams and teamwork.


Hospitalists should be able to:

  • Apply current outcomes data and evidence based literature to individual hospitalist practice and systems improvements.

  • Utilize quality data to define hospitalist practice.

  • Express the relationship between value, quality and cost, and incorporate patient desires and satisfaction into the optimization of health care quality.

  • Assess and incorporate new technology for systems improvement in hospital practice.

  • Differentiate outcome measurements from process measurements.

  • Interpret patient satisfaction metrics.


Hospitalists should be able to:

  • Practice patient centered care and appreciate its value in improving patient safety and satisfaction.

  • Apply the results of validated outcome studies to inpatient practice.

  • Promote the adoption of new practices, guidelines and technology as supported by best available evidence.

  • Structure QI initiatives that reflect evidence based literature and high quality outcomes data.

  • Lead, coordinate or participate in the design and implementation of QI initiatives at individual, practice, and system levels, using a collaborative multidisciplinary team approach.

  • Lead, coordinate or participate in Root Cause Analyses (RCA) and/or Healthcare Failure Mode Effects Analyses (HFMEA).

  • Lead, coordinate or participate in outcomes monitoring at the institutional, regional and national levels, with an emphasis on development of standards and benchmarks.

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