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The example illustrates the importance of QA, the ‘proving ground’ for the laboratory’s structure and processes. Does everything come together accurately and reliably? The more robust the Q A program, the better we are able to answer this question. Stepwise analysis of each aspect of service is how we initiate a QA program. Going further, we will want to know how our performance compares to that of our peers. This is where clinical registries enter our approach to quality. In benchmarking to peers, we learn not only of our areas of competence (or excellence) but also where we might not quite measure up.
What are we doing to get better? In his classic work, Avedis Donabedian defined the foundational elements of quality as structure, process, and outcome2. These domains correspond to the context of care, the actions of care, and the ultimate effects of care. Examining each allows us to learn where we excel, but more importantly where our opportunities for improvement may lie. Going further, rather than simply gauging our quality, a program of excellence seeks to improve upon it. This is what we mean by quality improvement (QI): after systematically reviewing all the elements of our program, we then act upon them to make them better.
From QA to QI and all the elements contained therein, how can we possibly keep track each step along the way? This is the role of accreditation4. A rigorous evaluation at each step of the so-called ‘imaging chain’, coupled with external expert review and peer benchmarking, help us to ensure that each aspect of our program meets our expectations for performance. It is actually the process of accreditation—the purposeful, step-by-step analysis of each domain of quality—that is the true dividend of any accreditation program, rather than any designation ultimately awarded. This is because when done right, participation in an accreditation program helps us to improve. And in the end, that is the aim of any programmatic approach to quality. References: 1. Institute of Medicine. Crossing the quality chasm: a new health system for the twenty-first century. Washington, DC: National Academy Press; 2001:207-214 2. Donabedian A. An Introduction to Quality Assurance in Health Care. Oxford University Press 2002. 3. Chinnaiyan KM, Weiner RB. Trials of quality improvement in imaging. J Am Coll Cardiol Img 2017;10:368-78. 4. Douglas P, Iskandrian AE, Krumholz HM, et al. Achieving quality in cardiovascular imaging: proceedings from the American College of Cardiology-Duke University Medical Center Think Tank on Quality in Cardiovascular Imaging. J Am Coll Cardiolog 2006;48:2141-51
The QI program is built on a framework of (1) assessment; (2) feedback; (3) education + application of support tools; (4) reassessment. This cycle is continuous, and the frequency of inspection (monthly vs. quarterly vs. annually) is dictated by the degree of deviation of present state from our targeted performance. Chinnaiyan and Weiner provide an excellent summary of a number of QI projects in imaging that have proven effective3.
The Three Pillars of Quality in the Echo Lab Educational Achievement: NBE/FASE/ ACS
Registry: Continuous Quality Improvement (CQI)