What is CQI?

The concept of continuous quality improvement (CQI) is an intentional approach to improve a process at a given stage of producing an optimum result. A process in its simplest form is a series of steps executed to produce goods or services. (Hamm, 2016).

Walter Shewhart first studied quality as an industrial process in 1931. His concepts included identifying customer needs, reducing variations in processes, and minimizing inspections. (Varkey et al, 2007). Inspired by Shewhart’s work, Edward. W Deming, “Recognized quality as a primary driver for industrial success and subsequently introduced these methods to post-World War II Japanese engineers and executive”. (Varkey et al, 2007).

The Shewhart cycle method had three steps: specification, production, and inspection. Deming adopted this method and the method, Plan; Do; check; Action (PDCA) cycle was born. (Moen et al, 2009). Deming developed this method further and in 1986 he stated, “because the English work ‘check’ means to ‘hold back’, be sure to call it PDSA: (Moen et al, 2009, p. 7).

DO STUDY ACT

STUDY - THE RESULTS, WHAT DID YOU LEARN, WHAT WENT WRONG.

4.

CQI has become a management philosophy and method widely employed by various settings. (Radawski, 1999). It subscribes to the principle that opportunity for improvement exists in every process on every occasion. (Varkey et al, 2007). PDSA and other methods created for improvement originally for the manufacturing industry have been adopted into healthcare. (Cantiello, 2016).

Healthcare has evolved over time, with the advancements in technology and patients’ expectations. In the past, healthcare was focused on quality assurance; the delivery of services and/or product, and quality control; verifying and maintaining a level of quality. These methods alone were not sufficient to obtain an optimum result. (Varkey et al, 2007). Checking for defects and recommending changes without recognising the effects of these changes on other parts of the organization may improve one process but harm others. (Varkey et al, 2007). Consequently, organizations are now combining the quality assurance with CQI. (Varkey et al, 2007).

As healthcare providers, Central Sterilising Supply Departments (CSSD) for reusable medical devises (RMD) are responsible to ensure they are providing a service, which has a foundation of best practice and continuous improvement. (NZ Standards, 2021). The end user, ‘the patient’, “trust there are systems in place that keep me safe, are responsive, and are focused on improving my experience and outcomes of care”. (NZ Standards, 2021, p. 39).

Requirements for an RMD can vary depending on the service their provided for. Whether it is an individual or multiple RMDs in a set, the quality of the reprocessed RMD is measured against the end users requirements. When an RMD is not meeting these requirements, there can be a risk to all stakeholders.

As an example, a CSSD has had ongoing incidents of incomplete RMD sets leaving the department. A risk assessment was conducted, and it was found on several occasions the risk to stakeholders, was possible with moderate consequence. The risks ranged from breakdown in customer relations, extended theatre time under anaesthetic and recovery time extended for the patient, stress on doctors/nurses locating other RMD and/or deciding on an alternative procedure and cancelled cases.

It became clear there were several steps in the process, identified to be contributing to the risks. These were surface problems, with underlying causes. By using the fishbone diagram method, they were able to analyse possible root causes.

Using this method identified four main factors:

▪ The mixing of theatre cases together in the decontamination area.

▪ No method to identify split sets if required.

▪ Tracking system not updated.

▪ Written processes confusing and hard to follow.

The most significant problems identified were, tracking system not updated and no method used to identify the splitting of sets. This resulted in large amounts of left over RMDs on a daily basis.

With feedback and further discussions, a decision to start a plan for improvements starting within the decontamination area, to keep theatre cases together throughout the process. Hoping that this would help reduce potential risk to end users of incomplete sets and start pinpointing more accurately, where RMDs go missing. This would also contribute to a smarter workflow, uniform approach, and better communication among the team.

With the use of the PDSA cycle method, they have been able to make changes with the aim of improvement, conducting testing on a small scale before implementing on a larger scale. By studying the results to determine what they learnt and what went wrong, they can then adopt the changes or abandon and repeat until they have the optimum result.

Cantiello, J. e. (2016). The evolution of quality improvement in healthcare: Patient-centered care and health infromation technology applications. Journal of Hospital Administration.

Deming, W. E. (1982). Out of the Crisis. MIT Press.

Hamm, R. E. (2016). Continuous Process Improvement in Organizations Large and Small: a guide for leaders. New York: Momentum Press.

Moen, R. e. (2009). Evolution of the PDCA Cycle. Asian Network for Quality, (p. 7). Tokyo.

Radawski, D. P. (1999). Continuous Quality Improvement: Origins, Concepts, Problems, and Applcations. The Journal of Physician Assistant Education, 12-14.

Standards New Zealand. (2021). Nga paerewa Health and disability services standard. Nga paerewa Health and disability services standard NZS 8134:2021. Wellington : Standards New Zealand.

Varkey et al, P. a. (2007). Basics of Quality Improvement in Health Care. Mayo Clinic Proceedings.

Midland (& Upper North Island) CSSD REGIONAL MEETING in association with Essity Health & Medical

1st April 2023 8:30am -1pm

Waikato Hospital ‘Bryant Education Centre’ Hague Road, Hamilton

Midland (& Upper North Island) CSSD REGIONAL MEETING in association with Essity Health & Medical

1st April 2023 8:30am -1pm

Waikato Hospital ‘Bryant Education Centre’ Hague Road, Hamilton

Agenda

8:15-8:30 Arrival Tea & Coffee

8:30–9:00 Welcome & NZSSA Update

• 9:00-10:00 : Essity Presentation of (Multigate : Pro-Zone Sterilisation Wrap) ‘Surgical Flow’ Online Education Modules

• 10:00-10:20 : J&J Depuy Synthes - Robotics and Navigation for TKA’s – Changes to TKA Joint Arthroplasty & What does this mean to Sterilisation Department Seminar - Joint Replacement with Robotics (Video & on-screen Presentation)

Workshop Station A: – Navigation & TKA sets

• 10:20 – 10:40 : Stryker Trauma Kit & Power Tools How are these used in Theatre? Kayley Kelly & Jin Girvan

Workshop Station B: Stryker Power Tools - CSSD Care & Maintenance.

10:40 - 11am : Brunch

• 11 – 11:30am : OBEX – 2 x 15min Instrumentation Focus & HiPOT Testing (Mehdy Farzaneh & colleagues)

Workshop Station C: OBEX Focused on Instruments & Station D: HiPOT testing

11:30 – 12.45am : Hands On WORKSHOPS Rotations

Station A: J&J Depuy-Synthes - Robotics and Navigation for TKA’s - Station B: Stryker Trauma Kit & Power Tools CSSD Care & Maintenance

Station C: OBEX Instruments & Station D: HiPOT testing

12:45 - 1pm Certification, Feedback Forms : Finish

Midland (& Upper North Island) CSSD REGIONAL MEETING in association with Essity Health & Medical 1st April 2023 8:30am -1pm

Waikato Hospital ‘Bryant Education Centre’ Hague Road, Hamilton

Midland (& Upper North Island) CSSD REGIONAL MEETING in association with Essity Health & Medical 1st April 2023 8:30am -1pm

Waikato Hospital ‘Bryant Education Centre’ Hague Road, Hamilton

RSVP with Staff Names by Friday 24th March 2023 email to lindsay.mccord@essity.com (021 678 352) & please CC. jenny.carston@bopdhb.govt.nz (0272691325)

Any Dietary requirements please let Lindsay know for catering purposes

WAIKATO HOSPITAL BRYANT EDUCATION CENTRE

Toi Ohomai Institute of Technology Ltd NZ

Diploma in Sterilising Technology (Level 5)

Nathaniel Atienza

Ibraam Faltas

Jeyarajah Velluppillia

Shalini Kumar