Delfini Approach to Clinical Quality Improvement & Value
We conduct consultations and educational programs to assist health care leaders, practitioners and staff carry out the tasks involved in developing QI systems and evidence-based clinical improvement work. We are dedicated to improvements in health care in ways that are successful, rewarding and enjoyable. Here is our approach.
| Delfini
Evidence- and Value-based Model for Clinical Quality Improvement
= Unite and apply together evidence, QI and value Consider
the plusses and minuses of — |
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| Efficiency and Effectiveness |
What is Quality In Healthcare? We, like many others, believe that quality in healthcare is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with the best available scientific evidence. According to the Institute of Medicine (IOM), a quality system is one that is effective, patient-centered, safe, timely, efficient and equitable. Achieving quality requires a systematic approach to—
Before you decide to change practice, you need to evaluate interventions for appropriateness. And appropriateness has a number of components. We evaluate appropriateness by following a set of steps in a specific order. The first thing to do is an evaluation for effectiveness and benefit. If an intervention is effective the next step is to perform a cost analysis. The last step is to “triangulate” other areas such as coverage, politics, etc., using the best data you have. This requires judgment. |
| Predictability of Outcomes Predictability is a critically important concept in learning the best model for achieving QI. |
If you are going to implement change, you need to be as sure as you can that the change will result in improved care. Typically variations in practice are not sufficient to establish a baseline for quality improvement. What is required to better understand optimal practice is a “round-up” of medical evidence which has been subjected to rigorous critical appraisal and synthesis. |
| Quality Medical Evidence We have effective training methods and tools to make this easy for staff. |
A centerpiece of our QI framework is critical appraisal of the medical literature, which we use to inform all our steps, from seeking the right thing to do, to doing the right thing right. We approach quality improvement first by asking what valid and useful evidence is currently available in the literature to assist leaders, clinicians and patients improve outcomes.
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| Impacts
of Change & |
Before you make change, it is important to predict what’s going to happen. Before implementing a QI initiative, the team should project the impact of change. This can range from an analysis of economic impacts as well as more subjective outcomes. All too often, this ends up being a neglected step or one that is made impossibly difficult and mysterious by those with “black box” approaches. |
| Implementation & Measurement Strong evidence of clinical improvement facilitates implementation because people understand what to expect. Even when there is little or no published evidence, QI teams become more confident about decisions when they know what is (and what isn’t) in the medical literature.
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We have considerable experience in the area of implementation and measurement—we can tell you what the evidence says on these topics, and we can share our vast experience (successes and failures) to help your staff prepare to make change. We have a set of implementation tools and measurement tips that are easy to understand and can jump start implementation planning. You also need information aids and decision-support for your staff and your patients. We have considerable skills in creating highly useful tools. We can provide people with clear advice and strategies for content and presentation along with dissemination tips. We have developed simple, effective methods and the tools to successfully “do” quality clinical improvements, based on the "value" equation — quality, cost and satisfaction.
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Delfini SERVICES
We offer a wide range of supportive services with the ultimate goal of increasing health care organizations’ and clinicians’ abilities to provide high quality, evidence-based care and to improve medical decision-making for organizations, leaders, teams, clinicians and patients.Areas We Provide Help In
• Creating the EBM Organization • Creating the Evidence-based Practitioner
Help for organizations to position for evidence-based care and health care quality; help for healthcare leaders and for individuals• Evidence-based Healthcare Educational Opportunities
Medical education and continuing medical education resources to provide evidence-based practice (EBP) training in evidence-based medicine (EBM), evidence-based nursing & other disciplines — we provide training in, and facilitation of, all aspects of evidence-based health care such as in critical appraisal to help you with medical literature review of scientific research studies and in performing all aspects of healthcare quality improvement activities• Evidence Assessment Training
How to perform a scientific review such as a systematic review and evidence synthesis and how to create a clinical review, clinical recommendation, clinical practice guideline, drug monograph, medical technology assessment, scientific research paper, performance measure, medical decision-making support such as communication aid and shared decision-making aid, patient safety advisory or other evidence-based clinical information• Evidence Reviews & Clinical Content
We can be engaged to perform scientific literature reviews to create systematic reviews, including comparative effectiveness research (CER), and can supply any kind of clinical content or clinical information item you wish such as those listed including clinical guidelines, drug monographs, decision support and more• Committee Help
Help for committee work such as pharmacy and therapeutics committee (P & T committee) or medical technology assessment by providing evidence-based guidelines and process steps including tips for all aspects of committee work from committee management, structures, processes and to clinical pharmacist education to inform all aspect of staff work such as conducting evidence-based reviews, development of drug monographs, meeting presentations and more such as formulary management advice• Quality Improvement Teams
Help for quality improvement teams by providing facilitation of facilitation of steps in systematic literature review, clinical practice guidelines development and clinical improvement projects, including project selection for success, cost analysis, implementation strategies and measuring performance for quality improvement in health care• Healthcare Leadership Help
If you are a healthcare leader, especially a medical leader or pharmacy leader, we have special help for you through our services and through our other website, medicalleaders.org — we can provide a variety of services including strategies for effectiveness in quality management in healthcare, how to identify good clinical practice guidelines, patient-centered care strategies including doctor patient communication training, performance measurement training and development of effective performance measures, tips for meeting management and more in your efforts for improving healthcare quality in your organization to provide true evidence-based health care• More to achieve quality in healthcare...
Delfini SERVICES
We offer a wide range of supportive services with the ultimate goal of increasing health care organizations’ and clinicians’ abilities to provide high quality, evidence-based care and to improve medical decision-making for organizations, leaders, teams, clinicians and patients.Delfini About Our Work
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