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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-based Value Model for Clinical Quality Improvement = Net Gain + (Net Loss) Unite and apply together evidence, QI and value Consider
the plusses and minuses of — |
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| Efficiency and Effectiveness The classic approach frequently omits much in the area of effectiveness. |
Much of the industrial model of QI deals with efficiencies in delivering health care. While CQI steps can be effective in implementing change, the classic approach frequently omits much in the area of effectiveness. This has been a major obstacle in getting many clinicians engaged in QI work or accepting of change – and if your docs won’t go along with you, you’re in major trouble. We think of QI projects as falling into several categories which can be ranked from strongest to weakest:
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. |
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| 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 & We teach a simple method that is straightforward, clear and easy to apply. |
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.
Contact us... |
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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