JACR: The secret to quality improvement success
When creating a radiology quality improvement program within an organization, whether academic or private practice, the probability of success increases if the process is understood through the discipline of change management and all stakeholders have clearly defined roles, according to an article published in the April issue of the Journal of the American College of Radiology.

“Quality improvement is best understood as a process supported by structures and technologies rather than an outcome. Neglecting the process can doom quality initiatives,” wrote Carl Miller, MD; Peter Pronovost, MD, PhD; and Paul Nagy, PhD, all of Johns Hopkins University in Baltimore.

The authors identified and defined five roles:

The Safety Officer – Responsible for compliance with regulations and guidelines from governing and accrediting bodies, the safety officer oversees safety initiatives on programs such as radiation safety or hand hygiene. The authors noted that this role is already well established in most practices, but is typically reactive, lending itself more to quality assurance rather than quality improvement.

“Although important, compliance is a minimum standard and is unlikely to significantly improve quality alone,” wrote the authors.

Leadership Support – Leadership is responsible for four main tasks, according to Miller et al. First, they must define the quality program’s mission and make sure it is aligned with the organizational mission. Second, they must establish relationships that span organizational boundaries.

“Quality issues tend to congregate around organizational boundaries because no one group can solve the issue on its own,” wrote the authors. “This may mean building an oversight partnership with partners such as the emergency department or the perioperative environment to garner a larger mandate.”

Leadership also must allocate resources for the quality program and incorporate the program into the business model. Finally, senior leaders must model behavior for staff to emulate.

Quality Coach – Many well-intentioned quality improvement programs don’t achieve their goals because the staff spearheading the program are not formally trained in the skills of improvement, according to Miller et al. While it’s often not practical to send an entire department for intensive training, a coach familiar with quality improvement can share his or her expertise and help other members within the initiative.

Information Technology – Quality programs should be based on data and the analysis of relevant quality metrics. The IT role assists in accessing and reporting these data as well as creating dashboards to communicate this information. A strong IT role is important also because many quality programs identify technology-based solutions to streamline workflow or solve other departmental issues.

Community Organizer – The community organizer networks and builds a proactive culture around the quality improvement program. This role engages radiologists, nurses, administrators and other stakeholders in the process.

Miller and colleagues stressed that the five roles are not necessarily for individuals. Depending on the organization, one person could fill multiple roles, or the responsibilities of a single role could be spread among multiple people.