title: How can we recognize continuous quality improvement?
abstract: OBJECTIVE
  Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI.
  
  
  METHODS
  Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process.
  
  
  METHODS
  Primarily United States and Canada.
  
  
  METHODS
  119 QI experts randomly assigned into four on-line panels.
  
  
  METHODS
  Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s) Panel consensus on definitional CQI features.
  
  
  RESULTS
  /st> Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features 'systematic data guided activities,' 'designing with local conditions in mind' and 'iterative development and testing' met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI.
  
  
  CONCLUSIONS
  We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as 'CQI.' All three features are needed as a minimum standard for recognizing CQI methods.
authors: The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA.; susanne_hempel@rand.org; amotala@rand.org.
authors: Lisa
authors: L
authors: Rubenstein
authors: Dmitry
authors: D
authors: Khodyakov
authors: Susanne
authors: S
authors: Hempel
authors: Margie
authors: M
authors: Danz
authors: Susanne
authors: S
authors: Salem-Schatz
authors: Robbie
authors: R
authors: Foy
authors: Sean
authors: S
authors: O'Neill
authors: Siddhartha
authors: S
authors: Dalal
authors: Paul
authors: P
authors: Shekelle
mesh_terms: D002170:Canada; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D058996:Quality Improvement / Q000592:standards; D017749:Total Quality Management / Q000379:methods* / Q000592:standards; D014481:United States
keywords: consultants; continuous quality improvement; health care organization; quality improvement