Research, Quality, and Performance Improvement

In today’s healthcare environment, key organizations are driving the focus on quality, outcomes, and evidence-based practice. The Institute for Healthcare Improvement Triple Aim initiative looks to improve the patient experience, improve population health, and reduce per capita cost. The Affordable Care Act of 2010 has promised quality affordable healthcare. Reports from the Institute of Medicine (IOM) have identified gaps in cancer quality care as well as the 6 components to quality care. The 6 components are engaged patients; an adequately staffed, trained, and coordinated workforce; evidence-based cancer care; a learning healthcare information technology system; translation of evidence into clinical practice, quality measurement, and performance improvement; and accessible, affordable cancer care. The 2001 IOM publication, Crossing the Quality Chasm: A New Health System for the 21st Century, supports the importance of research and quality improvement in its statement “the degree to which health services [knowledge] for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge [research evidence].”¹

Navigators can utilize research and outcomes to develop and validate the programs and services provided. The components of research and evaluation include defining the problem and establishing goals, implementing strategies based on objectives and time, and measuring outcomes. The first step is to create a workgroup consisting of the cancer committee, cancer registrar, and key stakeholders to conduct a community needs assessment to determine available resources and define the primary service area. The next step is to collect and document disparities and barriers to care in the primary community area. Data from the community needs assessment are generated and utilized to formulate the navigation process for the improvement of quality care and outcomes.

To develop implementation strategies for the identified needs, a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis may be conducted. It is recommended that, after identifying the focus of the navigation program, SMART (Specific, Meaningful, Action Oriented, Realistic, and Timely) goals be developed. Key elements of an objective are to define the time frame, criterion, target population, and action. A few criteria to consider when creating SMART goals include the following:

• What specifically do you want to achieve?
• Why is this goal important?
• What steps will be needed to achieve the goal?
• How do you know that the goal is achievable?
• When do you want to achieve the goal?
• Are the goals consistent with the policies and procedures of the organization?
• Does the initiative have enough resources?

Implementation of the plan with quality metrics and continuous process improvement are the final steps in the process. Using the PDSA (Plan, Do, Study, and Act) model is recommended to implement and analyze quality studies. Continual improvement is vital, and analysis of process and data is imperative to make informed decisions in the evolving healthcare environment to improve quality of service.

Academy of Oncology Nurse & Patient Navigators Competencies for the Domain of Research, Quality, and Performance Improvement

• Define Triple Aim and how this initiative drives quality
• Define healthcare environment that is driving the focus on quality and outcomes
• Address the IOM reports that describe the need for quality in healthcare and how it shapes practices and initiatives in oncology
• Define evidence-based practice, quality, and performance improvement terminology
• Identify regulatory agencies that mandate quality improvement
• Identify evidence-based practice models
• Identify key quality and performance improvement tools
• Describe the steps to develop a quality improvement project
• Discuss how data are used for continuous improvement

Reference
1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.