Glossary for: Quality Improvement

5 Whys

A question-asking method used to explore the relationships between cause and effect underlying a problem to identify the root cause.

Accountability

An obligation or willingness to accept responsibility. It’s an expectation of being responsible toward others.

Adverse events

Harm to a patient, structure or function and/or any negative effect from that.

Aim statement

A concise and measurable declaration of the improvement goal.  It includes what, where, by how much and by when. An example: “This is the third wave of Clear (which used to be known as CLeAR: A Call for Less Antipsychotics in Residential Care), and this time we’re focused on supporting care homes that have more […]

Bar charts

Visual displays that show data that has been categorized and counted. It is used to compare different categories.

Cause and effect diagram (Ishikawa/Fishbone)

A technique to organize and display ideas about what may be the root cause of a problem, designed to encourage innovative thinking (but not thinking about solutions, only potential causes).

Change

To make something different.  See “Improvement” for contrast.

Charter

A documented plan to guide the work of an improvement team. A Quality Improvement Charter details the following: What is the problem currently? What are we trying to accomplish (aim, goals)? How will we know that a change is an improvement (measures, data)? What changes can we make that will result in an improvement? How […]

Checklist

A list of things to be done, required items, or things to consider. Checklists are often used as reminders. In quality improvement, they are used to improve the safety of care, by ensuring that proven standards of care are met when used. They improve compliance with standards and decrease complications. Example: surgical checklists.

Coaching

An action-focused dialogue between two or more people that brings clarity to an issue and develops a plan of action for tackling it. It is a facilitated exploration of an issue through discussion, different perspectives and neutral feedback, as well as observations to allow for self-reflection and action.

Competencies

A set of skills, knowledge, attitudes and behaviours needed for a role.

Control charts

A graph of data over time used to understand the type of variation in a process or outcomes.  There are three lines that are determined by historical data – average, upper control limit and lower control limit.

Control charts

A graph of data over time used to understand the type of variation in a process or outcomes.  There are three lines that are determined by historical data – average, upper control limit and lower control limit.

Culture

When it comes to organizations, culture is sometimes described as “the way we do things around here.” It includes shared attitudes, beliefs, values and norms of behaviour, the way of making sense of the organization and the ways things are understood, judged and valued.

Data for improvement

Statistical tools and techniques used to measure the impact of improvements. Some common tools for display and interpretation are the run charts, control charts, bar charts, Pareto diagrams, histograms and radar charts.

Error

Failure to carry out a planned action as intended, or application of an incorrect plan.

Feedback

A situation when the results from an event will influence the next time the event takes place. When an event is part of a chain of cause-and-effect that forms a circuit or loop, it is said to “feed back” into itself.

Flow chart

A type of diagram that shows the steps of a process and their order, by connecting them with arrows. There are several types of flowcharts, and sometimes the word is used interchangeably with Process Mapping (which is a flowchart, with some extras).

Hazard

A circumstance, agent or action that can lead to or increase risk.

High reliability organization

An organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.

Histograms

Graphs showing the distribution of continuous data (such as time).

Human factors

The scientific discipline concerning understanding interactions between humans and other elements of a system. It’s also a profession that applies theory, principles, data and methods to how something is designed, with the goal of improving human well-being and overall system performance.

Improvement

Fundamental changes that alter how work or activity is done, producing visible, positive differences in results related to historical norms, with a lasting impact. Improvement always requires change, but not all changes will result in improvement.  Improvement comes from action. It means doing something better from the viewpoint of the customer or other beneficiary. It’s […]

Improvement

Fundamental changes that alter how work or activity is done, producing visible, positive differences in results related to historical norms, with a lasting impact. Improvement always requires change, but not all changes will result in improvement.  Improvement comes from action. It means doing something better from the viewpoint of the customer or other beneficiary. It’s […]

Infection control

The discipline concerned with preventing infections associated with health care.

Innovation

The process by which a novel idea or invention is put into practice, resulting in a change or improvement.

Lean

A philosophy focused on maximizing value while reducing waste or inefficiency.

Measures

Measures are recorded observations which include quantitative (numbers) and qualitative (words, pictures, images) data.  There are three types of measures that can be used in improvement work: Outcome measures are related to the goal (aim statement) and show whether changes are leading to improvement. Process measures show whether a change is having its intended effect […]

Medication error

A preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, infection or other ailment.

Mentoring

Giving advice and showing the way.

Mistake-proofing

A mechanism that avoids mistakes by preventing, correcting or drawing attention to human errors as they occur. Examples: adding fields in a software program that will only accept certain formats (think postal codes); using dropdown menus instead of free-text, creating clear visual differences in labels for medications with similar names.

Mitigating factor

An action or circumstance that prevents or moderates the progression of an incident from harming a patient, such as double-checking for certain types of errors.

Model for Improvement

An approach to improvement which helps people develop, test and implement changes. The Model for Improvement includes three questions and a cycle for learning and improvement, called a PDSA Cycle. The three questions are: What are we trying to accomplish (aim, goals)? How will we know that a change is an improvement (measures, data)? What […]

Monitoring

To observe a situation for any changes that may occur over time.

Pareto diagrams

Pareto diagrams are bar charts with categories organized in decreasing order of frequency with the cumulative total represented by a line. A Pareto diagram is used to identify the areas of an organization or process that will deliver maximum benefit (“the significant few”) when improved. Related to the Pareto principle, also known as the 80/20 […]

Pareto principle

The concept that, in many situations, 80% of the outputs will be generated by only 20% of the inputs. For example, 20% of users will make 80% of the calls to a service desk.  Also known as the 80/20 rule.

Patient safety

Freedom, for a patient, from unnecessary harm or potential harm associated with health care.

PDSA cycle

A method for learning and improvement based on a scientific method. The PDSA cycle includes four phases: Plan, Do, Study, and Act. PDSA cycles can be used to develop, test and implement changes, initially on a small scale. They can be used sequentially over time to build knowledge about what changes work, why they work, […]

Person-centred care

A system that is designed and delivered to directly address the health care needs and preferences of patients. To achieve person-centred care, the focus must be on following six principles: respect; choice; empowerment; patient, caregiver and staff involvement in health policy; access and support; and information.

Person-centredness

A focus on respect; choice; empowerment; involvement of patients, caregivers and staff in health policy; access and support; and information. See also “person-centred care”.

Process

A series of steps required to achieve intended outcomes.

Process mapping

A visual representation of activities and steps involved in a process, including who is responsible for each step, what the standard of practice is, and how success is determined.

Quality

In the context of health care, quality refers to health service delivery and is evaluated on the patient’s experience, the provider’s experience, the outcome of the service, and the cost compared to the outcome of the service. The BC Health Quality Matrix outlines five dimensions of quality that are prioritized when focusing on the patient/client […]

Rapid improvement events [Kaizen]

These are structured ways of bringing together people who are involved in all parts of the process of delivering a service in order to allow detailed sharing of all actions undertaken (the current state), the process and opportunities to define a future state, and the improvement action plan needed to get there.

Reliability

The ability of a system to perform and maintain its expected functions, not only in routine circumstances, but also in hostile or unexpected circumstances.

Risk assessment

An assessment of the probability that a potential hazard will occur, and its consequences.

Root cause analysis

A problem-solving method that addresses, corrects or eliminates the root cause of a problem, instead of merely addressing the immediately obvious symptoms. By identifying the root causes, it is more likely that the problem will not occur again.

Run charts

A run chart, also known as a time series plot, is a graph that shows observed data in a time sequence. It is used to show changes, patterns and trends in a process over time.

Safety culture

A term often used to describe the way in which safety is managed in the workplace, and often reflects “the attitudes, beliefs, perceptions and values that employees share in relation to safety.”

SBAR

SBAR stands for Situation, Background, Assessment, Recommendations, and is a method of framing conversations, especially critical ones, as it allows clarification of information to be communicated between team members.

Simulation

The imitation of a situation or process. The act of simulating something generally involves representing certain key characteristics or behaviours. Simulation is used in many contexts to gain insight into their function. Example: modeling an emergency room environment in which teams can experience errors, practice responses and then examine where they can improve safety and […]

Six Sigma

A set of management techniques for improving the results of a process by identifying and removing the causes of defects (errors), as well as minimizing variability, by using statistical methods and following a defined sequence of steps (known as DMAIC: Define, Measure, Analyze, Improve, Control).

Spaghetti diagram

A means of tracking movement in a specific area to identify wasted activity and movement.

Spread

The intentional sharing of best practices and knowledge about improvement interventions, and the implementation of these interventions and best practices. (Source)

Standard work

A Lean methodology concept, it is an agreed-upon method of following a process that maximizes value while minimizing waste.

Sustainability

The capacity to endure. It’s the potential for long-term maintenance of well-being which has environmental, economic and social dimensions.

System

Interdependent components (items, people, processes) that work together towards a common purpose. Systems have structure, behaviour and interconnectivity.

Teamwork

Work performed by a team towards a common goal, often using agreed-upon activities and behaviours to assure quality and safety.

Test

A trial of a new approach or process, usually starting on a small scale and then expanding. A test is designed to help a team learn if a change results in improvement, and fine-tune the change to fit the organization and patients. Tests are often carried out using one or more PDSA cycles.

Timeout

Refers to a pause in a procedure for a short amount of time. This allows team members to communicate to determine action or inspire morale. Teams usually call timeouts at strategically important points in a process to avoid members being misled or working with conflicting assumptions.

Trigger tools

A means to measure the level of harm in health care by identifying adverse events. Because they are metric, trigger tools can be used to track improvements in safety over time.

Triple Aim

The term “Triple Aim” refers to simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per-capita cost of care for the benefit of communities. It is a framework that serves as the foundation for organizations and communities to successfully navigate the transition from a focus on health […]

Value and waste

A process adds value by producing goods or providing a service that a customer will receive. A process also consumes resources, which may produce waste when more resources are used than are necessary to produce the goods/services.

Value stream mapping

A Lean technique used to analyze the flow of materials and information required to bring a service to a customer/patient.

Variation

The term variation refers to changes or differences in something within certain limits. All systems contain variation. Knowledge of the type of variation is needed to determine appropriate actions in each case. Common causes of variation are those that are inherent in a process or system. They affect everyone working in the process and affect […]

Waste

Any step or action that is not required to complete a process, that doesn’t add value and  unnecessarily using resources that could be employed in other activities. The eight main types of waste are: defects, overproduction, waiting, unnecessary transportation, inventory excess, motion, over-processing, and not utilizing talent.