What Quality Improvement Means To Me

In the clinical setting, the topic of quality improvement (QI) is often met with groans. One more thing to keep track of.

One more thing to be “dinged” for if it isn’t done to some faceless agency’s standards. More paperwork.

However, if you think about it, “quality” and “improvement” are two things that should be brought to every patient encounter. While nobody appreciates having their work scrutinized and picked through by strangers, when you think of QI as something that can only benefit patients, it becomes much more palatable.

The “quality” aspect of QI is fairly straightforward: provide the highest possible level of care to our patients. The “improvement” part is not quite as intuitive. What is it we’re trying to improve? Our care? Our communication? Our ability to empathize? Our documentation? Our patients’ outcomes? It could mean any or all of these things at any given moment.  If we’re not continually trying to improve, we’re just treading water, and that isn’t fair to the people who come to us for help.

“When we improve as clinicians—whether through research, continuing education, or experience—our care improves and, therefore, so do our patients’ outcomes.”

So what does QI mean to me when I’m in an exam room with a patient? I

t means protecting my patients with appropriate vaccinations. It means screening them to avoid dangerous, even life-threatening, complications before starting a new medication. It means measuring—consistently and accurately—their level of disease activity.

I would like to think I would do all these things anyway (and I did even before they became reportable metrics), but it never hurts to have a standard to live up to. The metrics we strive to reach in clinical practice have been debated and rigorously researched by the top experts in our field, so I am confident they are appropriate for my practice. While I am not entirely beholden to these metrics and still take time with my patients to focus on topics that aren’t included in current QI guidelines or requirements (nutrition and exercise come to mind), I know that when I aim to reach current QI standards, I am providing the best care for my patients.

AUTHOR PROFILE: Elizabeth Kirchner, CNP, is a nurse practitioner at the Cleveland Clinic in Cleveland, Ohio, and the Education and Curriculum Chair of the Rheumatology Nurses Society.