Methods & Tools

Accessibility

Ability of a patient or population to utilize needed healthcare services unrestricted by geographic, economic, social, cultural, organizational, or linguistic barriers.

Accreditation

A formal process by which a recognized body, usually a non-governmental institution, assesses and recognizes that a healthcare organization meets applicable, pre-determined standards.

Algorithm

Recommended patient management strategies designed to direct decision making, such as a structured flowchart, decision tree, or decision grid. Often algorithms are used in areas in which rapid decision making is required, e.g., emergency department.

Amenities

Features of health services that do not directly relate to clinical effectiveness but may enhance the client's satisfaction and willingness to return to the facility for further healthcare needs. These would include physical appearance and cleanliness of the health facility.

Bar chart

A graphic display of data in the form of a bar showing the number of units (e.g., frequency) in each category.

Baseline

An observation or value that represents the background level of a measurable quantity.

Benchmarking

A process of searching out and studying the best practices that produce superior performance. Benchmarks may be established within the same organization (internal benchmarking), outside of the organization with another organization that produces the same service or product (external benchmarking), or with reference to a similar function or process in another industry (functional benchmarking).

Best practice

A way or method of accomplishing a business function or process that is considered to be superior to all other known methods.

Brainstorming

A group process used to generate a large number of ideas about specific issues in a non-judgmental environment.

Case management

Coordination of services to help meet a patient's healthcare needs, usually when the patient has a condition which requires multiple services from multiple providers.

Cause-and-effect diagram

A display of the factors that are thought to affect a particular problem or system outcome. The tool is often used in a quality improvement program to group people's ideas about the causes of a particular problem in an orderly way. (Also known as a fishbone diagram because of the shape that it takes when illustrating the primary and secondary causes.)

Certification

A process by which an authorized body, either a governmental or non-governmental organization, evaluates and recognizes either an individual or an organization as meeting pre-determined requirements or criteria.

Clinical pathway

A patient care management tool that organizes, sequences, and times the major interventions of nursing staff, physicians, and other departments for a particular case type (e.g., normal delivery), subset (e.g., hysterectomy), or condition (e.g., failure to breastfeed). (Synonyms: critical path, care map.)

Clinical practice guidelines

A set of systematically developed statements, usually based on scientific evidence, to assist practitioners and patient decision making about appropriate healthcare for specific clinical circumstances. (Synonyms: practice guidelines, guidelines, practice parameters.)

Coaching

Providing guidance, feedback, and direction to ensure successful performance.

Competence

Demonstrated performance and application of knowledge to perform a required skill or activity to a specific, predetermined standard.

Compliance

Performance according to standards

Continuity

A performance dimension addressing the degree to which the care for a patient is coordinated among practitioners and organizations and over time, without interruption, cessation, or unnecessary repetition of diagnosis or treatment.

Continuous Quality Improvement (CQI)

A management approach to improving and maintaining quality that emphasizes internally driven and relatively continuous assessments of potential causes of quality defects, followed by action aimed either at avoiding decrease in quality or else correcting it an early stage.

Control chart

A graphic display of the results of a process over time and against established control limits. The dispersion of data points on the chart is used to determine whether the process is performing within prescribed limits and whether variations taking place are random or systematic.

Effectiveness

The degree to which program or system objectives are being achieved.

Efficiency

The relationship of outputs (services produced) to inputs (resources used to produce the services). Increasing efficiency is a matter of achieving the same outputs with fewer resources or more outputs for the same amount of resources.

Evidence-based medicine

The practice of medicine or the use of healthcare interventions guided by or based on supportive scientific evidence. Also, the avoidance of those interventions shown by scientific evidence to be less efficacious or harmful.

Flowchart

A graphical representation of the sequence of activities, steps, and decision points that occur in a particular, discrete process, such as registering a client in a clinic.

Focus group

A client-oriented approach for collecting information wherein a group (10-12) of participants, unfamiliar with each other, meet to discuss and share ideas about a certain issue. Results of focus group discussions help to understand the beliefs and perceptions of the population represented by the group.

Gantt chart

A type of bar chart used in process or project planning and control to display planned work targets for completion of work in relation to time. Typically, a Gantt chart shows the week, month, or quarter that each activity will be completed and the person or persons responsible for carrying out each activity.

Health outcomes

The effect on health status from performance (or non-performance) of one or more processes or activities carried out by healthcare providers. Health outcomes include morbidity and mortality; physical, social, and mental functioning; nutritional status; and quality of life.

Histogram

A graphic display used to plot the frequency with which different values of a given variable occur. Histograms are used to examine existing patterns, identify the range of variables, and suggest a central tendency in variables.

Impact

A change in the status (e.g., health, standard of living) of individuals, families, or communities as a result of a program, project, or activity. For example, the impact of an immunization program might be the reduction in infant mortality by 15 percent.

Incentive

A tangible or intangible reward that is designed to motivate a person or group to behave in a certain way. For example, in an effort to reduce fertility, community health workers may be given a small amount of money for each woman they refer to the health clinic for family planning services.

Indicator

A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or the level of quality achieved.

Inputs

The resources needed to carry out a process or provide a service. Inputs required in healthcare are usually financial, physical structures such as buildings, supplies and equipment, personnel, and clients.

Job aid

A repository for information, processes, or perspectives that support work and activities by directing, guiding, and enlightening performance. Job aids are often printed or visual summaries of key points or steps essential to the performance of a task.

Just in time

A method of minimizing product and supply inventories by ordering materials as close as possible to the actual time of need. This reduces the cost of maintaining inventories of expensive items, such as newer biotechnology drugs. Precise timing and reliable suppliers are essential for this technique to work effectively.

Licensure

A process by which a governmental authority grants permission to an individual practitioner or healthcare organization to operate or to engage in an occupation or profession.

Measure

A number assigned to an object or an event. Measures can be expressed as counts (45 visits), rates (10 visits/day), proportions (45 primary healthcare visits/380 total visits = .118), percentage (12 percent of the visits made), or ratios (45 visits/4 health workers=11.25).

Outcomes

Results of a process, including outputs, effects, and impacts.

Output

The direct result of the interaction of inputs and processes in the system; the types and quantities of goods and services produced by an activity, project, or program.

Pareto chart

A graphic representation of the frequency with which certain events occur. It is a rank-order bar chart that displays the relative importance of variables in a data set and may be used to set priorities regarding opportunities for improvement.

Patient satisfaction

A measurement that obtains reports or ratings from patients about services received from an organization, hospital, physician, or healthcare provider.

Performance

The actual output and quality of work performed.

Problem solving

A quality improvement approach that involves objectively identifying the causes of a problem and proposing potential, often creative, solutions to the problem, which will be agreeable to multiple parties or individuals.

Problem statement

A concise description of a process in need of improvement, its boundaries, the general area of concern where quality improvement should begin, and why work on the improvement is a priority.

Procedure

Step-by-step instructions on how to perform a task based on technical and theoretical knowledge.

Process

A series of actions (or activities) that transforms inputs (or resources) into a desired product, service, or outcome.

Proportion

A special type of ratio expressing a relationship between the part and the whole. The numerator represents a portion of the total; the denominator is the total. For example, five male health workers out of a total of 15 health workers make a proportion.

Protocol

A detailed plan, or set of steps, to be followed in a study, an investigation, or an intervention, as in the management of a specific clinical condition (e.g., care of a patient with diarrhea).

Quality

The totality of features and other characteristics of a product or service that bear on its ability to satisfy stated or implied needs.

Quality assessment

Determination of how processes and services correspond to current standards, as well as a patient's satisfaction with the care received.

Quality assurance

That set of activities that are carried out to set standards and to monitor and improve performance so that the care provided will satisfy stated or implied needs.

Quality design

Systematic approach to service design that identifies the key features needed or desired by both external and internal clients, creates design options for the desired features, and then selects the combination of options that will maximize satisfaction within available resources.

Quality improvement

An approach to the study and improvement of the processes of providing healthcare services to meet needs of clients.

Quality indicator

An agreed-upon process or outcome measure that is used to determine the level of quality achieved. A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or achievement of quality goals.

Quality management

An ongoing effort to provide services that meet or exceed customer expectations through a structured, systematic process for creating organizational participation in planning and implementing quality improvements.

Quality monitoring

The collection and analysis of data for selected indicators which enable managers to determine whether key standards are being achieved as planned and are having the expected effect on the target population.

Rate

A special form of proportion that includes specification of time. For example, the case-fatality rate of cerebral malaria is the number of cases of cerebral malaria who died over a period of time divided by the total number of cases of cerebral malaria in the same time period.

Ratio

The relationship between two numbers. For example, the ratio of males to females (known as the sex ratio) in a country is the number of males divided by the number of females. Any fraction, quotient, proportion, or percentage is a ratio.

Reliability

The extent to which the same result is achieved when a measure is repeatedly applied to the same group.

Root cause

The underlying reason for the occurrence of a problem.

Run chart

A visual display of data that enables monitoring of a process to determine whether there is a systematic change in that process over time.

Sample

A subset of the population. To the extent possible, a sample should possess all salient characteristics of the population from which it is drawn so that it is representative of the larger population.

Scatter diagram

A graphic display of data plotted along two dimensions. Scatter diagrams are used to rapidly screen for a relationship between two variables.

Specification

An explicit statement of the required characteristics for an input used in the healthcare system. The requirements are usually related to supplies, equipment, and physical structures used in the delivery of health services.

Standard

An explicit statement of expected quality. Standards represent performance specifications that, if attained, will lead to the highest possible quality in the system.

Standard operating procedure

Management processes that describe chronological steps to follow and decisions to make in carrying out a task or function.

Standing orders

Physician orders pre-established and approved for use by nurses and other professionals under specific conditions in the absence of a physician.

System

The arrangement of organizations, people, materials, and procedures associated with a particular function or outcome. A system is usually made of inputs, processes, and outcomes.

Team

A group of interacting individuals sharing a common goal and the responsibility for achieving it.

Technical performance

What the health provider actually does in a real situation.

Threshold

A level of achievement that determines the difference between what is deemed to be acceptable quality or not. For example, "the minimal acceptable level of coverage for the immunization program is 50 percent," means that every coverage figure less than that is an indication of a quality problem.

Total Quality Management (TQM)

An approach to quality assurance that emphasizes a thorough understanding by all members of a production unit of the needs and desires of the ultimate service recipients, a viewpoint of wishing to provide service to internal, intermediate service recipients in the chain of service, and a knowledge of how to use specific data-related techniques to assess and improve the quality of their own and the team’s outputs.

Validity

The degree to which an indicator accurately measures what it is intended to measure.

Variation

Differences in the output of a process resulting from the influences of people, equipment, materials, and/or methods.