The Evolution of a Quality Programme within a Changing Environment

Abstract

French

Health care facilities have been forced to re-evaluate traditional methods of quality assurance and consider quality improvement techniques. The Toronto Hospital Occupational Therapy Department has developed a quality programme that incorporates a foundation and supporting structures that can be adapted to accommodate the shift from quality assurance to continuous quality improvement. The foundation consists of a philosophy and principal functions, while the supporting structures include mechanisms to monitor principal functions and for communication. With a shift to continuous quality improvement, the quality programme was expanded to include clinical indicators and greater involvement of front-line staff and consumers. The programme also incorporates a framework that directs the development and implementation of clinical indicators related to occupational performance outcomes. Issues pertaining to the implementation and adaptation of the quality programme are discussed. Although initially developed in an occupational therapy environment, the framework and processes of this quality programme are being applied to multidisciplinary quality programmes in which occupational therapists are taking on leadership roles.

Keywords

Assurance occupational therapy Clinical indicators Continuous quality improvement

Get full access to this article

View all access options for this article.

References

Appel

(1991). From quality assurance to quality improvement: The joint commission and the new paradigm. Journal of Quality Assurance, 23(5), 26–29.

Ballinger

W.F.

Hepner

J.O.

(1993). Total quality management and continuous quality improvement: An introduction for surgeons. Surgery, 113, 250–254.

Bruhn

J.G.

(1991). Occupational therapy in the 21st century: An outsider's view. American Journal of Occupational Therapy, 45, 775–780.

Butterfield

R.W.

(1991, March). Deming's 14 points applied to service. Training, 50–59.

Canadian Association of Occupational Therapists. (1987). Standards for occupational therapy services and the internal review for accreditation of an occupational therapy service. Toronto, ON: Author.

Canadian Association of Occupational Therapists. (1991). Occupational therapy guidelines for client-centred practice. Toronto, ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists. (1996). Code of ethics. Ottawa, ON: CAOT Publications ACE.

Canadian Council on Health Facilities Accreditation. (1994). Proposed standards for acute care organizations: A client-centred approach. Ottawa, ON: Author.

College of Occupational Therapists of Ontario. (1996). Practice guidelines. Supervision of student occupational therapists. Toronto: Author.

10.

Deming

W.E.

(1986). Out of the crisis. Cambridge, MA: MIT Press.

11.

Dimant

(1991). From quality assurance to quality management in long term care. Quality Review Bulletin, 17, 207–215.

12.

Ernst

D.F.

(1994). Total quality management in the hospital setting. Journal of Nursing Care and Quality, 8(2), 1–8.

13.

Gage

(1995). Re-engineering of health care: Opportunity or threat for occupational therapists? Canadian Journal of Occupational Therapy, 62, 197–207.

14.

Health Services Research Group. (1992). Quality of care: 1. What is quality and how can it be measured? Canadian Medical Association Journal, 146, 2153–2158.

15.

Johnson

(1994). Transition to quality improvement: Adapting the quality management plan. Journal of Nursing Care and Quality, 8(2), 16–21.

16.

Keith

R.A.

(1995). Conceptual basis of outcome measures. American Journal of Physical Medicine and Rehabilitation, 74(1), 73–80.

17.

Law

Polatajko

Pollock

McColl

Carswell

Baptiste

(1994). Pilot testing of the Canadian Occupational Performance Measure: Clinical and measurement issues. Canadian Journal of Occupational Therapy, 61, 191–197.

18.

Lee

(1991, July). The customer. Training, 21–26.

19.

Loomis

(1994). Rehabilitation outcomes: The clinician's perspective. Canadian Journal of Rehabilitation, 7, 165–170.

20.

Maclntosh

A.M.

McCutcheon

D.J.

(1992). “Stretching” to continuous quality improvement from quality assurance: A framework for quality management. Canadian Journal of Quality in Health Care, 9(2), 19–22.

21.

Nadzam

D.M.

Turpin

Hanold

L.S.

White

R.E.

(1993). Data-driven performance improvement in health care: The Joint Commission's Indicator Measurement System. Journal on Quality Improvement, 19, 492–500.

22.

Reinertsen

J.L.

(1993). Outcome management and continuous quality improvement: The compass and the rudder. Quality Review Bulletin, 19(1), 5–7.

23.

Schoenbaum

S.C.

(1995). Health care reform and its implications for quality of care. Medical Care, 33(1), JS37–JS40.

24.

The quality march: National survey profiles quality improvement activities. (1993, December). Hospitals & Health Networks, 52–55.

25.

Walton

(1986). The Deming Management Method. New York: Putnam Publishing.