MOC DR PQI Message

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diagnostic radiology

Practice Quality Improvement - Not Just Another Hoop
a message from N. Reed Dunnick, ABR past president

When you read "Practice Quality Improvement," your first thoughts might be of all the blanks you'll have to fill in on one more endless form. You might feel a sense of resignation over yet another requirement to complete.

But Practice Quality Improvement (PQI) is a vital part of the Board's - and your - effort to improve both the safety and the quality of healthcare. As we progress deeper into the 21st century, we all - individually as physicians and medical physicists and collectively as "Radiology" - face challenges to make healthcare:

safe
efficient
timely
effective
patient-centered
equitable

Each PQI project you select is an opportunity to improve at least one of these essential dimensions of care.

You can participate in PQI individually or as part of a specialty organization's project. If multiple colleagues in the same practice participate in the same PQI project, each must maintain source data individually for substantiation in the event of an audit.

Most physicians and medical physicists don't have a background in quality management or systems engineering so it´s important to begin your PQI effort by reading the information available here .

The first requirement is simple.
Just learn about PQI principles in the various courses available through annual medical society meetings or at other seminars that are not medical in nature. Our quality improvement principles originated, not in medicine, but in quality manufacturing and aviation.

The next step is selecting a topic.
If you´re uncertain about what aspect of your practice is ripe for quality improvement, carry a notepad with you for a week and jot down thoughts whenever you encounter something frustrating, inaccurate, dangerous, potentially dangerous, wasteful, slow, inefficient, unreliable, erratic, unpredictable, suboptimal, redundant, or just plain wrong.

Select something from your list that makes sense to you.

Select something from your list that makes sense to you either because of its frequency, the magnitude of its impact on patient care, the cost saving potential, safety implications, or because you find it interesting. Whatever topic you choose, your project should be:

relevant to your practice
achievable in your practice setting
suited to repeat measurements over time
reasonably expected to bring about quality improvement

If you find issues, design a plan to improve the problems.

After you've decided on a topic.
Determine the measures you will use initially at baseline in a series of consecutive unselected patients and again at later points after you have implemented an improvement plan.

Once you´ve determined your metric you should obtain baseline data in a relevant number of patients. Analyze the data to determine if there are any quality issues.

If you find issues, design and implement a written plan to improve the problems. Sometimes you will have to conduct a root cause analysis before you can craft an improvement plan.

Once the plan is crafted and implemented:
Repeat your measurements on a second cohort of patients. Repeat the cycle until the increment of improvement from new baseline to next measurement becomes infinitesimally small after you´ve implemented the modified improvement plan.

Ultimately, if the increment of improvement becomes small enough and performance improvement plateaus, you can sustain the gain with your ongoing improved practices.

And then you can tackle your next PQI project.

For any questions on PQI, please contact our MOC division at abrmoc@theabr.org . Alternatively, you may call 520-790-2900 and ask to speak with one of the ABR MOC staff.