4 step process improves quality of care in medical practice

For doctors who want to improve patient care and office efficiency, there is a straight-forward, cost-effective way to achieve that goal. Learn the four steps you need to take.

Plan-Do-Study-Act

The AMA’s STEPS Forward™ collection of practice improvement strategies can guide you through the steps it will take to make quality-of-care improvements you have identified—anything from improving adult immunization rates to bettering diabetes or hypertension screening and care. It also can help your staff work flow concerns, such as lowering no-show rates and wait times and increasing your chances of finishing the day on time.

And once you’ve made changes, the steps can help you find opportunities to make “improved” processes even better.

The module—written by Laura Lee Hall, PhD, director of the Center for Quality and Office of Grants at the American College of Physicians—lays out a four-step Plan-Do-Study-Act (PDSA) strategy that physicians can follow.

Plan: Develop the initiative
Do: Implement your plan
Study: Check the results
Act: Make further improvements

Developing a plan

When deciding upon the quality improvement initiative, physicians should ask people on the front lines—for example clinical team members and clerical staff—their opinions on what needs to change. Patient surveys also can be a useful tool. Ask:

Where does the practice need to improve patient care? Performance measure data from a Physician Quality Reporting System or point-of-care registry may be able to point out gaps in care processes or patient outcomes.
Where is your practice less efficient than it should be? Staff can help identify bottlenecks in the work flow and key areas for improvement. Prioritize areas in which you have some control and that the team thinks will have the most impact.
What about the day is most frustrating for your team and/or patients? Ask them and prioritize which items should be improved.

The module can walk you through the steps needed to develop the plan, including what your practice wants to accomplish, when the changes will take place, and what team training and preparation is required.

Implementing a plan

The module also helps the change team with the follow-through once the plan is devised, offering suggestions and resources on how to implement the plan and determine how the changes are working.

For example, physicians trying to improve diabetes care can look at the percentage of patients with diabetes who have a current A1c level documented to assess actions taken by the clinical team; to measure patient outcomes, look at the percentage of patients who have an A1c level less than 7.0.

“I thought I had a good handle on managing my diabetic patients, but I learned about facilitating good decision-making by my patients, coaching behavioral changes and gaining insight into patient compliance,” said Baltimore internist Robert Dobbin Chow, MD, who used the PDSA model. “I also learned about how to engage my office staff into optimizing our care of our diabetic patients.”

A multi-specialty group in Brooklyn, N.Y., improved patient communication and outcomes for diabetes patients without hiring any additional staff using the PDSA model. It began with a simple questionnaire that uncovered that diabetic patients knew far less about their disease and their care plan than physicians realized. Read more about that practice’s experience on the STEPS in practice portion of the new module.

More practice resources

The module on quality improvement using Plan-Do-Study-Act is one of eight new modules recently added to the AMA’s STEPS Forward collection of practice improvement strategies to help physicians make transformative changes to their practices. Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.