DOUBLE-LOOP LEARNING AND THE QUALITY OF QUALITY IMPROVEMENT

Background: Double loop learning, an attempt to question underlying or ganizational policies and goals, offers the possibility of making qual ity improvement (QI) efforts more productive. Joint Commission standar ds in the Improving Organizational Performance (PI) chapter of the Com prehensive Accreditation Manual for Hospitals regarding the measuremen t of important processes or outcomes related to patient care and organ ization functions seem to incorporate the principle of double loop lea rning. Improving PI processes: QI can be applied to five sets of PI pr ocesses: planning, designing, measuring, assessing, and improving. A c omposite case study is presented, in which a consultant used the PI fr amework to review a 300-bed state mental hospital's al function. Examp le-Assessing: When data are assessed, is the organization using tools such as run charts and process control charts correctly to understand sources of variation? Because QI and other hospital staff were unfamil iar with run and control charts, the consultant gave a brief introduct ion to variation acid process control and helped them evaluate their d ata. The hospital's quality council voted to send two of its members, the directors of management information systems and QI, to a course on statistical process control and agreed to put in their QI plan and an nual appraisal a reassessment of their needs for more staff to be fami liar with statistical process control. Summary and conclusions: Taking an honest look at the value of al within one's organization can lead to actual performance improvement instead of ''paper'' improvement. In dicators should be developed to assess and improve Q1 processes.