PERFORMANCE IMPROVEMENT IN HEALTH-CARE ORGANIZATIONS - INCREASING THEIMPACT OF QUALITY IMPROVEMENT ON HEALTH - AN EXPERT PANEL METHOD FOR SETTING INSTITUTIONAL PRIORITIES

Background: Successful implementation of modern ongoing quality improv ement (QI) methods requires investment of institutional resources, but can produce significant improvements in medical care. A health care o rganization's goals and objectives for improving care are expressed in strategic plan documents, which could provide a framework for plannin g quality improvement initiatives. However, institutional strategic pl anning processes are often not well linked to QI staff and resources. We developed the Quality Action Program (QAP) to connect QI to strateg ic planning. History: In 1991, Sepulveda VHAMC implemented a major pri mary care initiative, documented in a comprehensive strategic plan. Th e QAP was developed to enable the initiative to be evaluated within a QI context. Three-round expert panel process: To carry out the QAP, me mbers of an institution's quality council engage in a structured conse nsus process. The first round involves reading educational materials a nd filling out a quality action survey the second round includes parti cipation in an expert panel meeting, and the third round involves maki ng final priority rankings. Eight-step QAP implementation plan: QI sta ff carry out activities to prepare for and carry out the three-round e xpert panel process. Results: QAP induced significant institutional QI activity directed toward achieving the top-ranked QI criterion-ensuri ng continuity of care. Continuity of care improved significantly over time between the pre- and post-QAP periods. Conclusions: Expert panel methods can be used to link strategic plan goals and objectives to QI efforts.