A Tracer-based Continuous Improvement (TCI) model is a conceptual tool applied by healthcare institutes that utilizes employees’ existing knowledge and expertise and well-established standards related to quality and patient safety goals to identify possible problems and risks and act on them before errors, incidents or other unwanted movements occur.
When properly implemented, the tool can make an important contribution to improving compliance against standards for accreditation and clinical governance and outcomes.
QTRACER’s software system supports this model, creating a clear and compelling way of mobile team working that improves accountability and enables healthcare professionals to easily collect meaningful information. You can set up a system that encourages employees to be more proactive by showing them that improvement is possible in an open and transparent manner. This ensures that the improvement journey isn't a pothole-ridden uphill battle, but will embrace change.
The preventive approach of the model makes you less dependent on big data, patient surveys and incident reports in the aspiration to achieve the highest standards of excellence in the provision of high-quality and safe care.
Take a look in the kitchen of QTRACER: I would like to share some insights about our TCI software solution; the what, why and how.
Healthcare Challenges to Continuous Improvement
Healthcare institutions are being held increasingly accountable for the safety and quality of care provided. The adoption of strict liability makes these institutions responsible for striving to achieve the highest quality and safety standards by focusing on continuous quality improvement work.
Implementing a continuous quality improvement cycle will help improve the quality and safety of care institutions provided; identify gaps and areas for improvement, address issues/opportunities and implement the changes, measure performance and show that high quality care or services are being provided.
Continuous improvement in healthcare means constantly striving to improve your quality and patient safety according to the highest standards. These can be standards for accreditation or for clinical governance.
Developing countries frequently use hospital accreditation such as the Joint Commission International (JCI) and Accreditation Canada International (ACI) to guarantee quality and patient safety. Accreditation standards can play a significant role in improving clinical practice and organizational performance since that accreditation systems adapt the philosophy of continuous quality improvement.
The accreditation process allows to measure quality and patient safety performance against international standards (best practices). This process is an essential part of ensuring that treatments and care services hospitals provide to patients meets or exceeds world-class standards and encourages continuous improvement.
The downside of obtaining and retaining accreditation is, that it demands a lot from the organization. Probably no healthcare institute making compliance journeys will deny this.
Despite that accreditation provides a robust tool for the continuous quality improvement efforts, in the healthcare facilities there are now signals from hospitals whether it is really worth the investment of money and time. Hospitals can become discouraged from continuing their accreditation due to the high and demanding workload – it’s an arduous and time-consuming process.
In the abolition of the Danish hospital accreditation in 2015 hospital employees negative attitudes towards accreditation were one of the decisive arguments. More often, after years of accreditation, it is perceived as entailing a burden of bureaucracy, and needing excessive registration and documentation.
But institutions must be aware of that high demands as stated by accreditation bodies also applies to the implementation of policies, procedures and national or organization own standards without the formal accreditation or certification processes.
Quality and patient safety benefit from unified collaboration. But awareness of a common goal is often lacking among healthcare professionals. Accreditation as well clinical governance ensures that professionals are aware that they are part of a process, that they work together in a team to achieve their goals and that they are collective accountable for the results to the public and government.
So the fact is, you can’t get around to replace accreditation with other means of quality improvement and working towards common goals of quality and patient safety.
It seems to me, however, that every hospital is able to obtain a world-class accreditation in one way or another. So I guess the most pressing question for moving forward is this: how to achieve and maintain your standardization / accreditation in the most cost-effective way? And with a future-proof approach, because both tools has no end point, it’s a continuous improvement process.
In a Danish study published in the International Journal for Quality in Health Care, lack of time and inexpedient IT tools were identified as the most problematic barriers to the full benefits of continuous improvement through an accreditation program (1). Verifying this statement is not that difficult – you just ask your staff.
In the quest for solutions we found two emerging approaches for supporting easy, engaged and effective implementation of the continuous quality improvement cycle that will contribute to improved compliance.
Approach #1: The Methodologies
The first approach is a proactive approach based on the fact that a lot of local knowledge and expertise is not fully utilized in the organization. This provides an opportunity to leave improving quality to healthcare professionals of your own organization through knowledge and expertise sharing. Employees understand the processes and speak the language of the workplace. This bottom-up improvement is effective because employees are closest to the problems, and thus better equipped to solve them.
To be successful it is highly desirable that employees are engaged and get the right tools to make it happen. So the primary concern was finding an approach, a methodology to drive employee engagement for improving and maintaining adherence to standards and policies.
There are a host of methodologies to bring structure to the process of identifying and acting upon opportunities for improvement. You may be familiar with Six Sigma, Kaizen, Lean, Toyota Production System and others. Although these methodologies differ, the heart of each of them is the continuous improvement model.
In the development of our model we focused on the methodology that is written in a study of our partner hospital University Medical Center Utrecht that is published in BMC Health Services Research (2). Special about this model is that it gives space to adopt techniques from the previously mentioned methodologies.
The approach to the enforcement of regulations, rules and standards for meeting and improving compliance is based on creating accountability to drive continuous improvement by persuasion that is accomplished by measurement, dialog and suggestion. According to Socrates, true knowledge arises in dialogue.
In addition, it is essential that responsibilities are delegated to lower levels of the organization.
Strive for continuous improvement, instead of perfection
- Kim Collins
In the cyclical process you should always strive for “perfection” through small improvements. Sometimes the smallest improvements yield the best results. This ultimately ensures improved quality, a shortened project duration and a reduction in costs.
The internal audit and feedback system that is used is based on the tracing approach of JCI. Whereas the main focus of the JCI audits is on controlling and judging, the tracer system approach of the hospital is based on the expectation of continuous improvement where performance is measured with tracers and evaluated in an atmosphere that supports openness and transparency.
We all need people who will give us feedback. That’s how we improve.
– Bill Gates
The main goal is to provide healthcare professionals with meaningful feedback on their implementation of practice and to stimulate the continuous quality improvement cycle in departments. Why? – Because feedback is a critical element of best-practice performance management.
Tracers have a learning, stimulating and controlling character. Yet we must build in a mechanism to encourage knowledge and expertise sharing and working on issues together towards the common compliance goals. This brings us to our second approach.
Approach #2: The Technology
Our second concern was finding ways for speeding up the process and reducing administrative burdens to save employee time. For this we deployed a technology to digitize and simplify the process.
A slow process isn’t cost-effective and probably missed opportunities for improvement
The idea behind the development was to make employees feel more comfortable by making the implementation process more attractive and enjoyable and to encourage and support teamwork. The technological system as a whole would foster a feedback culture.
Our improvement software serves as a framework for cross functional collaboration, analysis, and improvement of the healthcare processes and activities on an ongoing basis.
We call it QTRACER, a real Dutch design; straightforward, easy to understand and easy to use! In the development we focused across three pillars
- Consistency, Transparency and Efficiency
Consistency
The design of the mobile web application has been unambiguously and consistently implemented. Intuitive and streamlined user interfaces simplifies the complex and labour-intensive process of meeting quality and patient safety standards. This makes it easier to quickly measure compliance and get meaningful information entered into the system. It also helps you eliminate errors and inconsistencies with standard data and reporting methods. Ultimately, it will help you fully focus on document reviews, observations and dialogue and provide more valuable improvement insights to bring value to the patients.
Transparency
The software is built around the concept of openness and transparency within all levels of the organization. Transparency is important on its own because it allows learning, contributes to accountability, and shapes organizational performance.
Reporting of results and monitoring of progress are visualized centrally on a transparent dashboard. In this way all professionals can see whether policy is being adhered with or whether there are problems with adhering or implementation of policies and standards. The dashboard is accessible to everyone in the organization. Employees can thus learn from good practices.
Efficiency
To make the process more efficient we provide a guided workflow, a simple scoring system for quick, accurate and reliable performance scoring, automatic reporting in an uncluttered dashboard and the ability to easily manage multiple standards programs for departments and organizational wide.
With these concepts in mind, we succeeded to design a compelling way of mobile team working using a tablet linked to a central dashboard that lets you “track and trace” all your standardization programs, people and organizations you manage and run them through your processes as they work to meet the standards you’ve set.
Your entire tracers & feedback process from gaining insights to accelerating improvement actions can be easily managed. It speed ups the process, thereby resulting in a reduction of your administrative burden of up to 50%.
The Implementation
As a whole the solution is a technological transformation approach of proven methodologies that together form a tracer-based continuous improvement system of which the QTRACER software platform is an important part.
Hospitals can choose for cloud-based or on-premise delivery of this software platform.
It can be delivered ready to use with your organizational structures and standards measurement frameworks from among others JCI, ACI or Planetree.
After a 1-day training, the institute is able to implement the tracer-based continuous improvement cycle with the help of QTRACER.
We commit ourselves to always remain compatible with the standard frameworks and scoring systems of world-class accreditation bodies such as JCI, ACI and Planetree. We owe it to our partner hospitals who count on the QTRACER dedicated support team.
I imagine this post could raise questions about the strategy or practical implementation of tracer-based continuous improvement.
Feel free to call or email me.
William Sommer
+31 (0) 6 21 44 82 83
william.sommer@qtracer.com
1) Attitudes towards accreditation among hospital employees in Denmark: a cross-sectional survey. International Journal for Quality in Health Care, Volume 29, Issue 5, October 2017, Pages 693–698, https://doi.org/10.1093/intqhc/mzx090
2) Weske, U., Boselie, P., van Rensen, E.L.J. et al. Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits. BMC Health Serv Res 18, 62 (2018). https://doi.org/10.1186/s12913-018-2865-8