International accreditation requires CQI: what is it?


Continuous Quality Improvement (CQI) is a business philosophy. It does not follow the adage of ‘If it isn’t broken, don’t fix it’. Instead, CQI team members proactively search for improvements to efficiency and outcomes. The focus is on prevention of business errors before they happen, rather than curing them after they occur.

CQI is also referred to as Total Quality Management, Quality Improvement, Six Sigma, Kaizen and a variety of other labels. At its core, it is a scientific management method designed to identify wrinkles or gaps in business operations and to prevent problems in the delivery of healthcare services.

These are the essential CQI principles:

  • Processes, not people. CQI examines the organisation’s system and its processes. Most ‘problems’ are variations resulting from issues with the processes, not people. CQI looks at the root causes of these variations and/or errors, and seeks system-wide solutions, rather than blaming individuals.
  • Scientific method. CQI uses a statistical process to identify and detail variations and errors in service delivery. It employs the scientific method approach (also called serial experimentation) to measure business systems and processes. Teams of practitioners observe, measure, and then experiment with changing different variables to see which combinations produce the fewest variations or errors.
  • Inclusive. Cross-functional teams are drawn from various stakeholders including employees, management, volunteers, board members, and customers. Quality improvement is the responsibility of the whole team, not just management, so a holistic approach is used to gather input from all interested parties.
  • Empowering. All stakeholders are empowered to identify variations and/or errors as well as opportunities for improvement. Individuals are encouraged to develop and present solutions.
  • Understanding customers. ‘Customers’ are both internal and external to the organisation – i.e. employees, patients, patients’ families, and others. Understanding who these customers are and fulfilling their requirements is of paramount important.

A commonly recognised or observed ‘problem’ in any process is unwanted variation, in that a variation in process causes a variation in outcome. CQI and all quality management approaches seek to define the limits of variation in processes and, through experimentation, render those processes more reliable - that is, more consistent.

When output is consistent, processes improve.

Improvement should be part of the culture of the organisation and a natural part of how people perform their jobs. Improvement does not only mean success in a particular project; rather, it is an ongoing way of approaching one’s regular duties. Regular interventions also test improvements, as they happen without waiting for a formal evaluation.

What Is Needed to Implement Continuous Quality Improvement

There are several essential elements required for successful CQI implementation:

  • Substantial and strong leadership support, involvement, consistent commitment to CQI, and visibility are important in making significant changes
  • Substantial commitment from hospital boards is highly correlated to success
  • The inevitability of process changes and resource demands require senior leadership to:
    •  Ensure adequate financial resources by identifying sources of funds for training, purchasing and testing innovative technologies and equipment
    • Facilitate and enable key players to have the needed time to be actively involved in the change processes
    • Provide administrative support
    • Grant enough time for CQI-generated process changes to work
    • Emphasise safety as an organisational priority and support this, especially when the CQI process is delayed or results are periodically not realised

Senior leaders also need to understand the potentially high-level impact of CQI decisions on work processes and staff time, especially when there is a change in practice to allow quality improvement to be incorporated into system wide leadership development.

Leadership needs to make patient safety a key aspect of all meetings and strategies to create a formal process for identifying regular patient safety goals, and to hold themselves accountable for patient safety outcomes.

Is my organisation ready for accreditation?

If you are unsure if your hospital or clinic has any or enough CQI systems in place, a pre-accreditation assessment offered by Temos can provide an accurate picture of your systems and procedures, to determine readiness for accreditation.

The assessment can be on-site and in person or done online by completing an initial application on the Temos website. Recommendations will follow to either proceed with accreditation or a plan can be created to implement or improve an existing CQI system designed to improve systems while setting the foundation for accreditation.

For further support about implementing a CQI system, improving existing CQI processes or to start the accreditation process, contact Medical Tourism Training, Inc.

Temos is a leading worldwide independent accreditation body focused on the quality of international patient management from the medical and non-clinical perspectives.  It offers accreditation programs designed for hospitals, clinics, and facilitators who work with international patients. Specialised accreditation programs are available for hospitals, primary and other types of clinics including dental, IVF, physical rehabilitation, and eye care as well as for facilitators.

IMTJ has teamed up with Temos International, for the IMTJ Medical Travel Summit, Berlin, 2-3 December 2019.  The Summit will host the 9th Annual Meeting and training session for Temos partners, as well as the exclusive dinner for Temos-accredited partners by invitation only, hosted by the Diplomatic Council (DC) and Temos International.




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