Question

Discuss the relationship between CQI and SEIPS in producing quality outcomes for healthcare organizations.

Answer 1

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts.

Systems Engineering Initiative for Patient Safety (SEIPS) was created as a quality improvement tool to better understand the elements that threaten safety and to recommend ways organizations can improve quality outcomes by reducing risk.

CQI:

Continuous quality improvement approaches in comprehensive primary health care offer decision-making tools and feedback loops that can respond to the complex dynamic relationships between the historical, socio-cultural, economic, and environmental elements of systems that give rise to people’s opportunities and challenges in life. Using a systems approach, we can examine, develop understanding, and intervene to change the dynamic interrelations between the various components of the primary healthcare services (PHS) and  broader systems that impact client health at multiple levels, and how they work together as a whole. For example, PHS can augment their health assessments to incorporate questions that are systematically asked about clients’ social and cultural determinants of health, psychosocial stressors, and community participation. PHS can also audit their current systems and processes for advocacy, partnership, and/or inter-sectoral service integration to address the SCDOH, identifying strengths, gaps, and opportunities for further refinements to better address the critical SCDOH identified through the client assessments. Further, development and evaluation of such systems approaches to CQI will enhance the potential to improve quality and integration of services and improve health outcomes.

SEIPS:

The SEIPS model is useful for providing a view of the whole system instead of focusing on only one aspect of the work system and treating that aspect in isolation. It is descriptive, not prescriptive. It does not tell if a change in one factor in the work system leads to any specific employee, organizational or patient outcome. However, it provides a framework on how to think about the different aspects of a work system, their interactions, and possible outcomes. This can be considered as a limitation of the model because it does not provide specific guidance as to the critical elements; but it can also be a strength because the model is generic and adaptable to the particular context or situation.

It is critical to understand how resistance to a systems approach may limit effective implementation of the SEIPS model in practice. In particular, provider resistance may derive from a mismatch between the implications of the work system model and the degree of autonomy expected by providers in their work environment. The professional model assumes that providers have the ultimate authority to define and carry out the core tasks of providing medical care. Because the professional status of providers is linked so strongly to their autonomy, they may resist system efforts to manage the process of medical care as infringing on their autonomy and degrading their professional status. Recognizing potential resistance and obtaining strong support from key opinion leaders is essential to effective implementation of the SEIPS model.

Relationship between CQI and SEIPS:

CQI	SEIPS
implemented in or by a health-care service	The design of work systems affects patient safety as well as employee and organizational outcomes.
collecting qualitative or quantitative data on intervention effectiveness, impacts, or success	The design of work systems influences processes which, in turn, affect outcomes.
reporting client (or caregiver) health outcomes	The individual is at the centre of the work system and can be a healthcare provider, a healthcare team, or the patient.
aiming to change how delivery of care is routinely structured	The work system needs to be balanced and to consider the requirements of the various stakeholders involved in the process.
	Patient outcomes and employee/organizational outcomes are influenced by the work system design. They also influence each other.