Table 2 A Sample Discussion Thread: Feature 5 "Use of Evidence"

62

This score was most surprising to me. I think many improvement efforts - particularly those undertaken by learners - fail to adequately use the evidence. This is also the link between evidence-based practice (or evidence-based medicine) and QI. When evidence is weak for a change or if the focus of the change is more administrative, outcomes suffer. Strong evidence for a change should be a key element in any improvement effort.

58

I rated this as less important in the definition of QI...because, while I think using evidence relevant to the problem is important when strong evidence exists, I also think there are cases where evidence is lacking, but improvement still needs to happen. Therefore, I didn't think it could be a critical feature of the definition of QI, mostly because of the 2nd case I mentioned.

78

I agree with this last comment and rated this feature low for the same reasons.

51

Agree with 58 and 78

60

Agree with 58, 78, 51. Furthermore, one key reason for the "rapid cycle" element is the fact that prior evidence may not exist, or may not be relevant. The best evidence for the change is whether it is effective in the current context. Prior evidence, if available, should be consulted, but (a) it's not always available, and (b) even if available is not always relevant.

42

Targeting solutions to problems may help generate evidence that a given intervention is effective. (See The Joint Commission's Targeted Solutions Tool, which allows organizations to find the problem(s) they have and they pick the corresponding solution (starting with hand hygiene).

67

Agree with 62 on the assumption that, in the absence of scientific evidence, expert judgment is the next best thing and would constitute the available "evidence" - as is the case with much of what is asked about this process.