Continuous quality improvement in the cardiac catheterization laboratory: are the benefits worth the cost and effort?

Continuous quality improvement (CQI) has been described as a methodology to continually improve the processes associated with providing a product or service to meet or exceed customer expectations.1 In reality, the CQI process is a collection of techniques borrowed from the fields of systems theory, statistics, engineering, psychology, and others and is based on the work of pioneers in industrial management such as Deming and Juran.2 As a management philosophy, CQI is an organized, scientific process for evaluating, planning, improving, and controlling quality. Simply stated, the goal of CQI is to reduce variation and improve overall performance. Positive experiences in other industries lead to the application of CQI methods in healthcare in the hope that reduced variation and better performance would improve patient outcomes and result in cost savings. This is fundamentally different than the earlier quality assurance (QA) process used in healthcare, which was geared to identify and eliminate “low-end performers or outliers,” leaving only the acceptable performers. The CQI approach in healthcare has been promoted by individuals such as Donabedian,3 Berwick et al,4 and Jencks and Wilensky.5 It builds on traditional QA methods to develop programs that will reduce variation and improve overall performance.