An institutional approach to continuous improvement

The effectiveness of laboratory procedures is directly linked to the quality of the total medical complex. Therefore, quality management of laboratories must cross into the total quality management of the integrated medical practice. This paper describes the Mayo Foundation approach to continuous improvement (CI) for highest quality medical care. With the assistance of the Juran Institute, large numbers of medical and paramedical leaders at Mayo were trained in the principles of CI. Eight CI pilot projects were initiated at Foundation level involving cross-disciplinary teams. It is hoped that the success of these projects will spontaneously spread enthusiasm for this technique to many other projects. One specific project undertaken was an analysis of the cost variability of five high-volume disease-related groups (DRGs). The components of the resource utilization were analyzed to classify the various provider groups according to the cost of resources utilized. Also, a 'best case' composite was projected using the smallest components observed for each resource across all the services. Similarly, the laboratory utilization was analyzed to characterize the typical patterns of use and the variation across groups. Practice guidelines are another tool for continuous practice improvement used by the Mayo Foundation. Implementation of guidelines has resulted in more uniform practice patterns and increased compliance with consensus-derived standards of care.