Quality Improvement: Overview for Speech-Language Pathologists

What is Quality Improvement?

Quality improvement (QI) is an ongoing activity that objectively evaluates current work practices and client care provided by educators and health care practitioners, including speech-language pathologists (SLPs). It is a process that identifies practice trends, accepted levels of care, problems, and solutions to problems. It provides accountability related to the efficacy and efficiency of speech-language pathology intervention and identifies those factors that enhance or hinder client care.

Why do we measure quality?

Consumers, administrators, third party payers, and policymakers are demanding objective proof that services provided by SLPs are meeting specific standards or protocols of care. Providing quality care is critical to both receiving reimbursement for that care and positive outcomes of services. It also ensures consistency in the standard of care provided by SLPs. This consistency is measured through quality improvement monitoring systems.

How is quality measured?

Quality improvement (QI) measures typically include indicators for the areas of:

  • structure (e.g., facilities, equipment, qualifications of practitioners, staffing ratios, record keeping)
  • process (steps taken to perform evaluation and treatment)
  • outcomes (the results of evaluation and treatment)

QI monitoring systems can gather and track data retrospectively (after client discharge), concurrently (during client care), and prospectively (before client care begins). Systems to gather such data can be as simple as a checklist or as complex as an automated relational database. The database in and of itself does not improve quality; rather, these databases provide information on client care trends. When a changing trend or problem is identified, that change or problem must be addressed and resolved. It is in the resolution of the problem or action on change that we improve quality practice. QI measures may serve to identify populations currently underserved and justify additional resources to assure quality care and the enhancement of overall services.

Where do QI activities take place?

QI programs should be implemented in public and private schools, clinics, community speech and hearing centers, university speech and hearing centers, private practices, and health care settings (e.g., hospitals, rehabilitation hospitals, skilled nursing facilities). Standards and guidelines instituted by accrediting bodies (e.g., Joint Commission on Accreditation of Healthcare Organizations), regulations by third party payers (e.g., Medicare, Medicaid), laws (e.g., Omnibus Budget Reconciliation Act - OBRA), the profession itself (e.g., ASHA practice policy documents, the Code of Ethics), and consumers all require objective proof that quality services are rendered.

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