The Agency for Health Care Policy and Research funded the
development of the Quality Improvement Support System (QISS) to
facilitate information exchange on quality improvement in health
care organizations. This funding was made available because,
despite widespread interest and activity in continuous quality
improvement (CQI) and related efforts, very little scientific
research has been undertaken that provides guidance for quality
The QISS was developed by researchers at the University of
Wisconsin, as a network with over 40 member groups, organized to
share information about quality improvement activities. Because
many of these organizations were health systems that owned
multiple hospitals and clinics, QISS members represented over 200
acute care facilities and over 100 outpatient clinics located
throughout the United States.
The researchers solicited nominations for successful examples
of clinical quality improvement teams from quality leaders in the
network. Nominations were accepted from network members only if
they could demonstrate measurable improvement in outcomes, health
status, customer satisfaction, and/or economic value. After
collecting data from the nominees (e.g., team reports,
storyboards, charts, graphs, and bibliographies), the researchers
developed a project report with 15 case studies. This report,
after expert review, is now available to the public.
The Case Studies
For comparison purposes, the consortium applied Batalden's 10
principles of total quality management (TQM) to the 15 case
- Constancy of purpose.
- Management leadership.
- Continuous improvement.
- Suppliers as partners.
The consortium found that Batalden's 10 principles were
consistently confirmed across studies with the exception of
"suppliers as partners." Only four of the case studies
identified a partnership or customer/supplier relationship as
part of the project which at least partially contributed to its
Many of the case studies describe attempts to reduce cost
without degrading quality and represent a blend of CQI and
reengineering or redesign. They support the importance of an
interdisciplinary perspective, of an evaluation of the care
provided across settings, and of the inclusion of patients'
perceptions in adjusting the care process.
About the Project Report
The project report (AHCPR Publication No. 97-0022) consists of
an introduction as well as a background section. It also contains
15 separate case studies:
- Acute Chest Pain Management.
- Applications of Pharmaceutical Clinical Algorithms Used
in Conjunction with Critical Pathways.
- Asthma Self-Management Techniques in Home Health Care.
- Cardiac Surgery Clinical Pathway.
- Cardiac Surgery Rapid Recovery.
- Carotid Endarterectomy Length-of-Stay Project Team.
- Cesarean Section Utilization—Reducing Rates and
- Chronic Obstructive Pulmonary Disease Improvement Team.
- Coumadin Management.
- Myocardial Perfusion Study Team.
- Open Heart DRG Outcome Improvement Team.
- Partnership in Pregnancy and Parenting.
- Reducing Asthma Revisits to the Emergency Room.
- Surgical Preparedness.
- Total Hip Replacement Care Map.
The case studies contain sections on lessons learned, reviewer
comments, and resources for additional information.
While supplies last, single print copies are available free of
AHCPR Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907
800-358-9295 (toll-free within the U.S.)
(703) 437-2078 (callers outside the U.S. only)
888-586-6340 (toll-free TDD service; hearing impaired only)
Current as of April 1, 1997
Case Studies from the Quality Improvement Support System . AHRQ Publication No. 07-0055-EF, March 2007, Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/qiss.htm