Evaluation of 60 continuous quality improvement projects in French hospitals

Objective. To evaluate the feasibility of implementing continuous quality improvement (CQI) projects in French health care organizations. Design. The French Ministry of Health issued mio calls for CQI projects tin 1995 and 1996). ANAES was commissioned to monitor and evaluate the projects, and to provide advice. Setting. ANAES in collaboration with French public hospitals. Study participants. A jury selected 64 projects from 483 submissions. The first series of projects related to safety issues (e.g. blood transfusions), the second related chiefly to patient management. Interventions. ANAES instructed project leaders in process analysis (modified four-step FOCUS-PDCA model), convened regular meetings between leaders and performed on-site visits. Main outcome measurements. Objective outcomes: goal achievement, extension of projects to other topics and departments, allocation of resources. Subjective outcomes: changes in attitudes. Statistics were obtained from two questionnaires completed by project leaders. Results. Four projects were discontinued; 82% (49 out of 60) met more than half their objectives. The CQI method was adopted by other departments in 65% and 50% (1st and 2nd series respectively) of cases. Hospital management often chose to provide continued support (81%/88%), offer training (59%/80%), create a CQI unit (62%/73%), and allocate a budget (61%/65%). A positive impact on staff attitudes was noted in over 75% of projects. Conclusion. ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.