Primer part 2 - implementing a laboratory quality improvement project

The quality improvement (QI) paradigm is a continual approach to systematic improvement that focuses on patient outcomes and safety. This framework should be applied to laboratory driven quality efforts across the total testing process. However, there is minimal guidance and few resources on how to prepare, implement, and evaluate a QI initiative from a clinical laboratory perspective. Relative to other disciplines in healthcare, the quality gaps and types of errors and challenges in laboratory medicine are quite unique. This presents a major gap and barrier for clinical laboratorians to drive QI projects. This article is the second in a three-part primer series that aims to bridge this knowledge gap and act as a guide for clinical laboratories to execute and sustain QI initiatives. In the first article, an approach to preparing a QI project was outlined, including problem identification, root cause analysis, and SMART aim establishment. A clinical vignette of a real QI initiative related to serum protein electrophoresis (SPEP) utilization at our institution was introduced. The second part of this primer series focuses on the implementation of a QI initiative. Throughout, we introduce fundamental concepts related to change concepts and ideas, hierarchy of effectiveness, family of measures, and implementation cycles. Theoretical concepts are applied to the clinical vignette where we continue to follow the progress of a real SPEP utilization initiative.