Quality Improvement
NewSTEPs provides all U.S. state and jurisdictional newborn screening programs with the essential tools and techniques needed to successfully implement continuous quality improvement (CQI) initiatives and champion an improvement culture.
NewSTEPs provides resources and support that include:
Data support to track improvement is possible using the NewSTEPs Data Repository. Quality indicator data and State profile data are captured for state and territorial newborn screening programs across the nation.
Online Resources are available for the newborn screening (NBS) community to assist with CQI activities. NBS quality improvement (QI) resources are developed from QI Subject matter experts and NBS QI projects.
Technical Assistance and Coaching is available to newborn screening programs seeking to implement and expand CQI initiatives.
Funding opportunities may be available through the HRSA Maternal and Child Health Bureau to assist CQI expansion efforts.
National webinars sharing CQI principles, tools and resources and how to incorporate CQI into NBS systems are presented for the NBS community. This creates an opportunity for collaboration between programs.
CQI Facilitation from NewSTEPs staff and QI subject matter experts is available to support newborn screening programs with QI training and team development.
NewSTEPs' commitment to CQI includes providing resources and training for newborn screening partners to:
- Establish a culture of CQI
- Build CQI infrastructure
- Apply CQI methods to daily practice
The NewSTEPs Quality Improvement (QI) Subcommittee, established in 2019, actively guides and supports NewSTEPs quality improvement activities. Our mission is to assist newborn screening (NBS) programs in utilizing evidence-based quality improvement methodologies to enhance system performance and quality, develop replicable and sustainable models for NBS quality improvement initiatives, and ultimately improve health outcomes for newborns with a positive screen.
What is CQI and Why is it Important?
Continuous Quality Improvement (CQI) is a science-based method concentrated on understanding and improving systems. It encourages all members of the organization to continually think of ways to make processes more effective and efficient while keeping the emphasis on the client and outcome. CQI allows teams to learn what change ideas to incorporate to improve processes by involving affected and interested parties and using data to measure effectiveness.
The video below shares what is quality improvement, who should be involved and an example of building a CQI culture at an organization.
In the context of newborn screening, CQI involves regularly evaluating and improving the screening system processes.
CQI Applications in Newborn Screening:
- Timeliness: Use CQI to identify issues and test change ideas to ensure screening results are processed and communicated quickly, allowing for prompt diagnosis and treatment.
- Accuracy: By applying CQI, programs can enhance the precision of screening tests, reducing the likelihood of false positives or negatives.
- Efficiency: CQI helps streamline processes to minimize delays and resource wastage, ensuring that every newborn is screened effectively.
- Consistency: Through CQI, procedures can be standardized, ensuring uniformity in testing and follow-up care.
- Patient Safety: CQI identifies and mitigates potential risks in the screening process, safeguarding the health of newborns.
By implementing and sustaining CQI efforts, newborn screening programs can continuously adapt and improve, ultimately leading to better health outcomes for infants.
Additional applications of CQI by Newborn Screening programs are available. Choose the topic "Quality Improvement" in the NewSTEPs Resource Library for real-life examples and resources.
CQI Methods and Philosophies
Various quality management frameworks can be used for CQI. It is less crucial to focus on which method is better, but rather form a well-defined improvement strategy and consistently communicate and demonstrate this to the team.
Below, in no particular order, are a few methods to consider when pursuing CQI:
| Model for Improvement is a framework emphasizing learning from small-scale tests of changes applied in real life using the Plan-Do-Study-Act (PDSA) cycle to guide improvement activities. The model includes setting aims, establishing measures, selecting, and iteratively testing changes for improvement. Data and experience guide the team on which changes to implement and/or spread. For more information, see IHI.org. |
| Plan-Do-Check-Act (PDCA) is a scientific improvement method with four iterative stages that support continuous improvement by leveraging the previous cycle’s knowledge to strive for optimal measurable improvement. It is sometimes referred to as the Shewart or Deming Cycle and is similar to the PDSA cycle. Plan-Do-Check-Act is used to create an improvement plan, test the change, evaluate and measure the impact due to the change, and determine if the change should be implemented, revised, or abandoned based on what was learned during the stages. For more information, see ASQ.com. |
| Lean focuses on eliminating non-value-adding activities (waste) in processes. Ongoing learning and improvement occur in a lean culture through innovation and experimentation focused on value-added activities for the customer and the employees. For more information, see ASQ.org. |
| Six Sigma is a method to improve processes and increase performance by reducing variation. The Define-Measure-Analyze-Improve-Control (DMAIC) approach is often used as well as statistical data analysis and control charts. The concept is that each process input can be controlled or changed to control or improve the outputs and be measured and analyzed. For more information, see ASQ.org. |
| Lean Six Sigma combines both Lean and Six Sigma principles. It is a systematic approach to identify and remove the source of variation and waste in processes to produce quality products. For more information, see ASQ.org. |
| Kaizen is a philosophy encouraging small, frequent improvements done by everyone throughout all processes, at all times. It is often used to create a continuous quality improvement culture. The goal is to have efficient and standard work processes. Other CQI methodologies are used to support the Kaizen method. For more information, see Kaizen Institute. |
| Getting to Outcomes consists of ten steps for programs to follow to develop or improve. It consists of planning, implementation, and evaluation to assess how it is working and opportunities to continuously improve. For more information, see Rand.org. |
| 7S Model aims to best align the seven elements (Structure, Strategy, Systems, Shared Values, Style, Staff, and Skills) to meet the desired state. It is a tool that can be used to evaluate the current reality, create a plan, and identify gaps between the two. For more information, see McKinsey 7S Model |
| Kotter’s 8 Steps for Leading Change is a change management model outlining eight essential steps for implementing successful change in a world that is ever-changing. For more information, see kotterinc.com. |
Contact newsteps@aphl.org for CQI subject matter expertise.
Starting a Quality Improvement Project
At NewSTEPs, we understand the importance of continuous quality improvement (CQI) in enhancing newborn screening systems. Our toolkit and resources are designed to guide both newcomers and seasoned professionals through starting and managing a QI project. Meaningful improvements can be made by leveraging CQI principles and tools. Explore our different modules tailored for each phase of your project and take the first step towards excelling in newborn screening.
QI Subject Matter Expertise (SME) is available! Visit the Newborn Screening and Genetics Subject Matter Expert Support page or contact a staff member at newsteps@aphl.org.