A cognitive approach to understanding performance monitoring in clinical Continuous Quality Improvement (CQI)

The purpose of this study was to assess a normative framework of Continuous Quality Improvement (CQI) that is used in health care settings. This framework is based upon the belief that quality improvement is a data-driven, never-ending process which requires the creation of organizational CQI culture. Fundamental to the CQI framework is the use of measurements to maintain stable process performance over time. Control charts, run charts, and specification limits are commonly used for doing so. A primary goal of this study was to assess how perceptions about the usefulness of control charts, run charts, and specification limits in clinical CQI are related to behavioral intentions to use them. A secondary goal was to assess how organizational CQI culture affects such perceptions. An organizational psychology framework called expectancy theory was used in this study to identify and organize the variables of interest.;A mail survey was used to collect data from 135 leaders of clinical CQI teams in 42 hospitals. As hypothesized, a cognitive model that includes valence and beliefs about the usefulness of the three CQI tools (i.e. Valence model) was used in predicting behavioral intentions to use CQI tools. Contradictory to the study hypotheses, beliefs about ability to use the three tools, i.e. the force model did not add to the prediction accuracy of the valence model. Regardless of past experience with control charts, subjects overall considered control charts to be more useful than run charts and specification limits. No significant differences in perceived ability to use the three CQI tools were observed. The hypothesized relationships between organizational CQI culture and perceptions were not supported.;The results point to the need for understanding the beliefs and values of individuals charged with leading CQI projects. While the study results are inconclusive for some of the study questions, the data help in identifying the role of cognition in predicting and explaining the use of CQI tools.