Implementing organizational systems to measure outcome-related processes of end-stage renal disease care.

The process to implement a continuous quality improvement program for the patient with end-stage renal disease requires a basic understanding of the complex medical and often psychological circumstances that affect these patients. The organizational elements require, therefore, a recognition and integration of functions from all those involved in delivering care. This includes the medical, nursing, social work, dietary, and technical staff. In the development and establishment of the quality assessment and improvement program at Our Lady of Lourdes Medical Center, experience has identified certain basic elements to use in the organizational and functional aspects of the system to achieve a measurable level of success. The primary element in establishing such a program begins with the commitment at the highest level of the organizational structure. Selection of leadership whose responsibility is to provide education and direction of staff participants should follow. Through leadership, education, and early staff involvement, physician support is gained that provides the operational elements for a successful program. A multidisciplinary team, representative of the various aspects of care, can then develop a quality assessment and improvement plan that establishes clinical indicators used to measure various quality components. A data collection and review process is the next phase of implementation of the organizational system to measure the various types of outcome and/or processes of care. The process is one of continued education based on outcome data for all staff members involved in care.