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The RC Quality Corner

Additional Presentations are added!


The purpose of The Respiratory Care (RC) Quality Corner section is to provide information, and examples, on select Implementation Science (IS) concepts. The hope is that the reader will have a better understanding of how certain IS concepts may be applied in the healthcare setting and ultimately improve upon Respiratory Care service delivery.

Historically, in healthcare, quality was commonly associated with instrumentation calibration and quality control, both of which have been a mainstay in most Cardiopulmonary Diagnostic laboratories. But these processes alone were recognized to be insufficient to meet the needs of a rapidly changing healthcare environment.

Beginning in the mid-to-late 1980s the quality assurance and continuous quality assurance initiatives were introduced into the US health care industry. However, despite good intentions, many of these initiatives proved to be unsuccessful as they were based upon quality constructs developed for the manufacturing industry and not for the health care industry.

To fill this quality gap, Implementation Science principles (which began in 2006) were designed to improve upon the delivery of healthcare services. In essence, Implementation Science is the bridge between Implementation Research and evidence-based practice, with the intent to improve the quality and effectiveness of healthcare services. Implementation Science constructs can be applied to all areas of healthcare delivery and provide the needed frameworks to design, assess, modify, and enact sustainable evidence and quality-based healthcare practices.

Why now? The US healthcare arena is slowly transitioning, from volume-based, to value (evidence)-based practice. Healthcare costs are consuming enormous portions of the gross domestic product. Because of these (and other) factors, payers, patients, and employers are expecting better returns on their investments in delivered services. Implementation Science constructs provide the necessary frameworks to ultimately achieve validated and sustainable evidence-based programs.

  • Also, some professional healthcare organizations have developed position statements and have encouraged their members to be more proficient in understanding, and applying, IS concepts into service delivery.

The first area to be addressed is the Plan-Do-Study-Act (PDSA) Cycle:

The PDSA Cycle has been employed in the laboratory setting for numerous years, but may not have been labelled as such. While the PDSA Cycle has a Respiratory Care focus in this section, this cycle is commonly used in all aspects of healthcare delivery as well as everyday life when decisions are being made; think grocery shopping, planning on filling your vehicle gas tank, etc.,

Applying the Plan-Do-Study-Act (PDSA) Cycle to Improve Respiratory Care Delivery

Video Link:

The second area addressed is the GTO™ and the PIE Cycle:

The Plan, Implement, Evaluate (PIE) Cycle was incorporated into a 2004 RAND Corporation publication entitled, “Getting To Outcomes™2004: Promoting Accountability Through Methods and Tools for Planning, Implementation and Evaluation (GTO™ -04)”. By its design, GTO™ offers how-to steps for high quality, outcomes-based programs, which are flexible and applicable to numerous health-based systems improvement initiatives.

Keeping the PIE Cycle framework in mind, Respiratory Care Practitioners could effectively incorporate the GTO’s 10 Steps into a quality focused implementation plan strategy which could serve as a road map for developing, implementing, monitoring, and evaluating a quality-based improvement program.

Such a program could be used to construct Patient-Focused Respiratory Care Protocols (AKA: Respiratory Therapist-Driven Protocols) by applying the American Association for Respiratory Care Clinical Practice Guidelines as the primary reference of evidence-based information.

Applying The Getting To Outcomes™ 10 Steps and the Plan-Implement-Evaluate Cycle To Improve Respiratory Care Delivery

Video Link:

The third area addressed is, “Building a Sustainable Program of Evidence-Based Practice: A Practical Guide for the Respiratory Care Professional“:

The purpose of this video presentation is to provide the rationale, importance, and some potential options behind why and how to develop a program of Evidence-Based Respiratory Care information into your practice by using quality-focused principles.

Clinical Practice Guidelines are developed from evidence-based information and may also rely upon clinical expertise to support the guideline message. Clinical Practice Guidelines (CPGs) therefore provide the basis from which Evidence-Based Practice can be incorporated into healthcare delivery. There is however not a direct pathway between Clinical Practice Guideline information and how to successfully implement that information into actual clinical practice. This presentation will hopefully offer new information on potential quality constructs to consider when developing an Evidence-Based Practice program.

Select Implementation Science constructs reviewed include the

  • Plan-Do-Study Act (PDSA) Cycle
  • Plan-Implement-Evaluate (PIE) Cycle & the Getting To Outcomes (GTO™) 10 Steps™
  • Lewin’s 3-Step Model
  • Lean Six Sigma – Define, Measure, Analyze, Improve, and Control (DMAIC) Cycle
  • Dynamic Sustainability Framework (DSF)

Other areas addressed include aspects of assessing Organizational Readiness (for change), use of Process Teams, along with some considerations during phases of Pre-Implementation, Implementation and when evaluating program Sustainability.

“Building a Sustainable Program of Evidence-Based Practice: A Practical Guide for the Respiratory Care Professional”

Video Link:

The RC Quality Corner section will be updated as additional IS constructs are added. The PDSA Cycle is a good starting point to gain a better appreciation of how applying IS concepts may bring added value to your organization and to those customers (internal and external) that you provide service to.

If you have suggestions on any quality related topics that you would like to see addressed in this section, please reach out to me via the “Contact” page of the Pulmonary Diagnostic Laboratory Resource Center @ .



Robert A. Brown, BS, RRT, RPFT, FAARC; Developer and Content Manager; Pulmonary Diagnostic Laboratory Resource Center


FYI: My “Quality Related” Background Information:

My professional careers have provided me with opportunities to be immersed in the healthcare quality world through actions, teachings, and publications.

  • During the last 4+ years while employed in Merck Medical Services Division of Vaccinology, Immunology, and Infectious Diseases, I had the opportunity to daily teach Key Opinion Leaders on Implementation Science concepts and the importance of incorporating these principles when developing, monitoring, and implementing sustainable immunization programs within their specific organization.
  • Additionally, prior to Implementation Science becoming a recognized field, I taught and published methods designed to improve upon the quality of Pulmonary Diagnostic Laboratory delivered services.