The Psychology of Quality Improvement

You’ve probably heard the term “quality improvement” before but do you really know what it means? And what does quality improvement have to do with a private practice? Isn’t that just for big agencies and insurance companies?

I would say no, quality improvement relates to every therapist in every setting. It is often confused with it’s cousin, quality assurance. Quality assurance (in general) focuses on checking to ensure work is completed accurately and is usually a retroactive process.

On the other hand, quality improvement focuses on evaluating the effectiveness of work. This is totally relatable to therapists! As therapists, our work is often very subjective and intangible. It is difficult to describe the specific “outcome” of a particular session. Sometimes, it is difficult to put into words the level of intensity or resolution that occurred during a session. And while a client may feel better, more determined, or more clear after a session, they may have trouble telling a friend or spouse exactly what it is they “got out of” their therapy that day.

We live in a facts-based, results-oriented world. Clients want to know specific results they can expect to see. Family members want to “see change” very quickly (especially if they’re helping to foot the bill). Combine this with our digital era that emphasizes immediate gratification and the situation becomes even more challenging. 

Clients are looking up resources and researching psychological techniques ahead of time. A couple seeking therapy may ask you if you are a Gottman therapist. Another client may be specifically searching for DBT or exposure therapy. The term “archetype” is common language and clients are looking to see if your values match their goals.

Clients want to know treatment is researched, reliable and will give them the results they are seeking.These are the days of questioning long-term research on vaccines. People are not willing to simply “do what my doctor says” without something to back it up and an explanation from a professional they trust.

So, how can we address this in therapy? By using quality improvement techniques, no matter the size or resources in our practice. We can use more than attrition to evaluate a practice… without having to implement lengthy forms or lots of numbers. I recommend using your very own progress notes, assessment/intake forms, and most importantly, your client’s experience!

During your first session, talk with your clients and make note of the things with which they currently struggle. Take time to write those things down, especially in your first couple progress notes. Three months later, bring that up. Are those things still areas of concern? Have they improved and how so? Are these things still the focus of treatment or have you moved on to something else?

In our deep work with clients it is easy to get caught up in the weekly struggles and forget where our clients were just six months before. Quality improvement techniques encourage us to look at whether or not what we’re doing is effective and how we can improve upon it. More importantly, they keep you accountable to actively engaging your clients so they are part of the work and not just you.

You can easily use assessment or intake forms, progress notes and treatment plans to do this. If you have a ratings scale or questionnaire, even better! Pull out that intake questionnaire at week 18 and have your client complete it again. Compare and contrast the results. I guarantee you they will not have the same answers they did during your first session. And even if they did- you’ve now got some serious evaluation to do about why you’ve been working on something for 18 weeks with no subjective progress!

Most importantly, using quality improvement techniques creates buy-in from your clients. They’re able to put into words or onto paper what it is they’re experiencing after working with you. They’re able to focus on growth and see a tangible reward of all their hard work.

If you want to take a step further and implement a regular quality improvement plan as part of your group practice, look into my consultation service. I’ll work with your practice to see what makes sense and ensure you’re clear on how to improve.

Happy writing, everyone!