What Is Quality Improvement?

Quality improvement is a structured approach to evaluating the performance of systems and processes, then determining needed improvements in both functional and operational areas. Successful efforts rely on the routine collection and analysis of data. A quality improvement plan describes an ongoing, or continuous, process through which an organization’s stakeholders can monitor and evaluate initiatives and results.

Based on the thinking of such experts as W. Edward Demings, QI principles were developed in manufacturing in the 1940s. In the last two decades, QI processes have also become popular in healthcare and education.

Although organizations take many approaches, QI at its foundation concerns process management. If organizations operate according to many processes, by reviewing and improving one process at a time and leveraging the Pareto principle, they can more easily and gradually improve their entire system.

Quality improvement processes share these characteristics:

  • Quality improvement is data driven and regards the quantitative approach as the only reliable means to influence the qualitative elements. This principle is expressed in the following saying of quality improvement guru W. Edwards Deming: “The right data in the right format in the right hands at the right time.”
  • QI focuses on processes, not people. In other words, the individual is never at fault.
  • QI involves people as part of the improvement solution and looks for what is attributed to Deming as “the smart cogs,” the employees who are directly involved in and best understand the processes in an organization.

What Is the Main Purpose of Quality Improvement?

Quality improvement aims to create efficiencies and address the needs of customers. In healthcare, the main purpose of quality improvement is to improve outcomes. In healthcare settings, quality improvement may be associated with continuous quality improvement, the method used to identify problems and implement, monitor, and provide corrective action.

The Benefits of a Quality Improvement Process

A quality improvement process can offer organizations the following benefits:

  • Solutions that focus on failures in processes, not flaws in people
  • A reliance on objective, data-driven solutions, rather than subjective opinions, to identify inefficiencies, preventable errors, and inadequate processes
  • Improvements that provide better customer service, increased efficiency, greater safety, and higher revenues
  • A localized focus on testing small, incremental improvements that is less risky than a focus on making changes at one time
  • Data collection to monitor improvement efforts, which can provide the basis for reimbursement and certification programs, particularly in healthcare organizations

Primary Issues in Quality Improvement

Quality improvement plans are frequently measured in terms of results, employee and stakeholder satisfaction, ease of change, and cost. Quality improvement plans must also help companies understand how to meet the needs of diverse stakeholders (employees, customers, regulators, and others), find a method for prioritizing the improvement requirements of these stakeholders, comprehend the threshold of variation that will permit required change, and know how employees can succeed in a program if leadership support is inadequate.

Difficulties in Pursuing a Quality Improvement Process Plan

Here are some of the common difficulties in following through with a QI plan:

  • Expectations are not clear.
  • Leadership is not adequately engaged, making bottom-up initiatives difficult.
  • There is insufficient time and resources to properly implement the initiative.
  • In healthcare settings, some physicians don’t implement new systems until they have confidence in new processes.
  • There is an inadequate emphasis on the importance and use of new measures.
  • There is a poor level of collaboration between teams.
  • People underestimate the time required to implement a program.
  • The extent to which a result depends on a change can’t be measured because the extent of the original problem has not been measured.
  • Specific improvement cycles can’t be evaluated.
  • Costs can’t be evaluated.
  • Changes result from the Hawthorne effect rather than the QI program. In this interpretation of the Hawthorne effect, stakeholder behavior changes because their activities and results are monitored.
  • A small sample size makes generalizations impossible.
  • Solving some problems creates additional problems.
  • Targets are overly ambitious and therefore difficult to achieve.
  • There are too many diverse stakeholder conditions.

Common Outcomes of Successful Quality Improvement Process Projects

Many organizations have found the following successes with QI:

  • Standardization eliminates the need for individual decision making.
  • By limiting options and changes, information technology (IT) forces functions that reduce errors. For example, IT eliminates redundant checks and barcodes by using computer-aided calculations.
  • When a culture encourages teams to report errors and near misses, they generate data that creates a foundation for understanding root causes.

What Is the First Step in the Quality Improvement Process?

No matter which model you choose or what you call it, planning has to be the first step. You need to decide what problems you want to solve, how you will solve them, and how you’ll know when they are solved.

What Is a Quality Improvement Plan?

A quality improvement plan is the written, long-term commitment to a specific change and may even chart strategic improvement for an organization. A QI plan defines what your organization wants to improve, how it will make improvements, how it will test for success, and what are the anticipated outcomes and evidence of success. In essence, the plan becomes the monitoring and evaluation tool. Additionally, a QI plan provides the roadmap and outlines deliverables for grants, funding, or certification applications.

A plan differs from a QI project or QI program, both of which are considered subcategories of a plan. Projects grow out of the target areas you identify in the plan or those noted by stakeholders. With regular monitoring of changes, you can spotlight further targets for improvement.

Ensure that your quality improvement plans include the following elements:

  • Clearly defined leadership and accountability, as well as dedicated resources
  • Specified data and measurable results that suit your goals
  • Evidence-based benchmarks. In an evidence-based practice, teams determine the clinical or operational approaches that most often produce good outcomes, then create procedures to consistently implement those approaches. In benchmarking, employees learn about processes and results at comparable organizations. Then they consider how to implement similar processes in their own organization.
  • A mechanism for ensuring that you feed the data you collect back into the process. By doing so, you guarantee that you accomplish your goals. It also helps ensure that these goals are concurrent with improved outcome.
  • More than one QI method or tool
  • A built-in structure to keep the plan dynamic and ongoing
  • Attentive staff members who listen to the needs of all stakeholders

Quality Improvement Tools

The following tools work in conjunction with the quality improvement methodologies mentioned above:

  • Root Cause Analysis (RCA): This is a way of looking at unexpected events and outcomes to determine the underlying causes and to recommend changes that are likely to fix the resultant problems and avoid similar problems in the future.

    • RCA Tools: RCA tools include the five whys, appreciation or situational analysis (“so what?”), and drilldowns. These tools reveal finer details of a larger picture, such as state-by-state data emerging from national data and fishbone diagram subprocesses emerging from general processes. In healthcare, RCA is applied after sentinel events, which are unanticipated events that result in death or serious physical or psychological injury to one or more patients in a clinical or healthcare setting. By definition, these events are not caused by a pre-existing illness.
  • Failure Modes and Effects Analysis (FMEA): This is a systematic approach to identifying what could go wrong. Before an event, you apply FMEA to consider all adverse outcomes and mitigate these possibilities. Ideally, this mitigation process would take place both during the design phase and later, during implementation. The FMEA process addresses these questions:
    • Failure Modes: What could go wrong?
    • Failure Causes: Why could this happen?
    • Failure Effects: What would be the consequences of this failure?
  • SPC: Statistics is a science that deals with the collection, summarization, analysis, and drawing of information from the data.
    • Process: It converts input resources into the desired output (goods or services) with a combination of people, materials, methods, and machines, as well as measurements.
    • Control: System, policies, and procedures in place so the overall output meets the requirement.

  • Statistical Process Control Benefits

    • Reduce scrap and rework
    • Increase productivity
    • Improve overall quality
    • Match process capability to product requirement
    • Continuously monitor processes to maintain control
    • Provide data to support decision-making
    • Streamline the process
    • Increase in product reliability
    • Opportunity for company-wide improvements