The Practice (Quality) Improvement Process

Systematic quality improvement involves noticing a problem or opportunity and responding in a systematic and methodical way.

IDENTIFY a PROBLEM

Begin to ASSEMBLE a TEAM

What's GOING ON

What MIGHT be DONE (choose ONE to test)

TEST the CHANGE

Decide what to do NEXT

  1. 1. Identify a problem, issue, or opportunity to address. Begin to draft a rough statement of your objective or aim.
  2. 2. Begin to assemble an improvement team. Membership tends to evolve. (Note: Sometimes people begin here and ask team members to pool their thinking to identify what they want to target.)
  3. 3. Determine what is going on: Gather quantitative [numbers] and qualitative data [stories] in order to better understand the situation, potential causes of problems, opportunities, etc
  4. 4. Consider what might be done. Generate options. Then decide what to test. Refine your “aim statement” into a precise, achievable objective.
  5. 5. Carefully design, prepare for, implement, and monitor this test (and any needed subsequent) test(s) of the change you wish to introduce. Testing is done systematically using a four-phase process, the “Plan, Do, Study, Act (PDSA) Cycle.”
  6. 6. Based on how things go with the test and what you learn from the study and analysis phases of the PDSA cycle, decide what to do next. • Tweak (refine), Modify, Add, Abandon, Fully implement and maintain, Expand or Disseminate?

The Order of Things

The order in which you tackle the six aspects of the improvement process turns out to be something other than following a simple, one-step-at-a-time, one-step-after-another recipe. It’s similar to what you do as you carefully and thoughtfully diagnose and treat patients — where you constantly juggle the facts you have so far and hunches about what is going on, identify additional information you need, determine what you want and need to learn to better deal with this and consider what might be done to improve things.

In this instance, it’s your practice setting that is the patient. But working through the process can be every bit as non-linear as diagnosing and treating more conventional clinical problems despite the fact that here your focus is on procedures, processes and systems. Knowing what the parts of the improvement process are, and being alert when changes in one part of the process begin to suggest changes and/or actions needed in other parts of the process, is what is required.

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