Continuous improvement is a skill requirement for all staff working across healthcare.

Quality Improvement (QI) is not just a method or model, but more an approach to personal or organisation learning, development and improvement.

QI helps to bring a systematic approach to tackling complex problems by:

  • Focusing on outcomes
  • Flattening hierarchies
  • Giving everyone a voice
  • Bringing staff and service users together to improve and redesign the way that care is provided

QI can be defined as the application of a systematic approach that uses specific techniques to improve quality. Although there is a range of approaches that fit under this umbrella, they all have the following in common:

  • The concept of a cycle of improvement which involves:

– Problem definition and diagnoses

– Planning and testing of change ideas

– Data collection and analysis

– Implementation

– Evaluation

  • A set of tools and techniques that support individuals to plan and implement improvements
  • A recognition of the importance of engaging stakeholders, including patients and carers
  • Recognition of the importance of culture and the need for leadership – clinical and management.

When done successfully, QI can help change the culture of a system, whether the system is a single team, a department, an organisation or a whole health-economy.

Improving quality

The following dimensions of healthcare are widely recognised and universally accepted as describing ‘quality’:

Safe: avoiding harm to patients from care that is intended to help them

Timely: reducing waits and sometimes harmful delays

Effective: providing services based on evidence and which produce a clear benefit

Efficient: avoiding unnecessary waste

Equitable: providing care that does not vary in quality because of a person’s characteristics

Person-Centred: establishing a partnership between practitioners and patients to ensure care respects patients’ needs and preferences

Any aims to improve on these six dimensions should focus on:

Avoiding needless deaths

Avoiding needless pain or surgery

Eliminating waste

Eliminating unwanted waits

Eliminating patients and carers feeling helpless

Consistently: everyone, every time

Types of improvement

It is broadly recognised that there are three types of improvement that can be made:

  1. Reducing defects from the viewpoint of the patient or carer – this focuses on the quality of all aspects of the service being provided
  2. Reducing cost/waste to improve efficiency – see examples below taken from Lean methodology.

3. Providing a new product or service or an old one at an unprecedented level – this focuses on new attributes that can exceed the patient or carer’s expectations. For example, bringing new research into practice or the use of innovative technology.

Quality Improvement methodology
The West of England AHSN project, PreciSSion, uses Quality Improvement methodology to underpin it’s approach. Find out which Quality Improvement tools were used in this short video from PreciSSion’s clinical leads, Anne Pullyblank and Lesley Jordan.