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Why Quality Improvement?

'The 1000 Lives Plus Quality Improvement Guide’ brings together learning from around Wales – and further afield - to explain how a simple set of techniques can be applied to improve the quality of services provided. It will encourage everyone (the public, carers, managers, healthcare professionals, accountants, board members) to apply these techniques and be part of introducing change to bring about improvements.


What is Quality Improvement (QI) and why do we need to focus on it?
Quality Improvement is about making care better for everyone, every time.
We all want to deliver the best care for our patients and quality improvement enables us to make sure our healthcare is as safe as it can possibly be. But what is Quality Improvement?
Quality Improvement can be defined as a systematic approach that uses specific techniques to improve quality [1]. The father of QI, W Edwards Deming described the science of improvement as comprising the following factors which are incorporated within the PDSA Cycle (Plan-do-study-act):
  • Appreciation of a system - understanding the relationships amongst those involved in healthcare, from doctors & nurses to treatments, equipment and the patients
  • Understanding of variation - the difference between similar factors.
  • Theory of knowledge - predicting the results to enable a plan to be made even though the future is certain.
  • Psychology - how people interact with each other and the system.
The PDSA Cycle highlights the growth of knowledge through making changes and then reflecting on the consequences of these changes.
Quality should be controlled through the entire work processes and not at the end of the line[2]. This means collecting and analysing data throughout the processes in health care. This foundation of quality improvement by Deming was further developed by Langley, Nolan and Nolan to create the Model of Improvement which is a combination of building and applying knowledge to make an improvement alongside the PDSA Cycle:

The Model for Improvement [3] is a basic building block for change which aims to address three key questions, which used in conjunction with the PDSA cycle tests the change idea. By doing repeated small-scale tests, they will be able to adapt change ideas until they result in the reliable process improvement required.
How can we improve?
All Quality Improvement requires change and in order to sustain this improvement it is important to look at the way in which change is introduced and implemented. Not only this, but we must be clear on what we're trying to achieve; how we will know a change has led to improvement; and what change we can make that will result in an improvement [4].
Quality Improvement requires the unceasing efforts of all those involved in the healthcare system[5]. By collaborating, learning is shared and improvements can thus be achieved. Everyone in healthcare has two jobs when they come to work every day: to do their work and to improve it [6].
Quality Improvement also requires leadership to move things forward. It enables connections between the aims of these changes and the design and testing of these changes [7]. By leading these changes you can challenge the current system by offering clear ideas and alternatives. 
What are the benefits of QI?
Making changes will result in:
  • Better patient experience
  • Better care
  • Improved professional development / learning
  • Patient centred care
  • Safety 
  • Effectiveness 
  • Timeliness
  • Efficiency

Quality Improvement involves meeting the needs of the patient first and making sure healthcare can be as safe as it can possibly be.

If we can improve care for one patient, then we can do it for ten.
If we can do it for ten, then we can do it for a 100.
If we can do it for a 100, we can do it for a 1000.
And if we can do it for a 1000, we can do it for everyone in Wales.



[1] WHO Patient Safety Curriculum Guide for Medical Schools, 2009
[2] The Health Foundation: Quality Improvement Made Simple
[3] Langley GJ, Nolan KM, Nolan TW. The foundation of improvement. Silver Spring, MD: API Publishing, 1992
[4] Berwick, D. A primer on leading the improvement of systems. BMJ: Volume 312, 1996.
[5] , [6] & [7] Batalden, P. & Davidoff, F. What is “quality improvement” and how can it transform healthcare? QSHC, 2007.

Last updated: 18/05/2011