What is Quality Improvement?

Quality Improvement (QI) is an approach to learning, development, and improvement that is essential for all healthcare staff. It goes beyond being just a method or model and is more of a mindset.

QI brings a systematic approach to addressing complex problems by focusing on outcomes, breaking down hierarchies, giving everyone a voice, and involving staff and service users in improving and redesigning care delivery. It can be defined as the application of a systematic approach that uses specific techniques to improve quality.

At its core, QI involves a cycle of improvement, which includes problem definition, planning and testing change ideas, data collection and analysis, implementation, and evaluation. It also encompasses a set of tools and techniques to support individuals in planning and implementing improvements, as well as the recognition of the importance of engaging stakeholders, including patients and carers. Leadership, both clinical and management, is also crucial in driving QI efforts.

When successfully implemented, QI can transform the culture of a system, whether it is a single team, a department, an organisation, or an entire health economy. Read more in the Health Foundation’s guide on Making the Case for Improvement.

What do we mean by “quality”?

The goal of QI is to improve healthcare quality across several dimensions. These dimensions include safety, timeliness, effectiveness, efficiency, equity, and person-centredness. Improvement efforts should aim to avoid harm to patients, reduce waits, provide evidence-based services, minimise waste, ensure fairness in care delivery, and establish partnerships between practitioners and patients.

A short history of quality improvement

Quality Improvement (QI) has a rich history that can be traced back to medieval Europe when craftsmen organised into guilds. The industrial revolution in the 19th century marked a shift towards manufacturing on a larger scale, with an emphasis on product inspection. Quality processes began to be included in manufacturing practices in the early 20th century.

During World War II, quality became crucial for the war effort, as consistency and reliability were needed across different states. This led to the adoption of sampling techniques for inspection. The quality revolution in Japan following the war had a significant impact on the development of total quality approaches. Rather than focusing solely on inspection, the Japanese emphasised improving organisational processes through the involvement of the people who used them.

In the 1970s, the US response to the success of Japanese manufacturing was Total Quality Management (TQM), which embraced the entire organisation and emphasised statistical approaches. Quality improvement methodologies continued to evolve, with concepts such as the Model for Improvement (IHI), Lean (based on the Toyota production system), and Six-Sigma gaining prominence.

The concept of quality improvement expanded beyond manufacturing into service, healthcare, education, and government sectors. Healthcare quality improvement methods continue to evolve, focusing on maximising the ability of teams to deliver improvements, improving patient flow, and involving the public and patients in the co-design and production of services.

Recently, implementation science particularly in healthcare, has appreciated that healthcare is part of a complex socio-technical system. Complexity science and social science approaches have given different ways to explore and improve services. Read more in this paper by Trisha Greenhalgh and Chrysanthi Papoutsi.

Throughout history, quality improvement has constantly evolved, drawing inspiration from various disciplines and methodologies. It remains a vital approach to addressing complex problems and driving innovation and creativity in solving long-standing issues.

Case study

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