What is quality improvement in health care?

Quality improvement (QI) can be described as the continuous process to improve health outcomes for patients, improve health system performance and to improve practice of health professionals. [1] QI activities can take many forms including clinical audits, practice review, participant satisfaction/knowledge survey, service improvement, or program evaluation. [2]

QI focuses on ‘doing things right’, using data to identify and monitor for gaps between what we should do and what is being done. [3] In this way it ensures that actions are taken to achieve optimal outcomes at the patient, health professional and/or system levels.

QI complements evidence-based medicine (EBM) which focuses on ‘doing the right things’, ie, knowing the right thing to do based on the best available evidence. [3] In EBM changes are only implemented where there is a real likelihood of improvement. Together QI and EBM direct us how to ‘do the right things right’. [3,4] Research underpins this activity by determining what is and isn’t effective where this is not already known, and so provides an informed starting point for both QI and EBM. [1,3,4] Together with knowledge of the local context this can then be used to define appropriate changes which are closely monitored through data collection to assess the effect of changes. [1]

To achieve this, QI activities are embedded within a quality improvement cycle which can be generalised or specific to a localised setting or area of care. The PDSA cycle (Plan, Do, Study, Act) is a well-known and often implemented example of a QI model. This evolved from the FOCUS-PDCA developed in the early 1990s, an approach that incorporated analysis of the evidence and context of care before embarking on change. [3] Since not all change will bring about improvement, initial examination of the evidence for making change is increasingly seen as important for effective QI. [1,3,4]

All QI cycles involve phases of planning, implementing, collecting and analysing data to sustain improvement.

The 2018 National Palliative Care Standards include a specific standard which indicates that Services are engaged in quality improvement and research to improve service provision and development. (Standard 8, Palliative Care National Standards 2018).

  1. Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care. 2007;16:2–3. doi: 10.1136/qshc.2006.022046
  2. Government of Western Australia Department of Health, Southern Metropolitan Health Service (SMHS). Quality Improvement Activities - What is Quality Improvement (QI)? Murdoch (WA): SMHS Research Ethics and Governance; 2017. Contract No.: v3.0.
  3. Glasziou P, Ogrinc G, Goodman S. Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Qual Saf. 2011 Apr;20 Suppl 1:i13-17. doi: 10.1136/bmjqs.2010.046524.
  4. Djulbegovic B, Bennett CL, Guyatt G. A unifying framework for improving health care. J Eval Clin Pract. 2018 Nov 21. doi: 10.1111/jep.13066. [Epub ahead of print]

Last updated 06 September 2021