Quality Improvement (QI)

Learn QI methodology to systematically improve patient care and services

What is Quality Improvement?

QI is a systematic approach to making changes that lead to better patient outcomes, more efficient systems, and improved staff experience. It uses data and structured methods to test and implement improvements.

QI is different from:

• Audit: Measures against standards but doesn't necessarily drive change
• Research: Discovers new knowledge; QI applies existing knowledge
• Service evaluation: Assesses current service; QI actively improves it

The Model for Improvement

Three fundamental questions guide every QI project:

1. What are we trying to accomplish?

Define your aim. Be specific: "Reduce discharge delays by 30% in 6 months"

2. How will we know that a change is an improvement?

Choose measures. Track data over time using run charts or SPC charts

3. What changes can we make that will result in improvement?

Generate ideas, then test using PDSA cycles

The PDSA Cycle - Step by Step

PDSA (Plan-Do-Study-Act) is the core QI methodology. You test changes on a small scale before rolling out widely.

PLAN

• State your objective: What are you trying to accomplish?
• Make predictions: What do you think will happen?
• Plan the test: Who? What? When? Where? What data will you collect?

Example: Test same-day discharge letters for 5 patients next week. Predict: letters will go out within 24 hours instead of 7 days.

DO

• Carry out the test
• Document problems and unexpected observations
• Collect the data

Example: Clinician dictates letters immediately after ward round. Secretary types same day. Record actual turnaround times.

STUDY

• Analyse the data: What did you find out?
• Compare results to predictions
• Summarise what was learned

Example: 4 out of 5 letters sent within 24 hours. One delayed because clinician was on call. Learning: need cover system.

ACT

• Adapt: Modify the change based on what you learned
• Adopt: Implement on larger scale if successful
• Abandon: If it didn't work, try something different

Example: Adapt the process to include cover arrangements. Run another PDSA with 10 patients. If successful, roll out to whole ward.

Key principle: Start small, learn fast, scale gradually

Multiple rapid PDSA cycles are better than one big implementation

QI Tools and Techniques

Process Mapping

Visual diagram showing every step in a process. Helps identify waste, delays, and improvement opportunities.

When to use: Understanding current state before making changes

Driver Diagrams

Shows the relationship between your aim, primary drivers (major factors), and change ideas.

When to use: Planning which changes will achieve your aim

Run Charts & SPC Charts

Plot data over time to see if changes lead to improvement. Look for trends, shifts, and patterns.

When to use: Monitoring whether your changes are working

Fishbone (Ishikawa) Diagram

Identifies potential causes of a problem across categories: People, Process, Equipment, Environment, etc.

When to use: Root cause analysis

Pareto Chart

80/20 rule - identifies which few factors cause most of the problem.

When to use: Prioritising which issues to tackle first

Real NHS QI Examples

Reducing hospital-acquired infections

PDSA testing of enhanced cleaning protocols, hand hygiene campaigns, and environmental swabs. 40% reduction in C.diff in 6 months.

Improving medication safety

Process mapping revealed multiple handover points. Tested electronic prescribing in one ward. Errors reduced by 60%, rolled out trust-wide.

Reducing A&E waiting times

Rapid assessment at front door, streaming patients by acuity, discharge lounge for awaiting transport. 4-hour target improved from 82% to 94%.

QI Training Programmes

• IHI Open School: Free online QI courses and certificates
• NHS England QI Training: Various levels from foundation to advanced
• Silver, Gold, Platinum QI programmes: Progressive QI capability building
• Improvement Advisor training: Become a QI coach/facilitator