Quality improvement into practice

What you need to know• Thinking of quality improvement (QI) as a principle-based approach to change provides greater clarity about (a) the contribution QI offers to staff and patients, (b) how to differentiate it from other approaches, (c) the benefits of using QI together with other change approaches• QI is not a silver bullet for all changes required in healthcare: it has great potential to be used together with other change approaches, either concurrently (using audit to inform iterative tests of change) or consecutively (using QI to adapt published research to local context)• As QI becomes established, opportunities for these collaborations will grow, to the benefit of patients.The benefits to front line clinicians of participating in quality improvement (QI) activity are promoted in many health systems.QI can represent a valuable opportunity for individuals to be involved in leading and delivering change, from improving individual patient care to transforming services across complex health and care systems. 1 However, it is not clear that this promotion of QI has created greater understanding of QI or widespread adoption.QI largely remains an activity undertaken by experts and early adopters, often in isolation from their peers.2 There is a danger of a widening gap between this group and the majority of healthcare professionals.This article will make it easier for those new to QI to understand what it is, where it fits with other approaches to improving care (such as audit or research), when best to use a QI approach, making it easier to understand the relevance and usefulness of QI in delivering better outcomes for patients.How this article was made AB and FO are both specialist quality improvement practitioners and have developed their expertise working in QI roles for a variety of UK healthcare organisations.The analysis presented here arose from AB and FO's observations of the challenges faced when introducing QI, with healthcare providers often unable to distinguish between QI and other change approaches, making it difficult to understand what QI can do for them. How is quality improvement defined?There are many definitions of QI (box 1).The BMJ's Quality Improvement series uses the Academy of Medical Royal Colleges definition.6 Rather than viewing QI as a single method or set of tools, it can be more helpful to think of QI as based on a set of principles common to many of these definitions: a systematic continuous approach that aims to solve problems in healthcare, improve service provision, and ultimately provide better outcomes for patients. Box 1: Definitions of quality improvement• Improvement in patient outcomes, system performance, and professional development that results from a combined, multidisciplinary approach in how change is delivered.3• The delivery of healthcare with improved outcomes and lower cost through continuous redesigning of work processes and systems.4• Using a systematic change method and strategies to improve patient experience and outcome.5• To make a difference to patients by improving safety, effectiveness, and experience of care by using understanding of our complex healthcare environment, applying a systematic approach, and designing, testing, and implementing changes using real time measurement for improvement.6 In this article we discuss QI as an approach to improving healthcare that follows the principles outlined in box 2; this may be a useful reference to consider how particular methods or tools could be used as part of a QI approach.