Performance and Quality Improvement

The wide range of initiatives aimed at improving quality in health care build on models and tools first used in industry. One of the most widely used approaches promoted by the Institute for Health Care Improvement[1] is based on Langley’s Model for Improvement,[2] which asks three questions:

  1. What are we trying to accomplish?
  2. How will we know that a change is an improvement?
  3. What changes can we make that will result in improvement?[3]

A good quality improvement intervention:

  • Meets expectations and needs of community, clients, and providers, and internationally accepted technical standards
  • Focuses on systems and processes
  • Uses data to analyze the service delivery process, such as through a health facilities assessment, or other tools
  • Encourages a team approach to ongoing problem solving and quality improvement

Elements of Quality for Family Planning

Initially, six elements of quality were identified that needed to be in place if FP services are to address client rights. These are[4]:

  1. A choice of methods continuously available from FP service providers
  2. Interpersonal skills of FP service providers
  3. Accuracy and completeness of information given to clients
  4. Technical competence of providers
  5. Appropriate constellation of services
  6. Continuity of care and follow up

Based on further development of client rights and work in quality improvement, the following elements have been added for consideration:

  1. Adequate infrastructure and equipment
  2. Efficiency and effectiveness of services

Key Quality Improvement Resources:


[2] Langley, G.L., K.M. Nolan, T.W. Nolan, C.L. Norman, and L.P. Provost. 2009. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd Edition). San Francisco: Jossey-Bass Publishers.

[4]Bruce, J. 1990. Fundemental Elements of the Quality of Care: A Simple Framework. Studies in Family Planning. Vol. 21, No. 2 (Mar – Apr 1990) pages 61-91.