How do we improve quality?

I think it is a disservice to the sciences of improvement to reify the term “quality improvement” as if it were a device or even a stable methodology. Making patient care better is always a good idea, and there is no harm at all in using the term “improvement” to describe that quest. However, treating the pursuit of improvement (no initial caps) by searching for a boxable, boundable formula, let alone canonizing it with a proper-noun label—“Quality Improvement” (initial caps)—is misleading. The ways in which people and organizations try to overcome the destructive forces of entropy in complex systems and to continually improve the work that they do on behalf of patients are numerous and, thank goodness, will forever evolve.

--Donald Berwick, JAMA, May 16, 2012

There is no single best way to improve quality of health care; however, several basic principles underlie the most successful improvement efforts:

  • Understand health care in terms of processes and systems and seek better care by making changes to processes.
  • Promote team work: engage all relevant actors at all system levels in improvement.
  • Take regular measurement and use data to track progress for action (e.g., routinely measuring adherence to standards to identify gaps and tracking the results of improvement efforts).
  • Focus on client needs, values, and preferences.
  • Regularly share learning across multiple teams engaged in trying to improve care in a common technical area.