Quality Improvement Methodology

Quality improvement methodology consists of four key steps, as shown in Table 1.

Step One: Identify

The goal of the first step, identify, is to determine what to improve. This may involve a problem that needs a solution, an opportunity for improvement that requires definition, or a process or system that needs to be improved. Examples of problems or processes that are commonly identified include unavailability of drugs, lost laboratory reports, and waiting time.

This first step involves recognizing an opportunity for improvement and then setting a goal to improve it. Quality improvement starts by asking these questions:

• What is the problem?
• How do you know that it is a problem?

• How frequently does it occur, or how long has it existed?

• What are the effects of this problem?
• How will we know when it is resolved?

Step Two: Analyze

Once we have identified areas for quality improvement, the second step is to analyze what we need to know or understand about this opportunity for improvement before considering changes. The objectives of the analysis stage can be any combination of the following:

• Clarifying why the process or system produces the effect that we aim to change
• Measuring the performance of the process or system that produces the effect
• Formulating research questions, such as the following:
• Who is involved or affected?
• Where does the problem occur?
• When does the problem occur?
• What happens when the problem occurs?
• Why does the problem occur?

• Learning about internal and external clients through the tools available

To reach these objectives, this step requires the use of existing data or data collection. The extent to which data are used depends on the quality improvement approach chosen. A few techniques to analyze problems include:

• Clarifying processes through flowcharts or cause-and-effect analyses
• Reviewing existing data
• Collecting additional data