The Spectrum of QI Approaches

Many approaches to quality improvement exist; deciding on which one to use depends on the circumstances. Some problems are simple and can be resolved rapidly, while others involve core processes and require extensive research. The approaches can be visualized along a continuum of complexity of increased time, resource allocation, and group participation. Along this continuum, the QA Project has identified four points that represent four approaches to quality improvement. They are not the only points along the continuum of complexity, but they do illustrate how quality improvement approaches differ.

Individual problem solving occurs when an individual identifies an apparent problem, recognizes his or her ability to fix it, and feels empowered to make necessary changes. Although teamwork is an essential part of quality improvement, the QA Project has learned from experience that the simpler or more urgent improvement needs do not necessitate lengthy team-based approaches. The hallmark of individual problem solving is its use to address problems that are not interdependent, meaning that one person can make and implement the decisions necessary to address a problem. Individual problem solving tends to require little time or data and is methodologically the least complex of the approaches. It is seen in organizations where each individual recognizes the overall goal of delivering quality care and acts accordingly when needs arise that he or she can personally address.

Rapid team problem solving is an approach in which a series of small incremental changes are tested in a system for improvements in quality. This approach can be used in any setting, although it generally requires that a team has some experience in problem solving and/or seeks a mentor for help in managing this approach quickly. This approach is less rigorous in terms of time and resources required because it relies largely on existing data and the team's understanding of the cause(s) of the problem and likely solutions. Teams are ad hoc and disband once the desired level of improvement has been achieved.

Systematic team problem solving is often used for complex or recurring problems that require detailed analysis. The mainstay of this approach is a detailed study of the causes of problems and then the development of appropriate solutions. This detailed analysis often involves data collection, and therefore often requires more time and resources. Although systematic team problem solving can be used in any setting, its in-depth nature makes it most appropriate when the ad hoc team is able to work together over a period of time.

Process improvement is the most complex of the four approaches because it involves a permanent team that continually collects, monitors, and analyzes data to improve a key process over time. It is generally used in organizations where permanent resources are allocated to quality improvement. This permanent team can use more than one approach, for example, forming ad hoc teams to solve specific problems. Process improvement is often used to assure the quality of important services in a health facility or organization.

In sum, experience with quality improvement has rendered it a simpler, more robust methodology, and the application of QI methodology to a wide range of settings has become clearer. The settings include both clinical and nonclinical environments, with the approaches ranging from individual problem solving to core-process improvement by permanent teams. In all of these approaches, the methodology and principles remain unchanged though their different aspects are stressed differently.