Basics of Quality Improvement

Quality improvement (QI) is a systematic, formal approach to the analysis of practice performance and efforts to improve performance.

A variety of approaches—or QI models—exist to help you collect and analyze data and test change. While it’s important to choose a reputable QI model to guide your efforts, it’s more important that you fully commit to using the QI process and good QI practices.

Benefits of QI

Understanding and properly implementing QI is essential to a well-functioning practice, and is necessary for any practice interested in improving efficiency, patient safety, or clinical outcomes.

In addition, good QI practices and improved patient outcomes position your practice for success by:

Helping you prepare for the transition to value-based payment models.
Allowing you to participate in the public reporting of physician quality data.
Giving you the opportunity to participate in the federal Quality Payment Program (QPP) following one of two tracks: the Merit-based Incentive Payment System (MIPS) or the Alternative Payment Model (APM).
Equipping you with the skills necessary to apply for and complete national recognition programs, such as National Committee for Quality Assurance’s (NCQA) Diabetes, Heart/Stroke, and patient-centered medical home (PCMH)-recognition programs.
Helping you earn Family Medicine Certification-Performance Improvement activity credit (formerly Maintenance of Certification) requirements.

Quality Improvement Basics

The QI process is grounded in the following basic concepts:

Establish a culture of quality in your practice. Your practice’s organization, processes, and procedures should support and be integrated with your QI efforts. The culture of a practice—attitudes, behaviors, and actions—reflect how passionately the practice team embraces quality. The QI culture looks different for every practice, but may include establishing dedicated QI teams, holding regular QI meetings, or creating policies around your QI goals.

AAFP Office Champions Projects

The AAFP’s Office Champions Project are an example of QI demonstration projects in which participating family physician practices select staff and physician office champions to lead the implementation of an intervention. Read the results:

Determine and prioritize potential areas for improvement. You will need to identify and understand the ways in which your practice could improve. Examine your patient population (e.g., to identify barriers to care, frequently diagnosed chronic conditions, or groups of high-risk patients) and your practice operations (e.g., to identify management issues such as low morale, long patient wait times, or poor communication). Use established quality measures, such as those from the National Quality Forum, Agency for Healthcare Research and Quality, and the Quality Payment Program to guide your efforts.
Collect and analyze data. Data collection and analysis lie at the heart of quality improvement. Your data will help you understand how well your systems work, identify potential areas for improvement, set measurable goals, and monitor the effectiveness of change. It’s important to collect baseline data before you begin a QI project, commit to regular data collection, carefully analyze your results throughout the project, and make decisions based on your analysis.
Communicate your results. Quality improvement efforts should be transparent to your staff, physicians, and patients. Include the entire practice team and patients when planning and implementating QI projects, and communicate your project needs, priorities, actions, and results to everyone (patients included). When a project is successful, celebrate and acknowledge that success.
Commit to ongoing evaluation. Quality improvement is an ongoing process. A high-functioning practice will strive to continually improve performance, revisit the effectiveness of interventions, and regularly solicit patient and staff feedback.
Spread your successes. Share lessons learned with others to support wide-scale, rapid improvement that benefits all patients and the health care industry as a whole.

Quality Improvement Models and Tools

Quality improvement models present a systematic, formal framework for establishing QI processes in your practice. Examples of common QI models include the following:

Model for Improvement (Plan-Do-Study-Act [PDSA] cycles): The Institute for Healthcare Improvement’s Model for Improvement combines two popular QI models: Total Quality Management (TQM) and Rapid-Cycle Improvement (RCI). The result is a framework that uses PDSA cycles to test interventions on a small scale.
Six Sigma: Six Sigma is a method of improvement that strives to decrease variation and defects.
Lean is an approach that drives out waste and improves efficiency in work processes so that all work adds value.

Quality improvement tools are standalone strategies or processes that can help you better understand, analyze, or communicate your QI efforts. Examples of QI tools include run charts, process maps, and fishbone diagrams (ihi.org).