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Quality Improvement Initiative


Overview (Flynn, Scott, Rotter, & Hartfield, 2017)

The goal of healthcare quality improvement (QI) is to achieve and sustain changes that produce better care and health systems, thus positively affecting patient outcomes. QI is the application of improvement practices utilizing tools and methods to implement, test, and improve effective quality improvement practices. QI efforts should be based on sound evidence, rigorous assessment, implementation, adoption, evaluation, dissemination, and sustainability. Improvement science is a new field where scientific evidence is provided as a base for health care QI by incorporating QI research and implementing and scientifically evaluating QI interventions. 

The QI movement in healthcare gained momentum after the report by the Institute of Medicine (IOM), To Err is Human: Building a Safer Healthcare System. The report estimated that medical errors caused between 44,000 and 98,000 patient deaths annually with an estimated cost of $38 billion per year (IOM, 2000). With nurses at the frontline of patient care, we are strategically positioned to lead significant QI initiatives. We can nimbly bridge the gap between improving science research and implementing actions into patient care. 

Transformational Leadership (McFadden, Stock, Gowen, 2015)

Transformational leadership (TFL) is based on charisma inspiration and has been recognized as the most effective leadership style when compared to transactional leadership (based on rewards and punishment) and laissez-faire leadership (based on lack of leadership). TFL transforms organizations by empowering through inspirational motivation and encouraging innovation by giving followers a clear sense of purpose and a role model for conduct.


Quality Improvement Teams (Kurnik, n.d.)

Team-led processes are preferable to management-led processes, considering the following:

  • Suggestions and ideas are submitted from the bottom up, creating a sense of ownership and enthusiasm for the initiative.
  • Solutions that are easiest to implement are identified quickly, resulting in immediate process improvements.
  • Teamwork is emphasized and team members feels valued.
  • Team members work closely with the issues and have a vested interest in resolving issues through process improvements.

Composition of an ideal QI team:

  • Assemble a team that is knowledgeable about the process and diverse in thinking styles.
  • Appoint a team leader.
  • Restrict team size – less than eight members is ideal.
  • Ensure convenient meeting times and locations.
  • At first meeting, inform team of expectation for attendance, participation, and time requirements.
  • Appoint a recorder that will document ideas and record attendance at meetings.

Define, Measure, Analyze, Improve, and Control (DMAIC)

DMAIC is well-established methodology for process and quality improvement that aims to create innovative, targeted solutions and influence change (Christopher et. al 2014, Kurnik, n.d.).
  • Define Phase
    • Clarify the purpose and scope of the project while conveying a deep understanding of the problem.
    • Develop the team and assign responsibilities based on individual strengths.
    • Identify key stakeholders to ensure ownership and accountability throughout the project.
    • Develop a team charter to clearly define goals.
  • Measure Phase
    • Develop a detailed process map.
    • Develop an audit tool or identify a metric that is representative of the process performance.
  • Analyze Phase
    • Audit current processes (retrospectively and prospectively).
    • Review all data collected and consider chart/graph for ease of understanding.
    • Brainstorm solutions.
    • Focus on actual problems to solve.
  • Improve and Control Phase
    • Conduct a best practice review.
    • Develop a pilot.
    • Assign resources to improvement tasks along with a timeline for task completion. Consider assigning outside the team to identify the best person to execute the task (i.e. has authority to effect change).
    • Consider using a metric control chart to track actions, assignees, target completion dates, actual completion dates, and task status on a weekly basis and address obstacles.
    • Create a system to ensure that critical tasks continue without the team’s ongoing support so that process improvement initiatives are not lost.

Christopher, D.A., Trotta, R.L., Yoho, M.A., Strong, J., & Dubendorf, P. (2014). Using process improvement methodology to address the complex issue of falls in the inpatient setting. Journal of Nursing Care Quality, 29(3), 204-214. doi: 10.1097/NCQ.0000000000000053
Flynn, R., Scott, S.D., Rotter, T., & Hartfield. (2017). The potential for nurses to contribute to and lead process improvement science in health care. Journal of Advanced Nursing, 73(1), 97-107. doi: 10.1111/jan.13164
Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press.
Kurnik, R. (n.d.) Process improvement teams power six sigma success. Retrieved from
McFadden, K.L., Stock, G.N., & Gowen, C.R. (2015). Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health Care Management Review, 40(1), 24-34. doi: 10.1097/HMR.0000000000000006