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Strategies of Quality Improvement Curriculum
Continuous Quality Improvement
Institutions dedicated to preemptive, rather than reactionary, QI generally sub-
scribe to continuous QI, which is founded in the belief that every process presents
an opportunity for improvement [ 7 ]. It requires that an organization view the pro-
cesses and operations as a product of the healthcare delivery system on a mac-
roscale rather than an individual patient basis when considering opportunities for
improvement. Organizations committed to quality improvement generally
approach it from a combination of continuous QI and one of the approaches
detailed below.
Plan-Do-Study-Act
The plan-do-study-act (PDSA) cycle is an iterative four-step QI method popularized
by Dr. W. Edwards Deming, who was an engineer and management consultant who
many consider to be the father of modern quality control [ 8 ]. The PDSA cycle is not
meant to replace QI methods that an organization already has in place but rather to
provide a powerful framework to accelerate improvement. It is a refined take on the
traditional trial and error process with the addition of steps for iterative improve-
ment. The PDSA cycle is composed of four logical and sequential steps that with
each cycle leads to exponential improvements. The steps in the PDSA cycle are
summarized in Table 11.1 and Fig. 11.2.
Advantages of the PDSA cycle include its ability to adapt to the local context,
respond to unforeseen obstacles, and deliver effective interventions for complex
problems [ 70 ]. The PDSA cycle also lends itself to teamwork with well-defined
roles that can be performed over the long term. While short-term goals may be
achieved, the PDSA cycle enhances an organizations’ continuous improvement
strategy and can be transitioned from one team to another if the members of the
team change over time.
Canal et al. applied the PDSA cycle to surgical residents during an outpatient
ambulatory surgery rotation [ 12 ]. Residents received a didactic lecture on the appli-
cation of the PDSA cycle for QI from a faculty member for 1 h a week over the
course of 6 weeks. During this time, residents presented their project ideas to one
another, voted on which project they wanted to implement, and then worked on their
Table 11.1 Plan-do-study-act cycle
Plan Identify the change that you would like to implement
Select team members who will be involved
Evaluate what resources will be needed
Determine what data will be collected
Do Test the feasibility of your plan on a small scale
Be prepared to restructure the plan based on preliminary results
Study Analyze the data to evaluate whether the previous step achieved the desired outcome
Summarize lessons learned, unintended consequences, successes, and failures
Act Decide whether to adapt, adopt, or abandon the approach selected during the “plan” stageS. Helo and C. Welliver