Quality and performance improvement concepts

Related CCMC Glossary of Terms

Continuous Quality Improvement (CQI): A key component of total quality management that uses rigorous, systematic, organization-wide processes to achieve ongoing improvement in the quality of healthcare services and operations. It focuses on both outcomes and processes of care.

Outcome Indicators: Measures of quality and cost of care. Metrics used to examine and evaluate the results of the care delivered.

Outcomes Management: The use of information and knowledge gained from outcomes monitoring to achieve optimal patient outcomes through improved clinical decision making and service delivery. 

Outcomes Monitoring: The repeated measurement over time of outcome indicators in a manner that permits causal inferences about what patient characteristics, care processes, and resources produced the observed patient outcomes.

Performance Improvement: The continuous study and adaptation of the functions and processes of a healthcare organization to increase the probability of achieving desired outcomes and to better meet the needs of patients. 

Quality Assurance: The use of activities and programs to ensure the quality of patient care. These activities and programs are designed to monitor, prevent, and correct quality deficiencies and noncompliance with the standards of care and practice. 

Quality Improvement: An array of techniques and methods used for the collection and analysis of data gathered in the course of current healthcare practices in a defined care setting to identify and resolve problems in the system and improve the processes and outcomes of care. 

Quality Management: A formal and planned, systematic, organization wide (or networkwide) approach to the monitoring, analysis, and improvement of organization performance, thereby continually improving the extent to which providers conform to defined standards, the quality of patient care and services provided, and the likelihood of achieving desired patient outcomes. 

Root Cause Analysis: A process used by healthcare providers and administrators to identify the basic or causal factors that contribute to variation in performance and outcomes or underlie the occurrence of a sentinel event.
Standard (Organization): An authoritative statement that defines the performance expectations, structures, or processes that must be substantially in place in an organization to enhance the quality of care.


Quality improvements focus on impacting the quality of healthcare directly. Performance improvements focus on the administrative systems performance. Both can be prospective or retrospective and aim at improving how things are done. An example of quality improvement may be to decrease the number of hospital acquired infections, whereas a performance improvement may be to reduce lost charges.  

Objectives for QI include:

  • reducing medical errors, morbidity and mortality
  • assisting in the development of best practice guidelines
  • improving customer satisfaction
  • ensuring the environment of care promotes safety
  • ensuring professional performance

Quality improvement is not intended to attribute blame, but to discover where errors are occurring and develop systems to prevent them. 

There are 3 types of measures

  • structure: physical equipment and facilities
  • process: How the systems work
  • outcome: the final result

Methods of Quality Improvement

There are several methods used to measure quality improvement. Below are 3 of the most common. Although they vary, they all have the same basic design, to find where the problem is, to figure out an option to fix it, and to analyze the effectiveness of the changes.

FADE Model
Focus: Define the process to be improved
Analyze: Collect and analyze data to establish baseline and identify root cause
Develop: Based on the data from the previous steps, develop a plans for improvement
Execute: Implement the action plan
Evaluate: Ongoing measuring to ensure success.

PSDA Model
Plan: Plan a change
Do: Carry out the plan
Study: Evaluate results
Act: Decide what actions should be taken to improve.
Repeat as needed

Six Sigma
There are two Six Sigma models

DMAIC-used for an existing process that is not meeting standards and needs improvement Define


DMADV-used to develop new systems