✅ Reviewed for accuracy and relevance by Deanna Cooper Gillingham, RN, CCM, FCM on July 22, 2025.
Quality and performance improvement tools and processes provide a structured approach to systematically identify and analyze problems, implement solutions, and measure results. Popular methods used in healthcare organizations are:
Plan-Do-Study-Act method
The PDSA model asks three questions:
- What are we trying to accomplish? – The team identifies the issue and sets time-specific, measurable goals.
- How will we know that the change is an improvement? – The team determines what data will determine if the change creates improvement. Anecdotal information is not reliable for this step. Measurable data is key for demonstrating results.
- What change can we make that will result in improvement? – Suggestions from all stakeholders must be considered.
Six Sigma method
Six Sigma is a data-driven methodology used in healthcare to measure and improve patient outcomes, increase efficiency, and reduce costs while increasing patient satisfaction. Its focus is identifying and eliminating defects and inefficiencies in processes and practices, from patient care to administrative tasks.
Six Sigma uses a 5-step approach to process improvement, known by the acronym DMAIC: define, measure, analyze, improve, and control.
Define – Identify the problem and set a goal for improvement (e.g., problem: hospital length of stay (LOS) after hip replacement is above national benchmarks by 1.25 days. Goal: Decrease LOS by 1.25 days).
Measure – Collect data on the current process to develop a baseline. Identify all interrelated business processes to find areas for possible performance enhancement (e.g., listing all disciplines involved with the patient, mapping current process and patient flow).
Analyze – Analyze the data collected to reveal the root cause of inefficiencies and determine solutions to overcome them. Group discussions and analysis of the data collected in the Measure step will reveal where changes can provide the most effective results (e.g., physical therapy and occupational therapy are not available over the weekend, resulting in treatment delay; PT and OT availability on weekends will eliminate the delay).
Improve – Implement solutions developed during the analysis phase to address process deficiencies. By the end of this phase, a test run of the change has been completed, and feedback has been analyzed (e.g., LOS is reevaluated after PT and OT have been available on weekends).
Control: Metrics are monitored to maintain improvements. If adjustments are necessary, the cycle continues. Alternatively, the new changes may be made permanent, and the project is complete.
Lean method
The Lean approach to quality improvement emphasizes eliminating waste to increase value. Waste is identified as one of 8 areas, using the acronym DOWNTIME.
D: Defects
O: Overproduction
W: Waiting
N: Non-utilized talent
T: Transportation
I: Inventory
M: Motion
E: Extra-processing
Kaizen method
Lean and Six Sigma can be combined in a “Kaizen” event, merging both philosophies. Kaizen means continuous improvement. Kaizen events are team exercises in which a process is taken apart and mapped, and opportunities for improvement are identified. All stakeholders provide input along the way. Kaizen activities cycle through seven phases:
- Identify an opportunity: What is the issue?
- Analyze the process: Deconstruct and map the process, identifying potential gaps.
- Develop an optimal solution: What is the goal? How can we get there? Create a roadmap.
- Implement: Execute the roadmap.
- Study the results: What happened? Fix challenges and re-implement the roadmap until success is achieved.
- Standardize the solution: Implement it across all like units.
- Plan for the future: Discuss how to ensure a change becomes part of the culture. How do we avoid deviations? How often do we evaluate for updates?
Quality improvement tools and processes
Quality improvement tools help case managers collect, analyze, and visualize data to identify problems and monitor improvements. These include:
Process mapping
Process mapping visually represents the sequence of steps in a workflow or process (e.g., documentation workflow, hospital discharge process) to identify delays, duplications, bottlenecks, or gaps. Common types include:
Flowcharts – Basic sequential diagrams showing the steps of a process
Swim lane diagrams – Charts showing which people or departments are responsible for each step of a process
Pareto charts
Pareto charts are based on the Pareto principle, which states that 80 percent of effects come from 20 percent of causes. They help prioritize improvement efforts by identifying the most important cause(s) responsible for most problems among the many identified. For example, a Pareto chart might show that two of nine identified barriers to timely discharge account for 79 percent of discharge delays. This helps focus on interventions with the most significant potential impact.
Scatter plots
Scatter plots examine relationships between two variables to identify potential correlations. For example, a scatter plot can explore the relationship between the number of times a client has been contacted by case management and the client’s achievement of goals.
This article shares a portion of the information covered on this topic in CCM Certification Made Easy, 4th Edition by Deanna Cooper Gillingham, RN, CCM, FCM (2025). For more details on this topic and related concepts, purchase your copy at CCMCertificationMadeEasy.com
