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What is Quality Improvement (QI)?

Improving quality is about making healthcare safer, effective, patient centred, timely, efficient and equitable. There is no single definition of quality or quality improvement, and no one approach appears to be more successful than another. However, here are a couple of useful definitions:


A hospital operating theatre washroom. A man soaping his hands under running water, preparing for an operation. Washing his hands thoroughly “The conception of improvement finally reached as a result of the review was to define improvement as better patient experience and outcomes achieved thorough changing provider behaviour and organisation through using a systematic change method and strategies". (Ovretveit J, 2009).

"The combined and unceasing efforts of everyone  to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)". 
(Batalden and Davidoff, 2007).


A number of key national reports published in England over the past few years have highlighted failings in the quality of healthcare provision in a number of areas but also the importance of quality improvement in improving this care.


Six aims for Improvement - Institute of MedicineSix components of healthcare quality - IOM (IOM)

The Institute of Medicine in the United States has identified six aims for improvements to achieve the ideal healthcare system.

These aims are often used within quality improvement literature. They are all linked but the challenge for the NHS is to balance them.

“In order to begin achieving real improvement in health care, the whole system has to change”


For example, good healthcare should:

Safe Be as safe for patients in health care facilities as in their home
Effective Match science, with neither underuse nor overuse of the best available techniques
Patient Centred Revolve around the patient who should play an active role in making decisions about their own care
Timely Mean that patients do not experience waits or delays in receiving care and services
Efficient Be cost effective and reduce/remove waste
Equitable Disparities in care should be eradicated

  Crossing the Quality Chasm (IOM 2001)


Wessex School of QI

The definition of Quality Improvement which will underpin the work of the School is that described by Batalden and Davidoff  

 The combined and unceasing efforts of make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)

(BMJ Quality & Safety 2007;16:2-3.)


This ethos was reinforced by Don Berwick in his report “A promise to learn – a commitment to act (pdf)” (2013).

Among Don's ten recommendations, he states that the “Mastery of quality and patient safety sciences and practices should be part of initial preparation and lifelong education of all health care professionals, including managers and executives.”  

For additional information, follow the links below to access presentations from Don Berwick given at a Department of Health event held by The King's Fund in August 2013:


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