What is quality improvement?

This section addresses what is meant by the term quality improvement. Before reading this, you may wish to read the previous section which considers what is meant by quality.

If you are interested in quality improvement, you may wish to find out more about our locally-delivered quality improvement skills programme. 



There is a long history of quality improvement with three major eras:

Major Eras in Improvement Thinking


The early eras started with the pre-1900 era when quality improvement was based around craftsmanship, with quality resting in the skills of the individual. This was followed by the period of mass production and assembly line standardisation, with quality determined by end-of-line inspection.

The middle era started with the use of statistical process control, quality being considered a function of the process. This was followed by the period of quality assurance systems, with quality seen as a function of the organisational systems and infrastructures.

The modern era started with strategic quality management, with more customer focus, greater involvement of leaders and quality seen as a core competency of all concerned. The present period has been called the period of ultra quality with a fanatical attention to customer value and elimination of all waste, quality being considered a basic management tool.


Domains of Improvement

It is now accepted that there are three linked domains of improvement:

Three Domains of Improvement

In public services, a definition of quality improvement could be: continually working together to improve the experience and outcomes for users and the working lives of the staff who deliver it.

If the above is taken as a workable definition then the next question is often - what quality improvement frameworks are available?

One of the most applicable to public service improvement is that of Penny (2003). This model has four equally important, interrelated elements, two involving people and two involving processes:

Diagram People / Process

There are other useful frameworks - particularly the work by Paul Batalden on microsystems, and the eight domains model of the Institute of Healthcare Improvement. Penny's, however, is simple and practical.

It builds on the pioneering work of Deming and his ‘System of Profound Knowledge' (1994) with its four interconnected elements:


The Model for Improvement

We use Penny's framework at the Improvement Foundation, coupled with the model of quality improvement developed by Langley et al (1996).

Model for Improvement

This model has consistently been shown to deliver results. It consists of the three questions:

  1. What are we trying to accomplish?
  2. How will we know that a change is an improvement?
  3. What changes can we make that will result in improvement?

For each of these questions, there are various tools and techniques to assist in answering the question.

Once we have an idea of the changes we think may result in an improvement, they are tested using the Plan Do Study Act (PDSA) cycle of rapid change.

The PDSA cycle is similar to the scientific method of hypothesise (P), collect data (D), examine data against hypothesis (S) and rethink hypotheses (A). However the crucial difference is that the PDSA model enables change by being a series of rapid, small-scale cycles which successively build on the knowledge from the previous cycle.

To learn more about quality improvement, you may wish to consider our locally-delivered quality improvement skills programme.