8 improvement methodologies that work to boost healthcare quality

Quality improvement in healthcare is a continuous journey. From patient outcomes to operational efficiency, striving for excellence is paramount. But achieving these goals requires a structured approach, and that’s where robust improvement methodologies come into play.

Simply identifying problems isn't enough. You need proven frameworks to guide your efforts, ensuring that your improvement initiatives are effective, sustainable, and impactful. In this article we’ll explore some of the most effective improvement methodologies you can leverage to transform your healthcare improvement program and achieve significant and lasting results.

Why use improvement methodologies in healthcare?

Before diving into specific improvement methodologies, let's highlight why they're so important.

First of all, these methodologies offer a structured approach to improvement. In other words, improvement methods are systematic and data-driven solutions to complex problems. They emphasise data collection and analysis, enabling the tracking of progress and demonstrating the tangible impact of improvement initiatives through measurable results. By adopting these frameworks, your organisation can move beyond reactive fixes and embrace a proactive, evidence-based approach.

Furthermore, they focus on long-term solutions which not only resolve immediate issues but also prevent recurrence and build a foundation for continuous improvement. Ultimately, the driving force behind these improvement methodologies is the enhancement of patient care, safety, and satisfaction, leading to improved patient outcomes and a more positive healthcare experience for everyone involved.

Now, let’s see the 8 most common improvement methodologies that healthcare organisations are using.

Model for Improvement

The Model for Improvement is a simple, yet powerful framework developed by Associates in Process Improvement (API). It centres around three fundamental questions:

• What are we trying to accomplish? (Setting clear aims)
• How will we know that a change is an improvement? (Establishing measurable indicators)
• What changes can we make that will result in improvement? (Identifying and testing potential changes)
  
  

These questions are followed by the PDSA (Plan, Do, Study, Act) cycle, a rapid cycle of testing changes on a small scale.

• Plan - Develop your improvement plan
• Do - Implement your plan and collect data
• Study - Analyse the data and evaluate the results
• Act - Refine your plan based on the findings and implement the changes more broadly

Why it works

The Model for Improvement is adaptable and easy to understand, making it ideal for a wide range of healthcare improvement projects. Its iterative nature allows for continuous learning and refinement.

Lean Methodology

The Lean methodology was originally developed in the manufacturing industry, and it focuses on eliminating waste and maximising value for the customer through different tools and techniques like value stream mapping and 5S (Sort, Set in Order, Shine, Standardize, Sustain). Translating it to a healthcare setting, it aims to create maximum value for patients by reducing waste and waits. This involves identifying and removing activities that don't add value, such as:

• Defects (errors in processes or treatment)
• Overproduction (doing more than what the patient needs)
• Waiting (time spent waiting for appointments, tests, or treatment)
• Non-utilised talent (not fully using team members skills and knowledge)
• Transportation (unnecessary movement of patients, staff, or equipment)
• Inventory (excessive supplies that tie up resources)
• Motion (unnecessary movement of staff)
• Extra-processing (doing more work than is necessary)

Why it works

Lean helps streamline processes, reduce costs, improve efficiency, and ultimately enhance patient experience.

Case study

Seattle Children's Hospital implemented Lean methodology to empower faculty and staff with end-to-end solutions based on the philosophy that those closest to the work should improve it, striving to make the right thing the easy thing, and balancing customer and team experience with strong business results. By fostering a culture of continuous improvement and innovation, Seattle Children's aims to solve problems, improve outcomes, build capabilities, and create transformative solutions for both the organisation and the future of pediatric healthcare. They have continuous improvement consultants who help the entire organisation to put in practice what they’ve learnt during the workshops and share best practices across the teams.

Just as an example of their successes: their Microbiology team aimed to improve patient care by delivering quality results sooner. After implementing lean in their processes, they managed to reduce variation in culture incubation and reporting by optimising read times for when cultures are ready and reporting on the results within 18-24 hours after receiving the cultures, while they also achieved cost savings.

Read more about what Seattle Children’s Hospital have achieved so far in their journey to become the best children’s hospital and to be a nationally recognised leader in pediatric health.

Six Sigma

Six Sigma in healthcare focuses on reducing variation and defects in processes to improve patient safety, efficiency, and the overall quality of care. By rigorously identifying and eliminating the root causes of errors and inefficiencies, healthcare organisations can streamline workflows, minimise wait times, reduce medical errors, and enhance patient satisfaction.

The core of Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) methodology which provides a structured framework for solving problems and implementing sustainable solutions.

• Define: Clearly define the problem and project scope.
• Measure: Collect data to understand the current process performance.
• Analyse: Identify the root causes of the problem.
• Improve: Implement solutions to address the root causes and improve process performance.
• Control: Establish controls to sustain the improvements over time.

Why it works

Six Sigma is excellent for tackling complex problems with measurable outcomes. It relies heavily on statistical analysis to identify and eliminate sources of variation.

Case study

Froedtert Hospital in Milwaukee, Wisconsin, demonstrated the powerful impact of Six Sigma methodologies in improving patient safety and streamlining healthcare processes. Facing challenges with intravenous (IV) medication administration errors, the hospital initiated a Six Sigma project aimed at reducing these occurrences. By meticulously analysing the entire IV medication process, from ordering to administration, the team created a detailed process map of the twenty-two medication and identified the core factors of the high-risk areas. Through targeted interventions, such as standardised procedures, enhanced training for staff, and improved communication protocols, they were able to significantly decrease the number of IV medication errors.

The successful implementation of Six Sigma at Froedtert Hospital not only enhanced patient safety but also contributed to increased efficiency and cost savings. By minimising errors, the hospital reduced the need for corrective actions and prevented potential adverse events, ultimately leading to better patient outcomes and a more reliable medication delivery system.

Total Quality Management (TQM)

Total Quality Management (TQM) in healthcare represents a comprehensive and integrated approach to improving patient outcomes, enhancing efficiency, and reducing costs. It emphasises a patient-centred philosophy and focuses on continuously improving all processes and systems within a healthcare organisation to meet or exceed patient expectations. This holistic approach aims to eliminate errors, reduce waste, and foster a culture of quality throughout the entire organisation.

The implementation of TQM in healthcare involves various methodologies and tools:

• Lean principles
• Six Sigma
• Plan-Do-Study-Act (PDSA) cycles

Success with TQM requires strong leadership commitment, a clear understanding of patient needs, and a willingness to embrace change and innovation.

Why it works

TQM is highly effective in healthcare because it fosters a culture of continuous improvement focused on delivering the best possible patient outcomes. By empowering all staff members to identify and address areas for improvement, TQM promotes a proactive approach to problem-solving and reduces medical errors.

Kaizen (Continuous Improvement)

Kaizen, a Japanese term meaning "change for better" or continuous improvement, is a powerful methodology which can be applied to healthcare settings to optimise processes, enhance patient care, and improve efficiency. By empowering frontline staff to identify and implement small, incremental changes, Kaizen fosters a culture of ownership and continuous learning. This involves regular assessment of workflows, identification of bottlenecks and inefficiencies, and collaborative brainstorming to develop and test solutions. The focus isn't on radical, disruptive overhauls, but rather on consistently refining existing practices to eliminate waste, reduce errors, and enhance the overall patient experience.

The success of Kaizen in healthcare stems from its core principles of inclusivity, data-driven decision making, and a relentless pursuit of perfection. Engaging all levels of staff, from doctors and nurses to administrative personnel, ensures diverse perspectives are considered and buy-in is maximised. Measuring the impact of changes through data allows for objective evaluation and ensures that improvements are truly effective.

Why it works

The iterative nature of Kaizen allows for continuous learning and adaptation, enabling healthcare organisations to remain agile and responsive to evolving patient needs and emerging challenges within the dynamic healthcare landscape.

Clinical microsystems

Clinical microsystems represent small, interdependent teams of healthcare professionals working together regularly to provide care to a specific group of patients. These teams, often consisting of physicians, nurses, pharmacists, and other allied health professionals, directly interact with patients and their families, focusing on continuous improvement within their defined scope of service. Examples include a specific unit within a hospital, a primary care practice, or a specialised outpatient clinic.

The strength of a healthcare system is directly tied to the effectiveness and efficiency of these microsystems, as they are the point of contact where the patient experience is shaped and where the majority of healthcare processes occur.

This improvement methodology uses the 5P assessment (purpose, patients, professionals, processes, and patterns) to actively involve the microsystem team to build understanding and ownership.

Why it works

Clinical microsystems empower frontline staff to identify problems, implement solutions, and track their impact, fostering a culture of innovation and responsiveness to patient needs. Regular feedback loops, shared learning opportunities, and a focus on teamwork allow for rapid adaptation and standardisation of best practices.

Experience-Based Co-Design (EBCD)

Experience-based co-design (EBCD) is a collaborative approach to improving healthcare services by directly involving patients, their families, and staff in the design process. It centers around understanding the lived experiences of these individuals, capturing their emotional journeys, and identifying key areas for improvement.

Through in-depth interviews, observation, and storytelling, EBCD seeks to uncover the often unspoken needs and frustrations that contribute to a negative healthcare experience. This rich qualitative data is then analysed and shared, often through engaging video narratives, to create a shared understanding of the patient and staff perspective amongst all stakeholders involved in designing improved services, and to allow targeted interventions that can significantly improve patient satisfaction, staff morale, and ultimately, the quality of care provided.

Why it works

The power of EBCD lies in its ability to move beyond assumptions and traditional service improvement methods that often rely on aggregate data or expert opinions. By actively involving those who use and deliver services in the co-design process, it ensures that solutions are truly patient-centered and address the nuances of real-world challenges.

Virginia Mason Production System (VMPS)

The Virginia Mason Production System is a lean management methodology based on the principles of the Toyota Production System (TPS), developed by the Virginia Mason Medical Center. It emphasises a relentless pursuit of perfection through continuous improvement, driven by a strong culture of respect for people and a focus on delivering value to the patient. VMPS relies on tools like value stream mapping, 5S, and standardised work to eliminate waste, improve efficiency, and enhance patient safety and quality of care.

At its core, the Virginia Mason Production System aims to create a lean healthcare environment where every process adds value directly to the patient experience. By standardising processes and eliminating waste, VMPS reduces errors, shortens wait times, and improves overall patient satisfaction.

This methodology is deeply embedded within the organisation's culture, with leadership actively participating in and promoting the principles of continuous improvement. The system's success is demonstrated by Virginia Mason's consistent recognition for high-quality care and its role as a model for other healthcare organisations seeking to implement lean principles.

Why it works

VMPS is not just a methodology but an organisational philosophy that can affect the entire organisation to promote a culture of continuous improvement, reduce errors and waste, and enhance patient experience.

Case studies

Virginia Mason addressed the issue with Emergency Departments boarding by relocating their ED to a more efficient space, a decision informed by multiple process improvement initiatives, including a 3P event to design a new space.

By adopting the Virginia Mason Production System (VMPS), they have successfully implemented numerous enhancements arising from kaizen events, including direct bedding protocols and a strategy to have providers assess suitable patients directly in the triage area during peak periods.

This triage strategy employs standardised clinical assessment tools to rapidly identify and categorize patients based on the complexity of their needs. Patients requiring minimal intervention receive prompt treatment and are discharged directly from triage, freeing up inpatient beds for those requiring more comprehensive care.

Choosing the right methodology

Let’s start with stressing that one single method is not necessarily better than another, with their strengths lying in different areas. So, the best improvement methodology for your healthcare organisation will depend on your specific goals, challenges, and resources.

Consider these factors when making your decision:

• The nature of the problem - some improvement methodologies are better suited for specific types of problems.
• Organisational culture - choose a methodology that aligns with your organization's values and culture.
• Available resources - consider the time, budget, and expertise required to implement each methodology.

Read more about how to choose the right improvement method.

Conclusion

Enhancing your healthcare improvement program requires a commitment to structured improvement methodologies. By understanding and implementing approaches like the Model for Improvement, Lean or Six Sigma, you can drive significant and lasting improvements in patient outcomes, operational efficiency, and overall quality of care.

Start with the improvement methodology that best fits your organisation and begin your journey toward providing exceptional healthcare services. Good luck!