Which quality improvement method should I use?

Picture of Andrew Lavender

Published on 25 May 2020 at 13:24

by Andrew Lavender

Which QI Method - 01


If you are reading this, perhaps you’ve identified something in your department or hospital that frustrates you – a process, a clinical care issue or perhaps a simple inefficiency. You’re probably wondering what you do next to act on that frustration and make an improvement.  If it’s a simple issue, with an obvious solution that you can control, you might just go ahead and make a change, knowing that improvement will follow.  However, most issues are more complex – they may have several driving forces, multiple potential solutions and need to work across teams of disciplines.  In this case, you will want to formalise your improvement process, adopting a proven method for delivering improvement.


What is QI methodology?

When investigating QI methods, it is important to appreciate that improvement is more than just a process to follow. Any of the methods discussed here can give results when used to address a specific problem, but sustaining and scaling improvement in an organisation requires a more holistic outlook.  Improvement is most effective when is becomes part of everyday life and central to the core values of an organisation – this is often referred to as a “culture of continuous improvement”.


Running any number of improvement projects can have a positive effect on outcomes, but these are unlikely to be sustained and scaled if the approach is not embraced by the whole organisation. This requires commitment at all levels of the organisation especially leadership, and for improvement to become a way of thinking for all staff.


If you are considering how you build a culture of improvement at your organisation and which methodology or way of thinking to use as a basis for that, you can read more about that here.


Common Improvement Methods

Depending on the type and scale of the problem you might like to consider some different techniques to increase your chances of success. Each of the main improvement methods strive for sustained change through defining clear goals, using structured processes and maximising the use of data. We have summarised those below and in the linked articles…


  • Model for Improvement (MFI) – a cyclical improvement process using the well known PDSA cycle. Widely used in healthcare by many leading organisations.
  • Lean – a method for streamlining processes to deliver maximum value to patients. This is increasingly common in healthcare.
  • Six Sigma – a data-driven approach that strives to eliminate (or at least significantly decrease) variation and defects. This is less commonly applied in healthcare, but can be beneficial in some situations.

Due to the common underlying philosophies of all improvement methods, these approaches are not always mutually exclusive.  For example, elements of Lean and Six Sigma are often combined into the hybrid approach of Lean Six Sigma.


Comparing the main improvement methods

Improvement methods have origins in very different settings, from Japanese car factories to American telecommunications to consultants and innovators. Each method has differences in approach and application, normally stemming from the differing focus of the methods.


Having said that, they have much in common. All models arise from pragmatic philosophies, are based on scientific method and have been proven to deliver continuous and sustained improvements in multiple settings. Some common characteristics between all models are…

  1. Clearly defined goals
  2. Structured approaches to follow
  3. Data driven (to varying degrees)
  4. Uses tools to break down problems and establish priorities
  5. Focus on outcomes for patients

The table below shows how the main improvement methods stack up against each other and highlights some of the fundamental differences.


Click image to open table.


spreadsheet image - 01-1


Improvement Tools

The tools used in QI projects are generally not exclusive to the method followed, although some tools are synonymous with particular methods (e.g. Kaizen with Lean).


MfI puts one tool at the center of it approach – the PDSA cycle.  Tools such as the Key Driver Diagram are also popular in this approach.


Lean uses a variety of tools for different situations – since the focus is improving flow, Value Stream Maps are fundamental to most Lean initiatives.


Six Sigma has a strong focus on root cause analysis, and therefore tools such as Pareto Charts and 5-Whys are common.


All methods use measurement tools, including Statistical Process Control (SPC)


Which method should I use?

The choice of which improvement method to use can, in some cases, be divisive and individuals (or organisations) often have their own preferences.  No one method is necessarily better than another, and their strengths lie in different areas – as highlighted in the table.


Assuming you have a blank canvas to try the approach most suited to your particular problem these guidelines should help….


The Model for Improvement could be a good choice when a process or system needs changing, or a new one is to be introduced, for measurable quality improvement. Through small tests of change (using PDSA), the process is iterative and incremental – making it easier to see the results of change and increase confidence in their effectiveness. It is scalable and simple for anyone to apply.


Lean could be a good choice when healthcare systems are inefficient, flow poorly or are wasteful. It is particularly well suited to projects where patient flow is sub-optimal, leading to a poor patient experience. Lean cycles can be rapid, or long term and can vary in complexity.


Six Sigma Could be a good choice when there are obvious inconsistencies in quality of care and zero-tolerance to mistakes is required. This makes it well suited to reducing things like medical errors. The process can be long, but the results can be excellent. Unlike other methods, Six Sigma does not encourage incremental improvements but focusses on getting it right once.



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