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Practice Essentials

How to get started in quality improvement

BMJ 2019; 364 doi: (Published 17 January 2019) Cite this as: BMJ 2019;364:k5408

Linked opinion

The benefits of QI are numerous and the challenges worth overcoming

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  1. Bryan Jones, improvement fellow1,
  2. Emma Vaux, consultant nephrologist2,
  3. Anna Olsson-Brown, research fellow3
  1. 1The Health Foundation, London, UK
  2. 2Royal Berkshire NHS Foundation Trust. Reading, UK
  3. 3Department of Molecular and Clinical Pharmacology, The Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  1. Correspondence to B Jones bryan.jones{at}

What you need to know

  • Participation in quality improvement can help clinicians and trainees improve care together and develop important professional skills

  • Effective quality improvement relies on collaborative working with colleagues and patients and the use of a structured method

  • Enthusiasm, perseverance, good project management skills, and a willingness to explain your project to others and seek their support are key skills

Quality improvement (box 1) is a core component of many undergraduate and postgraduate curriculums.12345 Numerous healthcare organisations,6 professional regulators,7 and policy makers8 recognise the benefits of training clinicians in quality improvement.

Box 1

Defining quality improvement1

  • Quality improvement aims to make a difference to patients by improving safety, effectiveness, and experience of care by:

  • Using understanding of our complex healthcare environment

  • Applying a systematic approach

  • Designing, testing, and implementing changes using real time measurement for improvement


Engaging in quality improvement enables clinicians to acquire, assimilate, and apply important professional capabilities7 such as managing complexity and training in human factors.1 For clinical trainees, it is a chance to improve care9; develop leadership, presentation, and time management skills to help their career development10; and build relationships with colleagues in organisations that they have recently joined.11 For more experienced clinicians, it is an opportunity to address longstanding concerns about the way in which care processes and systems are delivered, and to strengthen their leadership for improvement skills.12

The benefits to patients, clinicians, and healthcare providers of engaging in quality improvement are considerable, but there are many challenges involved in designing, delivering, and sustaining an improvement intervention. These range from persuading colleagues that there is a problem that needs to be tackled, through to keeping them engaged once the intervention is up and running as other clinical priorities compete for their attention.13 You are also …

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