Intended for healthcare professionals


How to move beyond quality improvement projects

BMJ 2020; 370 doi: (Published 27 July 2020) Cite this as: BMJ 2020;370:m2319
  1. Amar Shah, chief quality officer, East London NHS Foundation Trust; national improvement lead for the Mental Health Safety Improvement Programme, NHS Improvement and RCPsych; quality improvement lead and chair of QI faculty, Royal College of Psychiatrists
  1. East London NHS Foundation Trust, London, E1 8DE, UK
  1. amarshah{at}, Twitter: @DrAmarShah

What you need to know

  • Quality improvement, by itself, does not represent a holistic approach to managing quality

  • Quality improvement needs to be used alongside quality planning, quality assurance, and quality control to create a single, consistent management system

  • Knowing when and how to use each of these four approaches, and creating an appropriate balance across all four, is the gold standard

In recent years we have seen a proliferation in the interest and use of quality improvement in health and healthcare. This represents a promising shift in our mental models about how to solve some of our most complex quality issues. Alongside the increasing use of the word “improvement” in our everyday language within healthcare, there are differences in understanding of what exactly we mean by the term “quality improvement.” This article explores the difference between quality improvement and a quality management system, by defining quality improvement and describing how to best use quality improvement alongside control, assurance, and planning as part of a more holistic management system focused on quality.

Is quality improvement the same as improving quality?

Quality improvement should be seen as part of an overall system of quality management. Quality improvement is a systematic and applied approach to solving a complex issue, through testing and learning, measuring as you go, and deeply involving those closest to the issue in the improvement process.1 Anyone who has undertaken quality improvement work will testify that it is not easy—you are generally tackling a problem to which we do not know the solution, and where part of the answer is about behaviours, and hearts and minds. Quality improvement can be used to reduce unwarranted variation, reliably implement interventions that have been shown to improve outcomes, or discover new solutions through a process of innovation. As we are looking to learn whether a particular service or issue has improved, the process also …

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