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Quality Improvement in Healthcare: A Discussion of Principles

With patients’ lives at stake, you would think that the healthcare industry would be in the forefront of using business efficiency principles to improve the quality of products and services. Unfortunately, this logical thought is wrong. There is more to quality improvement in healthcare than just telling everyone to be better.

For about 75 years, numerous industries have applied the principles of business effectiveness devised by W. Edwards Deming, who is best known for helping Japan's industries rebuild after World War II. His principles spurred industries to devise systems that focused more on improving the productivity of teams of workers than individuals, measured performance and got the right data in the right format at the right time in the right hands. We will list and discuss the principles below:

Principles of Quality Improvement in Healthcare

Principles of quality improvement in healthcare is an ongoing process. A variety of principles or methods exist in the hopes of improving healthcare. Additionally, many groups are taking steps to implement quality improvement principles that have been successful in other industries, such as those that helped the auto industry thrive. Those principles, called the Deming principles, may apply to healthcare as well. In all instances, the goal is quite simply to take steps to improve all aspects of the healthcare industry in terms of methodology and patient care.

Focusing on Quality Improvement
Quality Improvement, according to the US Department of Health and Human Services, Health Resources and Services Administration, involves the systematic and continues actions that are taken and lead to measurable improvement within the health status of patients or within health care services in general. Principles explain how things are done. Improving principles of quality improvement in healthcare can only better everyone involved.

Manage Complex Challenges Through Process Management
The development of these principles stems from the need to deal with complex challenges. Through the use of process management, it's possible to break down complex components to find a simple, but highly effective solution. Process management is applicable to most industries, including healthcare, though it is rarely put into place in this area. In short, healthcare is a mass of interconnected links, as Health Catalyst states. When process management is applied, it breaks down these complex components into smaller, easier-to-manage bits.

Changes Must Be Measurable
To be effective and possible, quality improvement must stem from a place of measurement. That is, if it cannot be measured by data, it cannot be improved upon in this manner. With data, virtually any problem can be overcome and any method improved, without it, there is no way forward.

Focus on the Management of Process
As the National Institutes of Health point out, the focus of any quality improvement in healthcare must focus on the process. More specifically, it is not about managing nurses or doctors. It means managing the process of care. Rather than telling doctors what to do, it is best to approach managing care through clinicians, who better understand the processes.

Healthcare Improvement Means Access to Information That's Fresh
A key component of improving healthcare quality is ensuring data is available. However, it is also important to have up-to-date and accurate data. That's because, as the World Health Organization notes, systematic quality approaches rely on access to up-to-date data. The right data must be available. Additionally, that data needs to be used in the right manner at the right time. And, it has to be given to the right hands to make it actionable. In most cases, clinicians need this information to operate and improve any component of the care process.

Outline the Specific Goals
Another principle that's valuable focuses on the actual goal of any quality improvement. In short, the health service must be delivered in the modern, updated manner. Then, there needs to be a change in health behavior and a change in health status. Ultimately, the end result is improved satisfaction in the patient. By taking a very fundamental problem within the healthcare sector and applying some level of change to it, it is possible to test and develop strategies for continuous improvement.

Utilize the Right People
For improvement to occur, the right people need to be empowered and involved throughout the process. This often comes down to clinicians being identified as the "smart cogs" as Deming points out. These are the most valuable individuals in this force of change because they understand the processes of care. They also are at the very front of the care process, providing that service to the patient, measuring the results, and gauging the change.

Ultimately, there is a need (and a growing one at that) for principles of quality improvements in healthcare. Identifying the right people, identifying the individual areas of necessary improvement, supplying data, and driving a goal-based solution may impact every component of the industry and drive successful implementation of these changes.

The Journey So Far! 

Deming believed that systems designed by management were responsible for 85 percent of an organization’s mistakes, while only 15 percent of mistakes were attributable to mistakes by employees. Applying Deming’s principles helped innumerable companies improve the quality of their products and services. The quality improvement concepts have been used to transform almost every major industry with significant results, the last industry with large amounts of data being in the healthcare realm.  

The healthcare industry has been so far behind other industries in adopting new technologies that research indicates it to be one of the final frontiers in shifting from a paper-based system to a digital communication system. It is well known that digital or electronic communication is more efficient, less costly, and more effectual in allowing doctors and patients to connect up and manage all types of care. However, many health professionals weren't able to move over to a digital system because the patient information wasn't readily accessible.

Fortunately, the healthcare industry has made more of a commitment to improving the quality of its services in recent years by adopting more business efficiency principles, including those advocated by Deming. An article found in TechTarget, explains how mobile technology such as e-mail, text messages, and other kinds of messages are used to inform doctors and other medical professionals as soon as possible that there are problems in treating patients. This means that corrective action to improve the outcomes of patients can also be implemented as soon as possible. Specifically, modern quality improvement in healthcare requires accurate, timely and readily available information through almost every phase of a quality and performance improvement initiative. 

One of Deming’s beliefs is that a company can’t improve its performance if it can’t measure it. Thus, he advocated a quality improvement system that included performance measurements. This belief can be applied to the healthcare industry, especially when focusing on the betterment of outcomes for patients.  In 2002, several organizations hired experts who produced the first “nationally standardized quality measures” for hospitals so they could quantify how successfully hospitals treated patients with acute myocardial infarction, heart failure, pneumonia, and pregnancy. By 2004, all of the USA’s accredited hospitals had to publicly report how successfully they treated at least two of these four groups of patients.


Hospitals that did not report the required information were penalized financially by the Center for Medicare and Medicaid Services. The new performance measurement and public reporting requirements dramatically improved medical care because hospitals increasingly directed resources to improve the quality of care received in their respective hospitals.

Initially, back in the 90's, it wasn't uncommon for hospitals to have performance rates that measured between 40 to 60 percent, with substantial variations throughout other hospitals. However, by 2009, hospitals had achieved very high levels of performance on many of specified measures and changed the wide variations when comparing hospitals.  Part of the substantial changes came due to mandatory reporting by all hospitals.


While performance has increased, so, too have costs. In fact, cost containment and risk of loss of reimbursements, are the primary factor driving much of the effort to institute quality improvement systems.

Quality improvement in healthcare is a major issue, but many people in the industry have made the mistake of hiring medical professionals to devise quality improvement systems. Dr. Joseph Fortuna of the American Society for Quality explains that hospitals are beginning to hire chief quality officers, which shouldn't be doctors or nurses with minimal little training. It’s no longer about the old quality assurance state of mind, but a need to understand that real quality improvement starts much farther upstream. It’s the Deming approach of doing it right the first time, and that will make the meaningful changes.