Completing a Quality Improvement Project

Whether you’re a seasoned quality improvement (QI) practitioner or just getting started, understanding the fundamentals is key. If you’re new to the concept, delving into resources from the BMJ Open Quality journal/website ( provide a solid foundation. This guide outlines the benefits of quality improvement and what’s necessary for systemic change.


Understanding Quality in Healthcare:

Quality in healthcare can be multifaceted, encompassing dimensions such as safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. Reflect on your team’s practices and consider where improvements could be made. Brainstorm with your team to identify areas for enhancement, whether related to structural factors, process inefficiencies, or desired outcomes. Leveraging feedback from recent adverse events, complaints, or positive patient experiences can also inform your improvement efforts.


Consider Your Context:

Every healthcare setting has its unique challenges and priorities. Aligning your QI project with your organization’s transformation initiatives can facilitate support and sustainability. Look into local priorities, such as reducing pressure ulcers or improving hand hygiene compliance, and integrate your project accordingly. Additionally, explore national initiatives and guidelines, patient stories, and quality standards to inform your project’s direction.


Choose Your Improvement Model:

Various improvement models exist, each with its strengths. While this guide primarily follows the Model for Improvement framework, you may find other approaches better suited to your context. The Model for Improvement poses three fundamental questions: what are we trying to accomplish, how will we know change is an improvement, and what changes can we make to achieve improvement? Even if you opt for a different methodology, framing your project around these questions can be beneficial.


Define the Problem:

Once you’ve identified your project’s focus, delineate its scope and set SMART (Specific, Measurable, Achievable, Relevant, Timely) aims. These clear objectives serve as guiding principles throughout your project, ensuring clarity and alignment with desired outcomes. Your aims should address the identified problem directly and be feasible within your resource constraints.


Background Research:

Thorough background research is essential for understanding the problem’s context and potential solutions. Dive into existing literature and local data to build a compelling case for change. Consider the evidence supporting your problem statement, previous attempts to address similar issues, and lessons learned from both successes and failures.



Establishing robust measurement strategies allows you to gauge the impact of your interventions accurately. Identify relevant structure, process, and outcome measures aligned with your aims. Ensure your measures are practical, reliable, and sensitive to change. Continuous data collection and analysis enable ongoing evaluation and inform iterative improvements.


Ready to Go:

With your groundwork laid, assemble your project team, stakeholders, and resources. Engage key players, including patients, and secure support from mentors and sponsors. Develop a project charter to crystallize your goals and guide subsequent actions. Address ethical considerations and ensure compliance with relevant regulations before proceeding.



Plan for sustainability from the project’s outset, considering factors such as process integration, staff engagement, and organizational alignment. The NHS sustainability model provides a useful framework for assessing and bolstering sustainability across process, staff, and organizational dimensions. Anticipate challenges and proactively mitigate them to maintain long-term improvements.


Process Mapping:

Understanding the intricacies of your current processes is crucial for targeted interventions. Utilize process mapping techniques to visualize workflows, identify inefficiencies, and pinpoint areas ripe for improvement. Engage stakeholders in mapping exercises to capture diverse perspectives and foster buy-in.


Design Interventions:

Based on process insights, devise interventions aimed at addressing identified gaps and enhancing performance. Embrace simplicity, efficiency, and feasibility in intervention design. Implement small-scale tests of change, such as PDSA cycles, to iteratively refine and validate interventions before broader implementation.


Strategy Implementation:

Execute your change strategy through systematic testing and learning cycles. Embrace the PDSA methodology or alternative improvement approaches to drive iterative change. Continuously measure and analyze outcomes, adapting interventions based on real-time feedback. Document key learnings and adjust strategies accordingly.


Results Analysis:

Evaluate the impact of your interventions through rigorous data analysis and interpretation. Plot run charts or control charts to visualize trends and assess improvement over time. Consider both quantitative and qualitative measures, including balancing measures and unintended consequences. Reflect on your results relative to baseline measurements and contextual factors.


Spreading Your Intervention:

Extend the reach of your successful interventions beyond your immediate team or department. Develop a dissemination plan to share insights and strategies with relevant stakeholders across the organization. Leverage communication channels, training sessions, and peer networks to facilitate knowledge transfer and adoption.


Lessons and Limitations:

Capture insights and reflections from your QI journey to inform future endeavors and benefit others. Document lessons learned, successes, challenges, and areas for improvement. Address any limitations in your project design or execution, highlighting opportunities for refinement and adaptation. Sharing your experiences contributes to collective learning and advances the field of quality improvement in healthcare.

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