Principles of QI

Quality is directly linked to an organization's service delivery approach or underlying systems of care. To achieve a different level of performance (i.e., results) and improve quality, an organisation's current system needs to change. While each QI program may appear different, a successful program always incorporates the following four key principles*:

  • QI work as systems and processes

  • Focus on patients

  • Focus on being part of the team

  • Focus on use of the data

*Advances in Quality Improvement: Principles and Framework, Spring 2001 issue of the Quality Assurance Project's QA Brief

QI Work as Systems and Processes

To make improvements, an organisation needs to understand its own delivery system and key processes. The concepts behind the QI approaches recognise that both resources (inputs) and activities carried out (processes) are addressed together to ensure or improve quality of care (outputs/ outcomes).

Activities or processes within a health care organization contain two major components:

1) what is done (what care is provided)

2) how it is done (when, where, and by whom care is delivered)

Improvement can be achieved by addressing either component; however, the greatest impact for QI is when both are addressed at the same time.

QI can use a variety of tools such as Audit, the Plan-Do-Study-Act (PDSA) cycles and LEAN methodology without the rigid restrictions often imposed by Clinical Audit. 


*  The Life QI system is an on-line resource to support quality improvement work provided by the South West Academic Health Science Network. It is free to use for any medical staff in the South West – to get registered and start using it log on click here.

*  Institute for Healthcare Improvement

*  iTorch:

*  RCP London:

*  BMJ Quality:

  • Sign up for a BMJ Quality license to work through the project and publish it at the end -                                                                 Contact Dr Wai Tse to request the application form for access to a licence purchased by HESW

*  NHS Improvement

*  Royal Devon & Exeter Hospitals NHS Trust - Service Development Toolkit

*  The Horizon Institute, Torbay

*  12 week plan model

*  The Cumberland Initiative

*  Do it yourself - search key terms: 'PDSA cycle', 'QI vs Audit', 'Process mapping', 'Run charts'

*  Publications in Patient Safety and Quality Improvement:

  • Human error:  modules and management (James Reason: 2000)

  • Implementing human factors in healthcare (Carthey: 2010)

  • The measurement and monitoring of safety (Vincent, The Health Foundation; 2013)

  • Review into the quality of care and treatment provided by 14 hospital Trusts in England: overview report (Keogh; 2013)

  • Benwick review into patient safety (Multiple publications; 2013)

 Useful References and Links

*  Institute for Healthcare Improvement

*  School for Health and Care Radicals