Quality improvement
Use a clear aim, measures and small cycles of change. Watch balancing measures so improvement in one area does not harm another.
Understand
Quality improvement uses iterative changes in a local system, with outcome, process and balancing measures. It differs from simply measuring whether a standard was met.
Assess
State a specific aim, map the current process and collect a baseline. Test a small change and examine variation over time, not only one before-and-after number.
Apply
Scale changes that work and monitor for unintended effects. Share enough detail that another team can judge what was transferable.
Key distinctions
Small iterative tests can reveal whether an idea works in a particular clinic before wider rollout. A run chart shows change over time more clearly than a single pair of averages. Balancing measures capture adverse effects such as extra workload or delay elsewhere. Improvement should be sustained and reproducible, with the local context documented for others.
Think through a case
A team tests a new reminder process and missed appointments fall, but staff workload rises markedly. A balancing measure makes the trade-off visible.
The distinction to remember
Do not scale a change on one favourable before-and-after point without checking variation and unintended effects.
Test your recall
What does a balancing measure detect?
Show answer
Unintended consequences of a change.