QI Framework

Part 1: Fundamental Questions

Three fundamental questions that are essential for guiding improvement work:

What are we trying to accomplish?

An organization's response to this question helps to clarify which improvements it should target and their desired results.

How will we know that a change is an improvement?

Actual improvement can only be proven through measurement. An organization should think about how it wants things to be different when it has implemented a change and agree on what data needs to be collected for measuring. A measurable outcome that demonstrates movement toward the desired result is considered an improvement. For example, showing how the service that patients receive will improve, or how an organization’s processes might change.

What changes can we make that will result in improvement?

Improvement occurs only when a change is implemented, but not all changes result in improvement. One way to identify which change will result in improvement is to test the change before implementing it.

Part 2: PDSA Cycles

Part 2 involves the Plan-Do-Study-Act (PDSA) cycle that tests and implements a change in real-work settings. One of the most common tools for improvement is the Deming (or Shewhart) Cycle. This method is also known as Plan-Do-Study-Act (PDSA) and it is well suited for many improvement projects. The PDSA cycle is shorthand for testing a change — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.

The use of multiple test cycles helps an organization improve upon each test of change. Most system changes require more than one PDSA cycle.

Adapted from Testing for Improvement, US Department of Health and Human Services, Health Resources and Services Administration. April 2011