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How to start continuous quality improvement in healthcare?

Updated at: 15 June 2020
Quality management platform

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In order to continuously work on quality improvement, it is important not to see quality as a project, but as an integral part of the operational management, based on the mission to deliver quality. Everything can always be better!

continuous quality improvement

From your own mission and vision it is important to want to work intrinsically motivated on the quality of your product or services. If you know what the quality characteristics are for your organization and what their indicators are for practice, you can choose an instrument or adjust one yourself to measure the results and satisfaction. You can then immediately initiate improvement actions with, for example, the Deming Plan-Do-Check-Act circle.


The most important basis for quality management was laid by the American former mathematics teacher Dr. W. Edwards Deming (1900-1993). He was one of the most influential people in the field of quality management or quality assurance after the Second World War. When you think of Deming, you think of the famous process diagram of Plan-Do-Check-Act. With this model he underlined the importance of leading continuous improvement instead of constantly changing an organization. The Japanese economy and Ford car factories have undergone the most important developments under his name and with this tool.

As a care provider you can sometimes compete on price, but especially in the areas of quality, working conditions, environment and safety. It is not only the creation of safe and responsible care that is important, but also to maintain and continuously improve are important pillars. But how exactly do you do that?

The Deming process diagram shows four activities that apply to all improvements in organizations and must ensure better quality. The cyclical nature emphasizes that quality improvement must be a continuous process that requires continuous attention.

The four steps according to the PDCA cycle are:

  1. PLAN: Look at current work and design a plan for the improvement of this work. Set objectives for this improvement.
  2. DO: Perform the planned improvement in a controlled test set-up.
  3. CHECK: Measure the result of the improvement and compare it with the original situation and test it against the set objectives.
  4. ACT: Adjust based on the results found at CHECK.

A unified quality management

To continuously improve quality, the quality policy must be an integral part of your mission. It must be part of the thinking pattern of all those involved within the healthcare organization. Knowing and applying the principles of integral quality assurance is therefore important at all levels, so that the same principles apply within every process, sub-process or department.

Affinity with quality in the workplace

When we take a production company as an example, quality thinking starts with the first idea of the products. To begin with, the specifications, the design, the production and ultimately the distribution. Every mistake that is made within one of the sub-processes will ultimately reach the customers. That is why it is of great importance that attention is paid to the quality of the product within every process step or sub-process. Every mistake made can have a negative impact on the final product. All the more important to identify the errors through a notification, so that it can be analyzed where the error occurred in the process. It's a great opportunity to improve the process and therefore quality. This also shows the importance of quality thinking at all levels of the organization. As soon as employees look at processes with these “quality mindset”, they have absolute added value for identifying and reporting errors, so that continuous improvement can be done every day.

It is of great importance that attention is paid to the quality of your service within every process step or sub-process, so that there is continuous attention for improvement.

This example can, of course, be directly applied to the quality of care, because in all sectors work must be carried out in accordance with the applicable quality and safety standards in order to achieve the desired end result. It is also important to guarantee quality and to continuously improve it in every process step. In healthcare, the way of work is based on protocols and quality frameworks set by, for example, professional associations and inspectorates. Here too, the standards must be maintained and evaluated on the basis of the outcomes of care. As soon as (near) incidents are reported, processes are analyzed to assess what caused an incident to occur. Based on this analysis, improvement actions can be used to guarantee quality and safety.

Quality is not a project

Regular measurement moments with all customer groups can provide valuable information. Therefore choose a method in which the customer groups are represented (such as improvement teams) and communicate regularly about progress, outcomes and successes. This increases the involvement of everyone in the organization, so that it is also supported within all departments and at all levels. For improvement teams to be successful, it is important to support them in terms of training, time and involvement in the work that contributes to quality improvement.

Some measuring instruments for measuring quality include internal and external audits, satisfaction surveys, complaints and incidents.

Culture of continuous improvements

Work can be done at any level to achieve results and improvement goals. By including quality and safety as important core values in the strategy plan at organization and department level, every department can manage quality by:

  • an A3 with a strategy plan according to the EFQM model below in which the mission and the vision, goals and desired results in all organizational areas are made transparent;
  • Distribute annual plans at department and organization level, so that every employee knows what the organization stands for;

EFQM modelFigure 1: EFQM model

  • describe the result areas with the desired results with the corresponding indicators (see figure 1) and discuss and evaluate quarterly which improvement actions should be taken;
  • include improvement actions in improvement plans, whereby an employee is made responsible for progress and feedback on this;
  • having progress feedback regularly discussed in work meetings;
  • include improvement actions in annual plans.

In this way you create a culture of continuous improvement and you can actively manage healthcare quality.

Read more about how to improve quality in healthcare.

How to make the business case for a quality management system?

Is your organisation about to transition from a paper-based to a digital workplace? Or does the organisation already have a digital quality management system, but wants to replace it? In both cases it is advisable to develop a business case. 

The business case describes the purpose of the project and provides insight into costs and benefits. A clear business case ensures involvement and improves the chances of successful implementation.

Do you want to know more about writing a business case for a digital quality management system? Download the ebook ‘Digital Quality Management System, the internal business case’.