QI stage 1: Analysing the problem

Quality improvement (QI) is a process which first recognises the present outcomes from health care provision and then reflects on possible actions to provide a better outcomes. QI is a cyclical, ongoing process. To illustrate this, let’s consider quality improvement for a simple activity, such as baking a cake.

Quality improvement for baking a cake

Imagine you are baking a new type of cake from a recipe you have found in a magazine. You mix all the recommended ingredients and follow the recipe instructions. After baking, the cake looks perfect but when you and your children taste it, it is not very good.

You reflect on what could have gone wrong and perhaps even discuss it with other bakers who have made a similar cake. Several suggestions and questions come up:

• Add more baking powder.
• Was the type of flour appropriate?
• Did you mix the ingredients in the correct order?
• Change the temperature at which you baked the cake.

Based on your reflection and analysis, you bake the cake again and make two key changes. You follow the exact order when mixing the ingredients and you adjust the baking temperature. This results in some improvement and the family agrees that the cake tastes better. To get to the exact taste you want takes a few more adjustments and cakes. Quality improvement is attained through testing, reflecting, retesting and then implementing the practice.

Health care is much more complex than baking of course, with many people and resources involved. Implementing QI in health care needs a scientific approach to provide a framework for reflecting, developing, testing and implementing sustainable change in practice. This approach also reduces inefficiencies from random changes implemented as an impulse or immediate action.

The PDSA approach to quality improvement

In this course, we introduce Plan-Do-Study-Act (PDSA) as a method for implementing quality improvement in ROP prevention and management. We explore the key steps of the PDSA cycles and provide opportunities to read and critically appraise case studies of PDSA being applied. The aim is to familiarise you with the PDSA approach and enable you to undertake quality improvement in your own setting.

Throughout the PDSA cycles frame your questions around:

• What are we trying to achieve?
• How will we know if the change is an improvement? What measures of success will we use?
• What changes can we make that will result in improvement? The ‘change concepts’ to be tested.

Watch the video on this step to learn more about the processes used to answer the first question above and who needs to be involved. As you watch, consider:

• How is quality of care provision assessment and managed in your setting?
• Is there an active process taken to guide the team on what is essential and feasible to improve care of the preterm baby to prevent retinopathy of prematurity?

Next week, we will explore how a QI team undertakes PDSA cycles to test a selected intervention for the identified problem.