Analyzing systems and performance continually improves care

April 1, 2011

Quality improvement is a concept that has benefited by being named.

In everyday life, it often happens that something prompts assignment of a name to a general concept or category of events that didn't have a name before, and the naming helps us understand our world a little better.

Quality improvement is another concept that has benefited by being named. According to one group, quality improvement is defined as "a formal approach to the analysis of performance and systematic efforts to improve it."1

Opportunities to make systematic changes that measurably improve care now seem to be everywhere we look. And if we don't take advantage of those opportunities on our own, we are prompted to do so in our training programs, by medical boards, and in our hospitals.

Names describing concepts and categories don't stick unless they facilitate communication. A decade after To Err Is Human, every medical student and every resident (hopefully) knows that whatever the quality of the care they provide today, it's their responsibility to make sure that it's better tomorrow. That means ensuring that their own knowledge and skills continually improve, that they consider the system of care in which they work and take notice of its inefficiencies and deficiencies, and that they accept responsibility for demonstrating that their efforts to improve it really have the outcome they hope for.

Measurement was more difficult in the past than it is today because available tools-pencil and paper-were cumbersome, and data collection was difficult or even impossible. Electronic records facilitate data collection, in hospitals and in offices, and have boosted the common understanding of quality improvement as a part of our lives as medical providers.

"Quality improvement," like "distracted driving," is a name for something that, once a part of everyday discourse, seems intuitive. Today, the fact that we haven't always measured outcomes so that we could continually improve care seems unacceptable. Now that we know what it is, and now that we have the tools, we have no excuse not to improve quality.


1. Wiseman B, Kaprielian VS; Duke Center for Instructional Technology. What is quality improvement? Accessed March 28, 2011.

2. Luce JM, Bindman AB, Lee PR. A brief history of health care quality assessment and improvement in the United States. West J Med. 1994;160(3):263-268.