Quality Improvement Cycle

The term quality improvement cycle has been used throughout the literature in a variety of ways. It is sometimes used in a general sense, for example, to represent a never-ending cycle of experimentation and continuous improvement. The term has also been used in a specific sense, to translate the well-known plan-do-study (or check)-act cycle (PDSA) into operations. Similarly, the term has been used to describe the circular and continuous flow of the PDSA cycle, a model frequently used in the health services arena to help quality improvement teams move through a step-by-step quality improvement process.

In its broadest sense, the quality improvement cycle symbolizes the continuous movement of the quality process and the belief that quality cannot be achieved merely by implementing a series of projects with a discrete beginning and ending. The concept of continuous quality improvement has been introduced and shaped by a succession of thinkers including Walter Shewart, W. Edwards Deming, Joseph Juran, Philip Crosby, and Armand Feigenbaum. It has been applied to the field of health care by several scholars, most notably Donald Berwick.

The significance of the continuous improvement cycle, and the importance of planning to the total process, is illustrated by Juran when he discusses a manager who is up to his waist in alligators. The manager's attempts to slay the alligators one by one are analogous to a project-by-project quality improvement approach. This approach, although common, is not satisfactory, because more and more alligators will simply emerge from the swamp. Juran instead suggests it is best to begin by establishing the vision and then the policies and goals of the organization. To convert the goals into results (“making quality happen”), he promotes the use of three basic managerial processes: quality planning, quality control, and quality improvement. In the planning stage, planners identify their customers and the needs of their customers. They then develop product and process designs to respond to those needs and, finally, turn the plans over to the operating forces. During the quality control stage, actual performance is evaluated and compared with quality goals. Managers then act on the difference. In the quality improvement stage, improvement projects are identified, controls are established to hold the gains, and a permanent infrastructure is established to hold the gains.