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Session 1: Introduction to Quality Improvement

The session is an introduction to QI through reading materials and completion of an interactive online module.  QI will be defined along with the processes that drive QI.  Specifically, the PDSA (Plan, Do, Study, Act) cycle, a systematic approach used to engage in a QI process, is emphasized.  Several tools, such as the fishbone diagram, are introduced.  Additionally, the membership, structure, and leadership support required for a QI team are analyzed.

PREPARATION: The readings and online module are to be completed at the learner’s desired pace, but prior to engagement in the active learning section.

Read: What is Quality Improvement?

Developed by the Health Resources and Services Administration, U.S. Department of Health and Human Services

Within this webpage:

Review: Donabedian Model

Read Section A slides (end at slide 23)

PowerPoint developed by Johns Hopkins School of Public Health

Read: Adapting Quality Improvement to Public Health (Pages 1-5)

Developed by the Robert Wood Johnson Foundation

Watch: CQI in Public Health: The Fundamentals

Developed by the Ohio State University College of Public Health

Click here to REGISTER. Allow a minimum of 48 hours for confirmation of registration for the module. Click here for more information on the registration process.

Read: Achieving and Maintaining Quality Performance

From the Community Tool Box developed at the University of Kansas.

ACTIVE LEARNING:  The preparation section provides a foundation for QI.  The following active learning section suggests questions and issues to promote application of information learned during the preparation section.  Topic areas for active learning are each bulleted and shown in bolded font.  Questions to ask are italicized.

Materials Needed for Group Discussions: White board or easel paper, markers

  • Definition of QI.

How do you define quality improvement without using the words “quality” or “improvement?”

What words do you use to define quality? What words would you use to define a quality MCH trainee or a quality staff person? Take 1 minute to write an exhaustive list of all words used to define quality in general or quality in relationship to something specific, such as an MCH trainee or staff person.

If in a group setting, gather the exhaustive list made by each individual to develop a word cloud using an online program, such as Wordle. Words that are repeated by participants are a larger font size in a word cloud, indicating similarities of how quality is defined.

  • Why is QI Important?

Why is there a focus on quality improvement within government organizations, such as the Maternal and Child Health Bureau or official health agencies?

  • QI Tools

Several QI tools were introduced during the preparation component. One tool, the fishbone diagram, can be used to uncover the causes of a particular effect. Draw a fishbone diagram on a board or easel paper (see example below). As an individual or collectively, determine an effect to analyze, such as the lack of influence on Title-V policy from MCH Trainees. Examine causes, classified into the inputs of people, equipment, materials, methods, and environment, related to the effect. Brainstorm causes of the effect based on each input.

For example

Once an effect is identified:

What are causes of the effect that are people inputs?

What are causes of the effect that are equipment inputs?

…..materials inputs?

…..methods inputs?

…..environment inputs?
Fishbone diagram

Select one of the causes (fish bones) and use the “5 Whys” to uncover the root cause of the selected cause from the fishbone diagram. For example, each immediate cause has a preceding cause, which was caused by something else.

Cause #5 —>Cause #4 —>Cause #3 —>Cause #2 —>Cause #1 —>Effect

State Effect. Why?

State Cause #1. Why?

State Cause #2. Why?

State Cause #3. Why?

State Cause #4. Why?

The fishbone diagram is one tool to present data; however, several others are available, such as a flow chart, run chart, histogram, pareto chart, scatter diagram, or control diagram.

Think of a particular audience that would perhaps use a different tool to present the data. Of the tools presented in the preparation section, such as a flow chart or scatter diagram, which ones would be more appropriate for a particular audience? Less appropriate?

What would be the best way to present data or outcomes from a QI process to the Maternal and Child Health Bureau? Title-V program director? Faculty or trainees from a training program? Child with special health care needs? A parent?

  • Definition of Team

Consider a QI team charged with increasing diversity among new hires in an organization.

Who should be on the team? What would be included in the team charter? What time and resources are needed?

  • Wrap-up

QI can be applied broadly to health care, public health, agriculture, and manufacturing. Regardless of what sector or setting, QI is a continuous process, but how this process is maintained over time is challenging.

What is the culture of quality that has been built within your organization or where you work?
Look to the next 5-years. What can be done to maintain the “culture of quality” that has been established?


This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number T79MC09805, Leadership Education in Maternal and Child Health Nutrition, $176,795, 50% funded by the University of Tennessee, Department of Nutrition. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.