Techniques for Improving the Quality of Care

Objective of Section

To understand the basic framework for quality improvement: the Model for Improvement, Lean, and Six Sigma methods as well as key tactics to create change.


Transformation implies a change in the status quo with the goal of improving existing structures and processes for better outcomes. Health care practices that are on the journey of transformation are aware that change is difficult and must be managed while continuing the daily operations of patient-care activities. It is important for individuals to approach transformation the same way they approach quality improvement. A strong commitment to—and focus on—adapting to an environment often requires adjustments in workflow, teamwork, patient engagement, and information systems that can lead to better outcomes.

Health care practices attempting transformation and quality improvement can accelerate their efforts if they have a shared model for the future, both in the short and in the long term. The predominant model for diabetes delivery occurs within the context of the patient centered medical home and neighborhood, with the chronic care model serving as the foundation.

Health care practices that understand how to create change will be the practices that continue to move closer to the idealized, future, and transformed state. There are multiple models for improvement, such as the Institute for Healthcare Improvement (IHI) Model for Improvement, Lean, and Six Sigma, which are discussed below.

This section also addresses specific quality improvement tools and tactics that have successfully improved outcomes.