Quality Improvement Glossary of Terms

There is a wide variety and range of terminology and language used to describe quality, improvement and the science of improvement - methodologies and techniques. This can make it difficult for the learner to understand and target their specific development needs and this glossary of terms, whilst by no means extensive, is intended to clarify some of the commonly used terms.

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A3 Problem solving: A means of capturing all stages of a problem - identification, analysis, review, solution planning and project management - on one piece of A3 paper. Facilitates visual tracking of a project.

Accountability: A concept in ethics or governance, often used with concepts such as responsibility, answerability, blameworthiness, liability and other terms associated with the expectation of account-giving.

Adverse Event: Harm to structure or function of the body and/or any negative effect which arises from that.

Care bundles: A selected set of elements of care gathered from evidence-based practice guidelines that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone.

Cause and Effect diagrams (Ishikawa/Fishbone): A technique to organise and display various theories about what may be the root cause of a problem designed to encourage innovative thinking (but not solutions, only possible causes).

Checklists: Designed to improve the safety of care, for example surgical checklists, by ensuring adherence to proven standards of care; improves compliance with standards and decreases complications.

Competencies: A set of descriptors outlining the skills, knowledge and behaviours (attitudes) needed by those concerned with quality improvement.

Consent: The provision of approval or assent particularly and especially after thoughtful consideration.

Continual Professional Development (CPD): A process of ongoing learning for all individuals and teams which enables professionals to expand and fulfil their potential and which also meets the needs of patients and delivers the health and health care priorities of the national health system.

Control Charts: Control charts, also known as Shewhart charts or process-behaviour charts, in statistical process control are tools used to determine whether or not a process is in a state of statistical control.

Data for Improvement: Statistical tools and techniques to measure the impact of improvements.

Demand, Capacity, Activity, Queue (DCAQ): The process of determining the maximum amount of work that an organisation or part of an organisation is capable of completing in a given time period to meet changing demands for its products or services.

Education: A systematic course of instruction designed to provide intellectual or moral support, knowledge and understanding.

Error: Failure to carry out a planned action as intended or application of an incorrect plan.

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Failure Mode Event Analysis (FMEA): An analytical method which highlights probable failures and the severity of their consequences allowing effort to be directed where it will produce the greatest value.

Feedback: The situation when output from (or information about the result of) an event in the past will influence an occurrence of the same event in the present or future. When an event is part of a chain of cause-and-effect that forms a circuit of loop the event is said to "feed back" into itself.

Five Whys: A question-asking method used to explore the cause/effect relationships underlying a particular problem. Ultimately the goal of applying the 5 Whys method is to determine a root cause of a defect or problem.

Flow charts: A type of diagram that represents an algorithm or process showing the steps as boxes of various kinds and their order by connecting these with arrows - can give a step-by-step solution to a given problem.

For work: Learning outside the workplace intended as preparatory or complementary to the work role.  Typically conducted at the beginning of a career, it also spans learning activities throughout the working life, eg through contact with professional bodies, interest groups and external boards and committees of all kinds.

Formal learning: Generally has a set learning framework within a period of time, and is conducted in the presence or under the direction of a designated trainer or teacher.  Formal learning involves the external specification of outcomes and may lead to the award of a qualification or credit.                                  

Handover: This is the time between the last customer-focused activity by a departing team and the first customer-focused activity by an arriving team.

Hazard: A circumstance, agent or action that can lead to or increase risk.

Healthcare Associated Infection (HAI): infections that are acquired as a result of healthcare interventions.

High Reliability Organisation: An organisation that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.

Histograms: A graphical representation showing a visual impression of the distribution of data; an estimate of the probability distribution of a continuous variable. Commonly known as a bar chart.

Human Factors: the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.

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Infection Control: The discipline concerned with preventing healthcare-associated infections.

Informal Learning: Is continuous, incidental, lifelong, personal and based on experience, and is not bounded by formal parameters.

Information Technology: The application of science to the processing of data according to programmed instructions in order to derive meaning. Includes all information and all technology.

Innovation: The process by which an idea or invention is implemented in practice, resulting in a change or improvement.                                          

Leadership: The process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task.

Lean: A management philosophy centred on preserving value with less work, by reducing waste to improve overall customer satisfaction.

Lean principles:
1. Specify value
2. Identify the value stream
3. Make the process and value flow
4. Develop pull systems   
5. Pursue perfection

Learning context: interplay of all the values, beliefs, relationships, frameworks and external structures that operate within a given learning environment.

Learning organisation: organisation which places a high priority on enabling individual learning, in matters which will directly benefit the organisation. Learning and sharing of new knowledge is typically encouraged among all employees, on the assumption that active participation will result in the development of a more responsive workforce.

Learning styles
: Various approaches or ways of learning, allowing the individual to learn best, by identifying and following an identifiable method of interacting with, taking in, and processing stimuli or information.

Measures: Output measures - quality, delivery, lead time; resource measures - cost and inventory levels, stock turns; flexibility measures - customer satisfaction, reduction in back / late orders, ability to accommodate new services.

Medication error
: A preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, infection or other ailment.

Mistake-proofing (Pokayoke): A mechanism that helps avoid mistakes by preventing correcting or drawing attention to human errors as they occur, ie behaviour-shaping constraints designed to prevent errors.

Mitigating Factor: an action or circumstance that prevents or moderates the progression of an incident towards harming a patient.

Model for Improvement: An approach to process improvement which helps teams accelerate the adoption of proven and effective changes. A framework for improvement that involves asking three key questions - What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement?

Monitoring: To be aware of the state of a system; to observe a situation for any changes which may occur over time, using a measuring device of some sort.

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Occupational Knowledge: Practical knowledge and understanding mostly gained through experience within a job or occupation.

Pareto Principles: The concept that, in many situations, some 80% of the outputs will be generated by only 20% of the inputs. For example, 20% of users will make 80% of the calls to a service desk. In problem management, Pareto charts identify the areas of an organisation or process that will deliver maximum benefit when improved or when failures or weaknesses are addressed.

Person Centeredness: A focus on respect; choice; empowerment; involvement of patients, carers and staff in health policy; access and support; information.

Person Centred Healthcare: A system that is designed and delivered to directly address the healthcare needs and preferences of patients, in a cost effective manner.  To achieve patient-centred healthcare, the focus must be on the following five principles: respect; choice; empowerment; patient involvement in health policy; access and support; information.

Patient Safety: Freedom, for a patient, from unnecessary harm or potential harm associated with healthcare.

Plan-Do-Study-Act (PDSA) Cycle:  Another name for a cycle designed to test a change. The PDSA cycle includes four phases: Plan, Do, Study and Act. PDSA Cycles are small scale, reflective tests used to try out ideas for improvement.

Process Mapping
: Activities involved in defining exactly what an organisation or part of an organisation does, who is responsible, to what standard a process should be completed and how success can be determined.

Quality: Refers to the inherent or distinctive characteristics of properties of an object, process or other thing which may set apart a person or thing from other persons or things, or may denote some degree of achievement or excellence. In terms of quality improvement in healthcare, quality is about learning what you are doing and doing it better.

Rapid Improvement Events (Kaizen): Also known as Kaizens. These are a structured way of bringing together people who are involved in all parts of the process of delivering a service to allow detailed sharing of all actions undertaken (the current state) process and opportunities to define a future state and the improvement action plan needed to get there.

Reflection: Thinking about past experiences in a structured way such that future actions are informed, enabled and improved.

Reliability: In general, reliability is the ability of a person or system to perform and maintain its functions in routine circumstances, as well as hostile or unexpected circumstances. Reliability theory describes the probability of a system completing its expected function during an interval of time.

Risk assessment: An assessment of the probability that an incident will occur and the consequences.

Root Cause Analysis: A class of problem solving methods aimed at identifying the root causes of a problem or events predicated on the belief that problems are best solved by attempting to address, correct or eliminate root causes, as opposed to merely addressing the immediately obvious symptoms. By identifying measures at root cause, it is more probable that problem will not occur again.

Run charts: A run chart, also known as a run-sequence plot, is a graph that displays observed data in a time sequence. Used to show changes in a process over time.

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Safety culture: A term often used to describe the way in which safety is managed in the workplace, and often reflects "the attitudes, beliefs, perceptions and values that employees share in relation to safety".

SBAR: Situation - Background - Assessment - Recommendations - an easy to remember mechanism to frame conversations especially critical ones; enables clarification of information to be communicated between team members.

Simulation: The imitation of some real thing, state of affairs, or process; the act of simulating something generally entails representing certain key characteristics or behaviours of a selected physical or abstract system. Used in many contexts, including the modelling of natural systems, such as weather systems, in order to gain insight into their function.

6S (5S): A workplace organisation methodology drawn from Japanese roots - sort, set, shine, standardise and sustain. (Sometimes safety, security, and satisfaction are included and it is termed as 6S).

Six Sigma: Seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimising variability using statistical methods and following a defined sequence of steps (DMAIC: Define, Measure, Analyse, Improve, Control) and has quantifiable targets.

Skills Mix: The learned capacity to carry out pre-determined results often with the minimum outlay of time, energy or both. Can be divided into general skills (eg time management, teamwork etc) and domain-specific (eg those useful only to a certain job). Across any team, we need to have balanced capability of general and specific skills.

Spaghetti diagram: A means of tracking movement in a specific area for the purpose of identifying wasted activity and movement.

Spread: The intentional and methodical expansion of the number and type of people, units, or organisations using the improvements.

Standard Work: An agreed method of following a process that maximises value whilst minimising waste.

Statistical Process Control (SPC): The application of statistical methods to the monitoring and control of a process to ensure that it operates at its full potential.

Supply Chain management: The management of a network of interconnected organisations involved in the ultimate provision of product or service packages required by end-users - from point of origin to point of use.

Sustainability: The capacity to endure - the potential for long-term maintenance of well being which has environmental, economic and social dimensions.

System: A set of relationships which are differentiated from relationships of the set to other elements. Systems have structure, behaviour and interconnectivity.

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Takt time: Aims to match the pace of production with the customer's demand and thus sets the rate at which each step in the process should be completed.

Teamwork: Work performed by a team towards a common goal; advocated by agreed activities and behaviours as a means of assuring quality and safety in the delivery of services.

Teamworking: A dynamic process involving two or more colleagues with complementary backgrounds and skills sharing common goals and exercising concerted physical and mental effort in assessing, planning or evaluating service delivery.

Test: A small-scale trial of a new approach or a new process. A test is designed to learn if the change results in improvement, and to fine-tune the change to fit the organisation and patients. Tests are carried out using one or more PDSA Cycles.

Theory of Constraints (TOC): Contends that any manageable system is limited in achieving more of its goals by a small number of constraints; the TOC process seeks to identify these barriers and restructure rest of the organisation around them.

Time Out: Refers to a stoppage in a procedure for a short amount of time. This allows for team members to communicate to determine action or inspire morale. Teams usually call timeouts at strategically important points in a process to avoid members being misled or work against conflicting assumptions.

Total Productive Maintenance (TPM): A maintenance process developed for improving productivity by making processes more reliable and less wasteful.

Trigger Tools: A means of conducting rapid structured case note review to measure the rate of harm in healthcare. Because they are metric they can be used to track improvements in safety over time.                                               

Value and Waste: A process adds value by producing goods or providing a service that a customer will receive. A process consumes resources and waste occurs when more resources are used than are necessary to produce the goods/services that the customer actually wants.

Value Stream Mapping: Used to analyse the flow of materials and information currently required to bring a service to a customer/patient.

Variation: A departure from a former or normal condition or action or amount or from a standard or type and the amount by which this occurs.

Visual Management (Kanban): Also know as Kanban. Tells what to produce, when and how much. Five core properties - visualise the workflow; limit the work in progress; manage flow; make process policies explicit; improve collaboratively.

Waste: The identification of which steps in a process add value and which do not. Seven categories of resource are commonly wasted - overproduction; unnecessary transportation; inventory; motion; defects; over-processing; and waiting.

Work flow analysis: A technique for gathering information about the possible set of values calculated at various points in a work flow process. A process's flow graph is used to determine those parts of a process to which a particular value assigned to a variable might propagate. The information gathered is often used by managers when optimizing a process.

Workplace learning: Workplace learning happens as an integral component of working. This is the kind of learning that occurs as we think about what we are doing, and how we might do it better. It has been called "reflection-in-action" and it is also classified as "informal" learning - see above.

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