Table 1

Quality improvement taxonomy

QI strategyDefinitionExample methodsSurgical examples
Articles reporting any QI intervention (1–9) must include one additional item (10–11)
1Provider reminder systemsAny ‘clinical encounter-specific’ information intended to prompt a clinician to recall information or consider a specific process of careDecision aids
Reminders
MEWS
The WHO Surgical Safety Checklist
2Facilitated relay of clinical data to providersTransfer of clinical information from patients to the provider (not during a patient visit)Telephone call
Postal contact
Relay of BP measurements to the preassessment team
3Provider educationDissemination of informationEducational outreach visits
Distribution of educational material
Clinical guideline information
Component separation, training and recurrence rates
Cadaveric training and surgeon confidence
4Patient educationDissemination of informationDistribution of educational material
Individual or group sessions
Trimodal pre-habilitation programmes compliance and effect on LOS
5Promotion of self-managementAccess to a resource that enhances the patient’s ability to manage their conditionBP devices
Patient diaries
Follow-up phone calls with recommended adjustments to care
6Patient remindersAny methods of encouraging patient compliance to self-managementAppointment remindersSMS exercise reminders before bariatric surgery
7Organisational changeAny change in organisational structureMultidisciplinary teams
Communication
Health records
Changes to staff rota to facilitate early patient mobilisation after elective arthroplasty
8Financial, regulatory, or legislative incentivesAny financial bonus, reimbursement or provider licensure schemePositive or negative incentives for providers or patients.18-week wait target for elective orthopaedic surgery
9FeedbackAny feedback of clinical performanceDistribution of feedback via staff education sessions or emails. Can occur as part of SPC or audit and feedbackPercentage of patients achieving target LOS
QI techniques (10–11)
10Audit and feedbackAny feedback of clinical performance summarising percentages of patients who have achieved a target outcome which has been measured at intervals over timePROMs
LOS
Morbidity and mortality
Percentage of patients achieving target LOS
11QI methodsSystematic techniques for identifying defects in clinical systems and making improvements, typically involving process measurement and remeasurementPDSA, Six Sigma, TQM, CQI, SPC, LeanImproving processes for acetabular cup placement in minimally invasive hip surgery
  • Adapted from Shojania et al (2004) Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 1: Volume 1—Series Overview and Methodology). Technical Reviews, Rockville (Maryland): Agency for Healthcare Research and Quality (USA).

  • BP, Blood Pressure; CQI, Continuous Quality Improvement; LOS, Length of Stay; MEWS, Modified Early Warning System; PDSA, Plan-Do-Study-Act; PROM, Patient Reported Outcome Measure; QI, quality improvement; SMS, Short Message Service; SPC, Statistical Process Control; TQM, total quality management.