QI vs. QA - how do I explain the difference??

Tue, 01/12/2016 - 11:23 -- QIangeloni

Hi colleagues!

Please help me with something I'm wrestling with: a section of our department of health does quality assurance (QA) on a regular basis as that is required for their specific accreditations, etc., and now that we are doing quality improvement (QI) agency-wide, they tell me their regular work they do (QA) is the same as "QI". I haven't found an effective, black and white way to separate the 2 (QI and QA) in a way that is understandable to them. Have any of you run into this issue? Help please!!!

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Submitted by johnshutze on

I keep it simple. Are you making changes for the better? If yes, then you're doing QI.

It's a little dated, but maybe this article will help: The role of quality assurance versus continuous quality improvement.

I also separate the two like this:

  • Quality Assurance answers the question: Are we meeting the standard(s)?
  • Quality Improvement answers the questions: Why didn't meet the standard? What can we do to meet and then exceed the standard?

When we touch on this during trainings, we frame it as a complimentary relationship. The evaluation aspect of quality assurance can feed your improvement efforts. That cycle continues when the next evaluation (assurance) period is upon you.

Honestly though, I wouldn't get hung up on making it black and white. That might get in the way of progress.

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Submitted by topclown56 on

Hi Magaly,

I have used the information below to describe the difference between QA and QI for years.  I put the points below describing QA and QI below on a single Power Point Slide side by side so staff can compare the differences.  I hope you find it helpful.

Susan Ramsey, Pearls of Wisdom Consulting



 - Reactive

- Works on problems after they occur

- Regulatory usually by State or Federal Law

- Led by management

- Periodic look-back

- Responds to a mandate or crisis or fixed schedule

- Meets a standard (Pass/Fail)


- Proactive

- Works on processes

- Seeks to improve (culture shift)

- Led by staff

- Continuous

- Proactively selects a process to improve

- Exceeds expectations

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Submitted by Georgianna on


For our QI training I developed a simple .ppt slide (I can't figure out how to attach files here, but am happy to email it to you).  The image is from the perspective of a car driver with the road ahead, and a rear-view mirror.  I put "QA" in the rearview mirror and "QI" on the road ahead.

The other thing we do in the training is a "quiz" where several statements are presented.  Some are QI statements, and some QA.  Once they identify the QA statements, I ask them to rephrase them as QI statements. 

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Georgianna Wood
Accreditation Coordinator
Humboldt County DHHS Public Health

Submitted by Kdyer on

I use the same explanation as Topclown56 and add the following example:

Problem - Phone messages taken by clerical staff are not complete and not delivered to staff in a timely manner.

QA would be a process to find out "who" was not getting complete information and delivering the message in a timely manner. (Reactive)

QI would be a process in which the entire task of taking/delivering messages are looked at and a uniform method is developed for all clerical staff to use. (Proactive process to improve).

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Submitted by madamalak on

Hi Magaly,

The QI Guidebook which can be downloaded from the link below also provides a nice description and distinction between each concept. This information be found on pages 15-16.


 Kusuma Madamala

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Submitted by dspindola on

QA procedure for reviewing completeness and quality of data

QI  consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.

Excellent previos comments and examples!

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D. Spindola

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Submitted by mrmalph on

The central QA question is, "Are we doing a task the way we agreed it is supposed to be done?"

The central QI question is, "How can we improve the way we do things?

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Submitted by wardd on

Hi Magaly,

I've been teaching this topic in our Division of Public Health, conferences, and most recently, my visit to the Federated States of Micronesia.  I have a condensed PowerPoint version I am happy to share but I don't see an option for me to attach it to this message.  Please email me and I will send it to you.  After you get it lets talk so I can walk you through the slides.

Dan Ward, MPA

Performance Improvement Manager

Idaho Division of Public Health


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Submitted by QIangeloni on

Everyone, this is great, thanks so much for your examples and feedback. I'm putting something together for the group here and will use it frequently. I'm now better prepared to respond to the question. I do appreciate it and I also want to say PHQIX is awesome!

Magali Angeloni

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Magali Angeloni, DrPH, MBA
Rhode Island Department of Health's Academic Center Director

Submitted by tkane on

Great suggestions.

Beneath this technical problem (i.e., defining QI & QA so that staff can differentiate the two sets of activities) lies the adaptive challenge of leading the organization to a place where QI and QA staff & processes work together in concert.

Challenges related to defining QI & QA in the public health setting are common. NACCHO's "Roadmap to a Culture of Quality Improvement" (qiroadmap.org) notes that during early phases of QI culture development, "Employees are unaware of QI and/or mistake it for quality assurance or quality control. No Knowledge, skills, and abilities (KSAs) necessary to undertake QI exist." 

It may be helpful to implement a number of strategies to gain ground on this challenge, including:

  1. Don't forget to define QI & QA in your agency QI plan. 
  2. Review definitions for QI & QA and facilitate an open discussion during staff trainings & meetings.
  3. Equip QI project managers, coaches & champions to address this issue on the front lines. 

Are there other ideas? 


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