Quality Improvement vs. Quality Planning
Response by Cindan Gizzi: acknowledgements to Laurie Call and Marni Mason. Cindan, Laurie, and Marni have been working collaboratively to define and describe QP.
Have you ever tried to apply quality improvement (QI) tools and methods to a planning process, for example, to develop a community health improvement plan? If you did, you would quickly find out that it’s like wearing a sweater one size too small; it doesn’t fit quite right and may even be a bit uncomfortable. Quality planning (QP) is the right fit for starting a planning process, developing a new prevention program, determining your clients’ needs, or working with multiple partners to develop a community health improvement plan.
At the most basic level, QP is a set of methods and tools to develop new programs and services or to revamp existing ones. QI on the other hand, is a set of methods and tools to optimize an existing process’s performance. Of course, there are also nuances and crossovers with both quality applications, but this is a way of remembering the main difference.
Both QI and QP focus on meeting customer needs, require understanding of variation in processes, involve standardizing those processes, and use continuous scientific methods to understand and improve processes. However, they have differences in objectives, starting places, steps, and tools.
QP is not a new concept. In the 1950s, Joseph Juran first talked about QP as the first of three components in a quality trilogy. QI and quality control (QC) are the other two components. Since then, there have been many adaptations and applications of QP.
QP is also not a new concept to public health. Even before we called it “quality planning,” QP has been the right way to plan. Many good public health programs started with QP. For example, many health departments currently use the Mobilizing Action through Planning and Partnerships (MAPP) framework for their community health improvement plan. MAPP includes several basic steps of QP, including identifying and understanding community needs during the assessment phase, developing strategies and approaches to address those needs, and establishing outcome and process measures to monitor progress.
QP begins with identifying customers and understanding their needs and requirements to frame the design of a service, process, or program. I don’t think we’re as good as we think we are at conducting this important step in public health; we have great intentions to identify customers and understand their needs, but lack of time and resources often shortchange the process. Instead of conducting focus groups or key informant interviews to ask customers open-ended and non-leading questions about their needs, we end up relying on information from a few years back. But customer needs change. Sometimes we forget about important customers, whose customer status might be less prominent. I frequently see this issue with public health administrative services; we—I can say “we” because I am a member of this astute group—forget that public health staff at our own agencies are the main customers. That shift in thinking about our customers can lead to many changes in our processes or services.
QP tools can also help public health professionals provide new or revamped services that reflect model or evidence-based practices. QP methods and tools can be useful in situations where services or programs have never existed before or where customer requirements are unknown. QP methods and tools can also be helpful if the existing service or program cannot meet customer needs.
One QP model follows these basic steps:
- Identify customers/stakeholders and understand their needs.
- Develop a program/service/intervention to address customer needs (e.g., establish customer-related measures).
- Optimize the program or service activities to meet health department or agency needs.
- Develop a work process to conduct the program/service/intervention.
- Optimize the work process and prove that it delivers needed results.
- Implement the program/service/intervention in the health department.
As you become more comfortable using QI tools, I hope you will think about how you might apply QP at your agency. Using QP now will minimize errors and problems later.
- JM Juran. Juran on Planning for Quality. Free Press. 1988.
- L Call, C Gizzi, and M Mason. MLC Topical Brief: Using Quality Planning in Public Health to Improve Results. National Network of Public Health Institutes. http://nnphi.org/program-areas/accreditation-and-performance-improvement/resources/stories-and-topical-briefs.
- NR Tague. The Quality Toolbox. ASQ Quality Press. 2005
- JA De Feo and JM Juran. Juran’s Quality Handbook, Sixth Edition: The Complete Guide to Performance Excellence. ASQ Quality Press. 2010.
- L Call, C Gizzi, and M Mason. MLC Teleconference/Webinar: The Quality Trilogy. National Network of Public Health Institutes. 2010. http://nnphi.org/CMSuploads/MLC.Teleconference-10.29.10-46532.pdf.