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DNP in Practice: Implementing QI


Quality Improvement initiatives, evidence-based practice initiatives, and research can overlap and intermingle. Clearly understanding which is which and the role of each can become muddled. Take a look at this article by Dr. Ginex for a refresher. It is brief, well-organized, and written for nurses.

Generally speaking:

  • EBP has a knowledge translation element to it and is a lifelong process
  • QI focuses on improving outcomes through process changes in a specific healthcare setting


PDSA is:
  • Part of the Institute for Healthcare Improvement Model for Improvement
  • A way to test change in a real work setting
  • Action-oriented AND reflective

PDSA allows the user to test a change in a microcosm before launching a full-scale operation. PDSA is accessible and simple for smaller facilities.

Six Sigma

Motorola developed the Six Sigma process in 1986 as a quality improvement process. Like Lean, Six Sigma was geared toward production-based businesses, but the process has been adapted by the healthcare industry. However, where Lean management is focused on eliminating waste and ensuring efficiency, Six Sigma focuses is on eliminating defects and reducing variability.

The Six Sigma principles are:

  1. Work for the customer
  2. Find your problem and focus on it
  3. Remove variation and bottlenecks
  4. Communicate clearly and train team members
  5. Be flexible and responsive

Many institutions, like Purdue, offer online and in-person training in Six Sigma for healthcare.


Consider Capacity & Scope

Choose a method that you can easily implement in your organization. Consider the staff hours that will go into the QI model and plan, the number of staff available, available funding, and the scale of the project.

Larger projects with more funding may enable you to enlist Six Sigma consultants. PDSA may be more useful for a smaller change with less funding.


Lean is based on the Toyota Motor Company 5 Why's Technique, which asks "why" until the root cause of a problem is found. This technique has traditionally been geared toward production-based business models (like auto manufacturing). However, healthcare has adapted the model for QI purposes.

Focused on:

  • Constant improvement
  • Eliminating waste
  • Identifying the root cause of a problem

Accomplishes this through:

  1. Identifying value
  2. Mapping the value stream
  3. Creating flow
  4. Establishing pull
  5. Seeking perfection

Organizations like the Lean Enterprise Institute, the Virginia Mason Institute, and the Institute for Healthcare Improvement offer information, training, and support for implementing Lean management principles.