Quality and Improvement: Theory and Practice in Healthcare

Document first published:
Page updated:
Publication type:
Medical Conditions and Contexts of Care:
Improvement Challenges:

This report by the NHS Institute for Innovation and Improvement and written in conjunction with the Manchester Business School focuses on quality improvement in healthcare, and summarises the evidence about how it has been implemented and the results of this process.

The report draws on academic literature as well as other sources, including accounts published on the web, but recognises the methodological limitations of accounts of success in quality improvement without any comparative data being made available.

The purpose of this report is:

• to provide a guide to the main approaches being used, in terms of their context as well as their impact.
• to enable links to be made between aspects of quality improvement which are often regarded as separate; specifically improvement from clinical and organisational perspectives.


The report focuses on the role of various industrial quality improvement approaches: the Plan-Do-Study-Act (PDSA) cycle, Statistical Process Control, Six Sigma, Lean, Theory of Constraints and Mass Customisation. It also outlines the development of quality from a clinical perspective and the way in which industrial approaches are now being applied in healthcare.