Develop an Integrated Approach to Quality Management
IHI’s Whole System Quality (WSQ) approach helps health systems bring all aspects of quality together, including improvement, assurance, control, and planning. By aligning these efforts within a single quality management system, organizations can connect quality goals to their overall strategy while supporting better day-to-day operations and more consistent results.
Is Your Organization Trapped in a Cycle of Reacting to Quality and Safety Issues?
Many health systems struggle with fragmented priorities, disconnected teams and functions, and reactive approaches to quality and safety. These challenges make it difficult to align efforts, coordinate improvements, and achieve sustainable results.
What is Whole System Quality?
Whole System Quality (WSQ) offers an integrated approach - developing a single management system that brings together and balances quality planning, control, assurance and improvement to achieve organizational goals and achieve a culture of continuous improvement. This helps health systems shift from "reactive quality"— taking action after adverse events occur — to a proactive stance, enabling an entire organization to reliably meet the evolving needs of patients and the workforce. It also helps bring together all organizational functions as part of the single management system - quality, safety, equity, workforce/HR, finance, data & analytics - and considers how each of these need to contribute and collaborate as part of the single management system for quality.
Why Organizations Choose Whole System Quality
Quality Planning (QP)
Quality planning establishes the groundwork for dependable results by identifying stakeholder needs, defining aims, and designing the systems and processes to meet them from the outset.
As the foundation of WSQ, QP:
- Identifies stakeholder needs and defines quality aims
- Designs systems and processes to meet those needs from the outset
- Establishes measures and goals to assess performance
By embedding quality in design, quality planning helps prevent problems before they occur.
Quality Control (QC)
Quality control is the day-to-day work of monitoring performance and maintaining reliable operations, using data over time, visual management, and huddles to solve emerging issues in real time.
As the operational discipline within WSQ, QC:
- Monitors results against defined aims and standards
- Identifies and addresses variation or defects as they occur
- Responds in real time to risks to patient safety
These practices promote day-to-day consistency and reduce unintended variation.
Quality Improvement (QI)
Quality improvement is the systematic work of changing systems to achieve better results using the Science of Improvement and methods such as the Plan-Do-Study-Act (PDSA) cycle. This enables teams to test changes, build capability, and improve outcomes.
As the method for advancing performance within WSQ, QI:
- Uses measurable, time-bound aims to guide improvement efforts
- Translates rapid learning into coordinated action
- Enables sustained, system-level change rather than isolated fixes
Using the Science of Improvement, teams move beyond maintaining performance to achieving new levels of quality, safety, and outcomes.
Quality Assurance (QA)
Quality Assurance (QA) provides mechanisms to ensure that care is being a defined standard - either based on evidence-based guidelines, or standards defined by patients or the organization. Examples of quality assurance include audit, accreditation and inspection.
QA continues to remain important, but needs to be in balance to the effort needed for effective planning, control and improvement. There is opportunity to evolve the methods of QA to reduce waste, and strengthen patient involvement in both setting standards and measuring care against the standards.
How Whole System Quality Works
IHI’s approach to embedding Whole System Quality within your organization focuses on enabling teams to shift from reacting to harm to preventing it in real time.
Understand the System
Assess current performance, identify variation, and uncover risks and opportunities.
Align and Design for Impact
Connect improvement efforts to strategy and co-develop actionable priorities with leaders and frontline teams.
Test, Learn, and Scale
Apply proven methods, tools, and coaching to test changes, use data to guide decisions, and spread what works.
What is required from leadership to advance quality across the system?
Grounded in leadership and management practices, WSQ helps organizations to align efforts and objectives, reduce unwanted variation, and deliver better results for patients, the workforce, and the communities they serve.
Whole System Quality helps leaders establish a shared aim, build the systems and structures needed to advance that aim. Achieving this requires a proactive, system-based approach to quality that includes:
Defining What Quality Means for patients, populations, communities, and the healthcare workforce and establishing a clear, shared aim
Building the Structures, Systems, and Processes that enable the workforce to achieve that aimConnect improvement efforts to strategy and co-develop actionable priorities with leaders and frontline teams.
Fostering a Culture of Learning through leadership practices that support problem identification, testing of changes, and the application of what is learned
Additional Resources
Frequently Asked Questions
Ready to Explore Whole System Quality?
IHI can help your organization sustain improvement through a whole system quality approach.
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