2010 President’s Report

At PCP we desire to improve the health of the people we serve through the best quality health care that can be provided with the resources that are entrusted to us. We believe that one tool to achieve these results is quality improvement (QI) strategies. Most health care systems in the U.S. use this and many in the developing world use QI.

The easiest way to understand this work is to consider what the Institute for Healthcare Improvement (IHI) calls the model for improvement. It is based on asking three simple questions: What am I trying to accomplish? How will I know that a change is an improvement? and, What changes should I try? This is followed by running change ideas through a cycle of work in which you plan out a change, do the change, study the results of the change, and act on those changes (PDSA).

QI Diagram 1

Normally this work is done in repetitive cycles until the change is fully implemented.

QI Diagram 2

This is a basic way to think about QI. There are lots of other names out there for this type of methodology, such as Six Sigma, which focus on decreasing variation, or Lean, which focuses on getting waste out of the process. But at the heart of all these methodologies is creating a clear aim, understanding how to measure the improvement, and coming up with a set of changes to try. Even in developed countries like the U.S., health care is fraught with unnecessary variation and waste. For example, in some work in South Africa that was focused on maternal infant HIV transmission, dramatic improvements were obtained by using the same workforce but redesigning the processes. A significant improvement was obtained in maternal transmission of HIV.

Our plan for implementing this in the Congo is to identify areas where the Congolese feel that improvement is needed, then help them develop the skills to analyze the process, generate ideas for improvement, test those ideas through PDSA cycles, and then steadily measure whether improvement is taking place. One or two of us who are skilled in the application of improvement science will visit them. We also hope to invite at least one Congolese doctor to the BMJ-IHI International Forum on Quality Improvement that will be held in Paris next April.


Contributed by John Whittington, M.D.
Faculty Lead Triple Aim, IHI
Member, PCP Medical Strategy Team



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