4 Continuous improvement cycle


4 Continuous improvement cycle

4 Continuous improvement cycle

Ideally, the continuous improvement process makes it is easy for individuals to see and fix issues that they come across – or to escalate them to where the issues can be fixed quickly and as close to the point of care or service as possible.

In reality people see things and don’t do anything, or they tell someone else, and they don’t do anything, or it goes up the line to the point of failure – the point at which no-one does anything.  The person reporting it either gets frustrated or stops worrying about it – becomes complacent – stops saying anything.

So in this model I have identified a number of tools that I believe make it easier or individuals an teams to engage in continuous improvement.  Let’s have a look at them and consider what you have in your place – what works and what might not.  The tools I am mentioning are in the downloads.

1.Issue identified

Issue is identified either as something NQR, or in the performance data (clinical, financial, people survey, etc).  It represents a tension between what is and what should be.  Ideally, the individual who identifies the issues is motivated and authorised to fix it in the moment rather than wait to be told.

2. Issue reported:

The issues is reported either via the Continuous Improvement Form (CI form) posted on the Visual Management Board (VMB – more on this later), or on Riskman, or directly to the manager.  An individual (not necessarily the reporter) needs to take responsibility for moving this issue through the system or resolving it, and they have to feedback to the reporter on how the issues is being dealt with and how they can keep informed of progress (ie. VMB) and contribute to the resolution of the issue (i.e. project group or investigator).


How is this done in your place?
Do people tend to fix issues they come across or ignore them, or tell someone else hoping they’ll fix it?

How do individuals raise issues, to who, what tools can they use?

Check out the improvement form as a suggestion.

3.  Distributed to fixer

The issue is given to the person, project group or committee (the fixers) best able to investigate and resolve the issue.

4. The Fixer investigates

The Fixer either checks it out and fixes it, or if it is a more complicated issues, could form a project group around the issue, or there could be a project team already looking at similar issues.  They investigate the actual problem by making contact with the reporter, looking at the symptoms and the likely cause, researching and exploring how the issues has been fixed elsewhere – looking at the evidence (review the process of revealing and analysing problems in the change manage process earlier in this Module).

5. Fix instigated

The fix might be a large project or a small action.  If it is a larger project then the Improvement Project Process should be instigated, a project team might be convened (see section on Improvement Project Team) and a IP Report prepared (to be discussed in the section on reporting).

The IP Report goes up the chain to the appropriate managers and committees so they know that an issue has been picked up and is being fixed up.

For really serious issues – escalation

If the issue is a serious breach or risk to people’s safety or organisational safety, then it should be reported immediately to the person in charge.  They must then escalate it as per the organisation’s escalation process.

So let’s look at the tools:


Process map how the continuous improvement process works in your place – use post-it notes to identify the various elements and stages of the process and what already happens.  You can do this brain storming all of the elements of the process that you can think of – one per post-it not.  Then arrange the post-it notes from the start of the process to the finish.

At the moment, where are your points of failure? Where does the process fall down?

Are people seeing and fixing the issues? Are they taking personal responsibility and using their initiative when they see things that are not working?



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