Performance measures can be used for internal quality improvement processes within institutions and for external quality improvement processes across institutions. Continuous quality improvement (CQI) is an ongoing process to improve products and processes either through incremental improvement or sudden “breakthrough” improvement. In CQI, service delivery processes are evaluated in iterative cycles to improve their effectiveness and efficiency. The National Quality Measures Clearinghouse identifies three basic quality improvement steps: (1) identifying problems or opportunities for improvement, (2) selecting appropriate measures of these areas, and (3) obtaining a baseline assessment of current practices and then remeasuring to assess the effect of improvement efforts on performance (AHRQ 2013).
Baseline results can be used to (1) better understand a quality problem, (2) provide motivation for change, (3) establish a basis for comparison across institutional units or over time, and (4) enable prioritization of areas for quality improvement (AHRQ 2013). Although the genesis of quality improvement was in the healthcare industry, quality improvement methods can also be used to improve the implementation of evidence-based strategies for population health. For example, the Centers for Disease Control and Prevention (CDC) has specified a set of winnable battles: health priorities with large-scale impacts and known strategies for combating them (CDC 2013). The CDC is promoting the use of quality improvement methods through its Future of Public Health Awards to recognize positive initiatives in public health that use quality improvement to address winnable battles (Public Health Foundation 2012).