Improving Quality in Healthcare With FOCUS PDCA

Creating a Culture of Continuous Quality Improvement

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There are plenty of confusing acronyms for methodologies to improve quality in healthcare. FOCUS PDCA is one of the earliest and longest-lasting methods used in healthcare quality improvement. It can be explained in everyday terms, with common and accessible language.

Process Matters in Healthcare

Process improvement aims to eliminate waste and streamline processes. The pressure is on to deliver higher quality care at lower costs. Everyone in the healthcare services continuum needs to pitch in to reach this goal. Devices, drugs, supplies, and equipment all need to be produced for the lowest possible cost. In the administrative and clinical areas of a hospital or clinic, there are many opportunities to reduce waste, including:

A Simple Plan

W. Edwards Deming created the acronym FOCUS PDCA so organizations could have a simple plan to eliminate waste in their production and service processes. This was a big shift from the old way of thinking. Before Deming started to persuade people to examine the process, companies typically only had a retroactive quality control effort. That is, a process or service would happen, and hopefully, someone checked the result of that effort. Anything that did not meet the benchmark standard would be re-worked. Deming's focus on process showed people that a greater impact on waste occurs when you begin upstream, by understanding the entire process, not just looking for the end result.


This acronym really packs a punch, here's what it stands for:

  • F: Find a process to improve
  • O: Organize a team that knows the process
  • C: Clarify current knowledge of the process
  • U: Understand the variability and capability of the process
  • S: Select a plan for continuous improvement

PDCA, the acronym for Plan, Do, Check, Act, gives the team a continuous quality improvement cycle to test their improvement strategies one by one, in a controlled manner, to measure results and drive further improvements. Note that some organizations use the acronym PDSA instead, for Plan, Do, Study, Act.

Sample Improvement

Using an example to work through a process improvement using FOCUS PDCA might look like this:

  • Find a process to improve: Discharge process for hospitalized heart failure patients over age 65.
  • Organize a team that knows the process: Could include the Chief of Cardiology, cardiology nurse, administration.
  • Clarify current knowledge of the process: The team meets to create a flowchart or process map.
  • Understand the process: The team measures the process as-is to determine a range of data, which in this example could be: (1) what percentage of patients with heart failure, over age 65, are readmitted within 30 days? (2) how long does it take the staff to discharge this type of patient?
  • Select what to improve: The team chooses to reduce the 30-day readmission rate.
  • Plan: The first plan they select is to set up heart failure patients over age 65 with a connected health program upon discharge.
  • Do: The team implements this one change during a fixed time period.
  • Check: The team measures and checks the results of their connected health discharge intervention.
  • Act: The team acts on the results. If the intervention worked, then the team keeps this new program in their discharge process. They may even take some action to try to further improve their 30-day readmission rate reduction. If the test did not improve 30-day readmission rates, they would try another idea, and run it through the PDCA Cycle.

Quality Improvement Tools

There are other, more complicated statistical tools and methodologies such as Six Sigma and 5S Lean, require intensive training. However, Deming's FOCUS-PDCA is a great place to start, especially when you need to create an early victory to get people on board with making changes for improvement.

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