Building knowledge for quality improvement in healthcare: an introductory glossary

At the heart of organization-wide quality improvement in healthcare is the need to build knowledge for improvement that complements the subject matter knowledge of healthcare. Dr. W. Edwards Deming, the quality improvement pioneer, has suggested that "profound knowledge," or knowledge required for improvement, consists of four basic dimensions: Knowledge of the organization as a system. At its heart this knowledge is an understanding of the methods of production, the methods of improvement, and the aim of the entire enterprise. This concept was first presented by Deming at Mount Hakone, Japan, in 1950. In his book Out of the Crisis (1986), Deming illustrates the organization as a system. Knowledge of variation. This understanding comes from the awareness that a system of causes is at work producing any result. These sources of the variation, which can be observed in any process, are what must be acted upon to improve the results of the process. Studying the variation in a process can provide clues to the most economical actions that managers can take for improvement. It involves knowledge of the difference between common and special cause variation. Knowledge of psychology. The focus is on an awareness of the power of intrinsic motivation, a sense of self-worth and pride in what is done in the workplace. Theory of knowledge. How is new knowledge built? What is the purpose of knowledge? What is the nature of knowledge? Unless these issues are clear, it will not be easy to build useful knowledge. Deming has provided further insight into this framework in a recent unpublished essay and is currently working to further expand these concepts in additional publications in preparation. This framework helps build the knowledge necessary for the improvement of healthcare. As you work to build that knowledge, however, you will confront a wide variety of terms and a language that may in some ways be unfamiliar. In recognition of that, an introductory glossary is offered for your use and reference. With time, it can, should, and will be replaced by an expanded lexicon. Other sources that interested readers may wish to consult include the references listed at the end of the glossary.