Finishing big by starting small. Continuous improvement is the key to enhancing community health

Although healthcare organizations increasingly seek involvement in community health improvement, they are often unprepared to do so because of their inexperience in disease and injury prevention. In recent years, however, continuous improvement (Cl) methodology has produced insights that are useful in such projects. An organization considering a community health improvement project should, from the start, test it through "Plan, Do, Study, Act" (PDSA) cycles. The project's leaders should begin by selecting an issue to work on. They must accurately define the community and involve its members in the project, because health improvement work is most effective when the people who care most strongly about a problem help solve it. Leaders should clearly define the project's aim, perhaps through analyzing hospital records and other databases. In forming a collaborative group to work on the project, leaders should begin with a "core team," perhaps adding other members later. This team should track data using three kinds of measurement--global, intermediate, and process--building data evaluation into its daily practices. The team would do well to get the guidance of someone familiar with Cl methodology. It should also use a process involving regular meetings, time lines, a means of communicating with experts outside the area, and a format that enables it to document progress and capture lessons learned.