{"doi":"10.1002/jpn3.12110","title":"The Associate Editors' Corner: A quality improvement primer—The why and what, the how, and reasons to publish","abstract":"Quality improvement science (QIS) is the study of an endeavor clinicians engage in everyday—translating evidence-based guidelines (or expert recommendations) into clinical practice. QI projects evaluate whether targeted aims (SMART aim; see Section 2.1) of projects have been successfully achieved. Since QI happens in the real-world of the clinical workspace, rigorous methods have been developed to account for the inherent variation and chaos of this environment. Because clinical interventions are a learned and adapted experience, QIS methods account for this evolving dynamic over time. The central tenet of QIS is that standardization of clinical protocols through continuous, incremental change will reduce variations in practice and improve the quality of care. Further, equity is a key concept of QIS where each individual patient with a given problem should receive the same care regardless of background or socioeconomic situation. Many are familiar with the Plan-Do-Study-Act (PDSA) cycle (Figure 1). However, some may not be familiar with the methods and tools2 used to achieve goals within each quadrant of that cycle. To start, one must have a plan of action, a goal, an objective. In QIS this is called a SMART aim, where SMART = specific, measurable, achievable, realistic, and time bound. A SMART aim typically is worded as follows: To accomplish a change (gain or reduction defined by absolute number or percentage or proportion) in a given metric within a given timeframe (e.g., To increase performance of a new endoscopy procedure from 3 to 10 cases per month over 1 year). Second, develop your intervention. The intervention you start with does not have to be perfect. In fact, QIS expects that interventions will be edited over time. To begin, one should use available QIS tools to decide what initial intervention might be most effective. Resources can be found at ihi.org (Institute for Healthcare Improvement1). Commonly utilized tools include the Pareto chart, the Cause-and-Effect Diagram, the Key Driver diagram, and the Flowchart or Process Map (Figure 1). The Pareto chart3 quantifies the types of issues associated with the process one is trying to standardize to identify which should be targets of the intervention. The Cause-and-Effect Diagram or Ishikawa4 or fishbone diagram helps analyze and identify the root causes contributing to an outcome. The Key Driver diagram5 visually displays the planned interventions in relation to who and what will “drive” achievement of the project's SMART aim. Flowcharting6 maps out the processes involved in each protocol, identifies personnel that will need to be engaged, and helps visualize, analyze, and identify problems and opportunities for intervention. Identifying and engaging key stakeholders early can be crucial to the success of any QI project. Third, define what are you going to serially measure to determine whether your intervention is a success or failure. Metrics fall into one of four categories, including structure, process, outcome, and balance measures. Structure measures measure the infrastructure, or the physical equipment, needed for the intervention (e.g., ready availability of functioning, sterilized equipment for performance of a new endoscopy procedure). Process metrics measure the performance of the chosen intervention (e.g., how many staff received education to perform the new endoscopy procedure). Outcome metrics measure the desired clinical result (e.g., how many endoscopists perform the new endoscopy procedure over time or patient accessibility to the new procedure). And, finally, balance measures quantify the unintentional negative impact on a different part of the system targeted by the intervention (e.g., reduced endoscopy staff availability to perform other standard endoscopies in an intervention improving performance of a new endoscopy procedure). Once the initial intervention protocols have been developed and baseline metrics have been measured, it is time to launc","journal":"Journal of Pediatric Gastroenterology and Nutrition","year":2024,"id":482942,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9618,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":668360,"name":"Jeannie S. Huang","orcid":"0000-0002-2742-5557","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-19T02:07:22.248464Z","pmid":"38374553","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}