Clinical practice improvement (CPI) encompasses the methods used to plan, implement and evaluate the impact of changes in the delivery of health services. CPI is a continuous cycle of improvement activities, rather than a one-off event.
CPI provides clinicians with formal methods and tools to improve practice with a scientific underpinning for those methods. This process is part of an ongoing cycle where identification and diagnosis of a clinical issues or problem leads to the planning and implementation of change, the evaluation of the impact of the change and further review to determine whether the interventions have been effective. In terms of clinical practice, this process is known as The Clinical Practice Improvement Model.
Before clinical improvement activities can take place it is first necessary to gather information about the quality of current clinical care. There are various methods for providing this information. These include:
• Facilitated incident monitoring
• Sentinel event management
• The effective use of clinical indicators
• Peer review meetings
• Morbidity and Mortality meetings (M&Ms)
• Ad hoc audits/reviews
• Retrospective chart review
Further information about these activities can be found in the ‘Clinician’s toolkit for improving health care’ (link below).
Once adequate information has been collected about the current quality of care it is then possible to identify any problems with systems of care or with individual clinician’s practice, and begin to plan changes that will result in an improvement in the delivery and quality of health care.
It’s important that potential changes to delivery of health services are carefully planned and considered. Several tools can help you successfully manage change and implement improvement strategies, including:
• PDSA cycle (the most commonly used tool)
• PEPPA framework.
It may seem unusual to test a change before you’ve implemented it, but this approach helps you save time, enhance patient safety, reduce disruption for patients and colleagues, and gain valuable learning.

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