Steps to Quality Improvement > Overview

As shown in the following sections, the Quality Improvement (QI) process for improving CLAS and reducing disparities in health care follows a pattern that has become common in many health care organizations. As more organizations have adopted QI programs, they have followed a course similar to that outlined in the following sections of this Guide.

This approach follows the basic steps of the QI process. As this Guide suggests, the organization begins the process of minimizing disparities by first assessing the situation (Chapter 1: Assessment) and identifying gaps in cultural and linguistic competence. Are there gaps among the staff, or among providers, programs or services—or in each of these areas? How wide is the gap between providing “ideal” care and care that the organization currently delivers? Does the organization reach all patients, members or clients that it could reach, or has it disenfranchised members of certain minority groups because it fails to address their needs in a culturally and linguistically appropriate manner? A thorough assessment that considers the opinions of stakeholders both within and outside the organization will help QI teams identify gaps.

Now the QI team can plan an appropriate response to identified problems. As detailed in Chapter 2: Planning, this part of the process may be the most challenging because it involves pinpointing a problem’s root cause. During the Assessment Phase, the QI team found gaps in cultural and linguistic competence, but if it failed to identify the root causes, the organization may need to collect and analyze more data. Only after root causes have been discovered can potential solutions to problems be identified and the intervention properly planned.

Once the root causes are recognized and possible solutions identified, the organization can work on implementing interventions (Chapter 3: Implementation). The organization must develop interventions to address different problems, and many problems will require multiple interventions. Interventions may be directed at problems that involve the system, individual practitioners, staff, patients, the community—or a combination of these. Some organizations may find that working to close the gaps in delivering culturally competent care will require a series of interventions. This Guide accounts for such scenarios by preparing the organization for small tests of change, evaluating the results and conducting more small tests. After each test, the QI team analyzes the results and refines its process.

If analyzing results of the individual components of an intervention is necessary to develop a solution, then evaluating the full set of interventions (Chapter 4: Evaluation) is critical to understanding the intervention’s success. Organizations regularly make decisions about these programs, and decisions are best made when informed by accurate information about the program, how it is running and its success to date. In other words, as data on results are routinely gathered, analyses are updated and new changes are introduced.

Ideally, efforts to improve the provision of culturally competent and linguistically appropriate care and services and to reduce disparities are part of a continuous cycle of quality improvement. Organizations that undertake this approach are making a great start. Small changes made now will add up and contribute to more patient-focused, responsive and higher quality care for diverse populations.