Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Roadmap to a successful quality improvement project


Although the benefits of quality improvement initiatives are largely understood by practicing neonatologists and perinatologists, the vast majority have not received any formal training in quality improvement methodology. Even as reporting requirements of quality metrics has increased from a number of outside agencies and public reporting entities, education for physicians regarding how to carry out quality improvement projects has largely remained the individual’s responsibility. The first in a series of quality improvement education papers, we focus on the reasons why quality improvement matters and how to develop a team of stakeholders that will be functional and productive in addressing specific quality and safety concerns.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2


  1. Donovan EF, Lannon C, Bailit J, Rose B, Iams JD, Byczkowski T . A statewide initiative to reduce inappropriate scheduled births at 36 0/7–38 6/7 weeks’ gestation. Am J Obstet Gynecol 2010; 202: 243e1–248e1.

    Article  Google Scholar 

  2. Walsh M, Laptook A, Kazzi SN, Engle WA, Yao Q, Rasmussen M et al. A cluster-randomized trial of benchmarking and multimodal quality improvement to improve rates of survival free of bronchopulmonary dysplasia for infants with birth weights of less than 1250 grams. Pediatrics 2007; 119: 876–890.

    Article  Google Scholar 

  3. Lee SK, Aziz K, Singhal N, Cronin CM, James A, Lee DS et al. Improving the quality of care for infants: a cluster randomized controlled trial. CMAJ 2009; 181: 469–476.

    Article  Google Scholar 

  4. Horbar JD, Carpenter JH, Buzas J, Soll RF, Suresh G, Bracken MB et al. Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomized trial. BMJ 2004; 329: 1004.

    Article  Google Scholar 

  5. American Board of Pediatrics. Improving Professional Practice. Available at: (accessed on 15 July 2016).

  6. Profit J, Zupancic JAF, Gould JB, Petersen LA . Implementing pay-for-performance in the neonatal intensive care unit. Pediatrics 2007; 119: 975–982.

    Article  Google Scholar 

  7. Pearlman SA . Why quality matters. J Perinatol 2015; 35: 311–312.

    Article  CAS  Google Scholar 

  8. Lachman P, Jayadev A, Rahi M . The case for quality improvement in the neonatal intensive care unit. Early Hum Dev 2014; 90: 719–723.

    Article  Google Scholar 

  9. De Blacam C, Healy C, Quinn L, Spillane C, Boyle T, Eadie PA et al. Is satisfaction with surgeon a determining factor in patient reported outcomes in breast reconstruction? J Plast Reconstr Aesthet Surg 2016; 69: 1248–1253.

    Article  Google Scholar 

  10. Dy SM, Chan KS, Chang HY, Zhang A, Zhu J, Mylod D . Patient perspectives of care and process and outcome quality measures for heart failure admissions in US hospitals: how are they related in the era of public reporting? Int J Qual Health Care 2016; 28: 522–528.

    Article  Google Scholar 

  11. Friedberg MW, Chen PG, Van Busum KR, Aunon F, Pham C, Caloyeras JP et al Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. RAND Corporation. 2013. Available at: (accessed on 14 July 2016).

  12. Ellsbury DL . Crossing the quality chasm in neonatal-perinatal medicine. Clin Perinatol 2010; 37: 1–10.

    Article  Google Scholar 

  13. Spitzer AR, Kirkby S, Kornhauser M . Practice variation in suspected neonatal sepsis: a costly problem in neonatal intensive care. J Perinatol 2005; 25: 265–269.

    Article  Google Scholar 

  14. Ho T, Dukhovny D, Zupancic JAF, Goldman DA, Horbar JD, Pursley DM . Choosing wisely in newborn medicine: five opportunities to increase value. Pediatrics 2015; 136: e482–e489.

    Article  Google Scholar 

  15. Powers NG, Bloom B, Peabody J, Clark R . Site of care influences breastmilk feedings at NICU discharge. J Perinatol 2003; 23: 10–13.

    Article  Google Scholar 

  16. Lee HC, Gould JB . Factors influencing breast milk versus formula feeding at discharge for very low birth weight infants in California. J Pediatr 2009; 155: 657–662.

    Article  Google Scholar 

  17. Swanson JR . Necrotizing enterocolitis: is it time for zero tolerance? J Perinatol 2013; 33: 1–2.

    Article  CAS  Google Scholar 

  18. Shepherd EG, Kelly TJ, Vinsel JA, Cunningham DJ, Keels E, Beauseau W et al. Significant reduction of central-line associated bloodstream infections in a network of diverse neonatal nurseries. J Pediatr 2015; 167: 41–46.

    Article  Google Scholar 

  19. National Center for Health Statistics. Final Mortality Data, 1990-1994 and Period Linked Birth/Infant Death Data, 1995-Present. Available at: (accessed on 14 July 2016).

  20. National Center for Health Statistics. Final Natality Data. Available at: (accessed on 14 July 2016).

  21. Berwick DM, Hackbarth AD . Eliminating waste in US health care. JAMA 2012; 307: 1513–1516.

    Article  CAS  Google Scholar 

  22. Dukhovny D, Pursley DM, Kirpalani HM, Horbar JH, Zupancic JAF . Evidence, quality and waste: solving the value equation in neonatology. Pediatrics 2016; 137: e20150312.

    Article  Google Scholar 

  23. Silver SA, Harel Z, McQuillan R, Weizman AV, Thomas A, Chertow GM et al. How to begin a quality improvement project. Clin J Am Soc Nephrol 2016; 11: 893–900.

    Article  Google Scholar 

  24. National Institute for Child Healthcare Quality Resources. QI tips: How and Why to Include the Patient Perspective. Available at: (accessed on 16 July 2016).

  25. Ellsbury DL, Ursprung R . A primer on quality improvement methodology in neonatology. Clin Perinatol 2010; 37: 87–99.

    Article  Google Scholar 

  26. Agency for Healthcare Research and Quality Practice Facilitation Handbook. Module 14: Creating Quality Improvement Teams and QI Plans. Available at: (accessed on 20 July 2016).

  27. Swanson JR . Nuts and bolts of quality improvement. EJ Neonatol Res 2014; 4: 24–26.

    Google Scholar 

  28. Taitz JM, Lee TH, Sequist TD . A framework for engaging physicians in quality and safety. BMJ Qual Saf 2012; 21: 722–728.

    Article  Google Scholar 

  29. Mate KS, Johnson MB . Designing for the future: quality and safety education at US teaching hospitals. J Grad Med Educ 2015; 7: 158–159.

    Article  Google Scholar 

  30. Faherty LJ, Mate KS, Moses JM . Leveraging trainees to improve quality and safety at the point of care: three models for engagement. Acad Med 2016; 91: 503–509.

    Article  Google Scholar 

  31. Bundy DG, Morawski LF, Lazorick S, Bradbury S, Kamachi K, Suresh GK . Education in quality improvement for pediatric practice: an online program to teach clinicians QI. Acad Pediatr 2014; 14: 517–525.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to J R Swanson.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Swanson, J., Pearlman, S. Roadmap to a successful quality improvement project. J Perinatol 37, 112–115 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links