QUALITY IMPROVEMENT METHODOLOGIES

Determining the Best Approach for Incorporating QI

into Your Agency’s Practice
February 2020

What’s in a Method?
Kaizen, Lean, Six Sigma, and Lean Six Sigma methods are often used by health departments to make measurable improvements in their business
processes. Some health departments simply use a Plan-Do-Study-Act (PDSA) cycle. All of these methods are interrelated and understanding the
similarities can help distinguish the differences.
As a starting point, it’s helpful to think of PDSA as a summary of the steps involved in the other four methods. Kaizen, Lean, Six Sigma, and Lean
Six Sigma were created initially for the manufacturing industry, and PDSA is a more generic framework that captures the progression of
thoroughly examining a current process and its problems, followed by developing solutions, then testing the solutions and measuring the results,
and ending by institutionalizing a new process. The steps in the other four methods conceptually are quite similar and many differences largely
are a matter of semantics.
Furthermore, all four methods focus on improving processes and require participation from all employees involved in the process in order to
achieve maximum effectiveness. They rely on data to understand the problem and whether changes result in improvement. Moreover, the
methods essentially all use the same tools and often combine approaches. Finally, all are grounded in a philosophy of continual improvement;
therefore, QI is not merely a series of discrete improvement efforts but rather is part of an organization’s culture.
However, there are some useful distinctions to understand, related to philosophy and specific objectives. The chart below is intended to
highlight these differences and help you determine the best approach for incorporating quality improvement into your agency’s practice.

This document was developed with feedback from PHAB’s Evaluation and Quality Improvement Committee, and in consultation with Grace
Gorenflo.
 QUALITY IMPROVEMENT METHODOLOGIES: UNDERSTANDING THE DIFFERENCES

PDCA/PDSA Kaizen Lean Six Sigma Lean Six Sigma

Defined A cycle for identifying and Philosophy of gradual, A method to maximize A method to greatly reduce An approach to
testing a change. Plan-Do- incremental and orderly customer value while the probability that an eliminating waste and
Check-Act (PDCA) and continuous improvement, eliminating waste. error or defect will occur. variation; combines both
Plan-Do-Study-Act (PDSA) always working to create Lean and Six Sigma
are the same thing and more value and less waste. Follows the A3 process Follows the DMAIC process tactics.
reflect different Kaizen “events” or that essentially is a version (described below)
translations from the “blitzes” are intensive of PDCA. (The specific
original Japanese concept. sessions involving all steps are outlined below in
employees working on a the PDCA section.)
process to identify and
make multiple rapid
improvements. This
column describes a Kaizen
event.
Objective Test a change on a small Make small, incremental Develop a set of Reduce variability in the Increase quality and
scale before adopting it as changes that add up to standardized practices that outputs or products of a reduce de-defects/varia-
a standard practice. significant changes over maximize process speed process. tion while increasing
the longer term. (least amount of time) and process speed and
decrease waste (no efficiency
unnecessary steps).
Situations PDSA is a part of Kaizen, Any process in which • When a process is too slow When a process has Combination of situations
in which Lean and Six Sigma changes can be tested in a to meet customer needs. established “normal limits” in which it would be
the methods. All of them very limited time period. • When a process is felt to for its measurable helpful to apply both
approach entail steps to: examine be overly cumbersome due outcomes and yet the Lean and Six Sigma tools
is most the problem and its root to excess motion, people, outcomes vary more than and methods.
helpful causes and identify supplies, or time delays. what is considered to be
potential solutions (plan); within the normal limits.
test the solutions (do); The goal is to reduce the
analyze the results of the variation so all outcomes
test (study); and are within normal limits.
implement the new
process (act). On its own,
PDSA is a useful framework
for process improvement
when it is not clear
whether one of the other
approaches is indicated.

Quality Improvement Methodologies: Understanding the Differences 2

 QUALITY IMPROVEMENT METHODOLOGIES: UNDERSTANDING THE DIFFERENCES

PDCA/PDSA Kaizen Lean Six Sigma Lean Six Sigma

- Define the problem - Define the problem - Identify the problem and - Define: Articulate the
- Gather baseline data - Gather baseline data convene the team problem and convene the
- Convene the team - Convene the team - Develop a “current state” team, customer, voice of
- Create aim statement - Review current process map that the customer and critical
- Develop flow chart situation/process identifies problem areas process outputs
- Conduct root analysis - Identify root causes/key (and gather baseline data - Measure: Establish
- Identify and mistake- issues if needed) baseline process
proof solutions. - Create high impact - Conduct a root cause performance measures
- Carefully consider the solutions analysis - Analyze: Identify root
proposed solutions, - Identify causes, develop
identify problems that countermeasures hypotheses as to why
could occur, and revise - Develop an “ideal state” problems exist and prove
the solutions as needed. process map or disprove the
- Develop a workplan to - Develop a plan for hypotheses
test the changes implementation
- Develop a follow-up plan
with predicted outcomes
- Communicate with
everyone affected by the
process
Plan

- Test/Implement the - Test solutions - Implement the plan - Improve: Develop and
changes and collect data pilot test solutions then
collect data to measure
improvements.
Do

- Analyze the results - Evaluate results

according to the follow-
up plan
Study

- Do more planning and - Obtain sponsor approval - Control: Create a

testing or, once desired to install solutions Monitoring Plan to
results have been - Install solutions continue measuring the
Major Steps

obtained, institutionalize performance of the

the new process and process and develop a
monitor indicators to Response Plan in case
Act

“hold the gains” performance lags.

Quality Improvement Methodologies: Understanding the Differences 3

 QUALITY IMPROVEMENT METHODOLOGIES: UNDERSTANDING THE DIFFERENCES

PDCA/PDSA Kaizen Lean Six Sigma Lean Six Sigma

Key tools - Flowchart/Process - Value Stream Mapping - Value Stream Mapping - Voice of the Customer
- Map - Gemba Walk - Takt Time - Value Stream Mapping/
- Data Tools (e.g., run - Root Cause Analysis - Root Cause Analysis Process map
chart, Pareto chart) Tools Tools - SIPOC diagram
- Root Cause Analysis - Pareto chart - Load Balancing - Root Cause Analysis Tools
Tools (e.g., fishbone - 5S - Kanban
diagram, - 8 Wastes - Control charts
interrelationship - Kanban
diagraph, force field
analysis)

Notes on Value Stream Mapping Value Stream Mapping Value Stream

Value captures detailed readily identifies wasteful Mapping/Process Maps
Stream measurements of many steps in a process identify problems that
Mapping small improvements that, can lead to variation
when combined, can add in process outputs
up to significant
improvements.

Quality Improvement Methodologies: Understanding the Differences 4

 QUALITY IMPROVEMENT METHODOLOGIES: UNDERSTANDING THE DIFFERENCES

References

Gershon, M. “Which Process Improvement Methodology to Implement. [Link]

Methodology-to-Temple/2360292ae7eeea30d02aba080bf241e76d9e97a4 Accessed 10.18.19

Nayab, N. A Comparison of Various Quality Improvement Methodologies. [Link]

relationship-among-various-quality-improvement-tools/

Scoville R, Little K. Comparing Lean and Quality Improvement. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2014.
(Available at [Link])

Taylor, C. Comparing Improvement Methods. [Link] Accessed 10.30.19

Valencia, S. Process Improvement: Which Methodology is Best for Your Project? [Link] Accessed 10.30.19

PDSA Example

Kuber, K. Public Health Quality Improvement Exchange. Forest County Potawatomi Car Seat Safety Program. Wed, 10/09/2013 - 13:39. Available at
[Link] Accessed October 30, 2019.

Kaizen Example

Lenartz, S. Public Health Quality Improvement Exchange. Public Health Laboratory: Influenza Process Improvement Kaizen. Mon, 10/23/2017 - 15:26. Available
at [Link] Accessed October 30, 2019.

Lean Six Sigma Example

Shultz, R. Public Health Quality Improvement Exchange. Enforcing Public Health Law: Improving the Administrative Hearing Process to Reduce Staff Time. Wed,
05/28/2014 - 21:57. Available at [Link]
Accessed October 30, 2019.

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