A team quality improvement sequence for complex problems

John Øvretveit*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

27 Citations (Scopus)


To solve complex quality problems teams need to follow a systematic sequence of inquiry and action. In this article a practical description of a team quality improvement sequence (TQIS) is given based on the experience of the more successful teams in the Norwegian total quality management experiment. There are nine phases in the sequence and teams have the flexibility to choose the best quality methods for completing each phase. The strengths of the framework are in ensuring that personnel time is used cost effectively and that changes are made which result in measurable improvement. One limitation is that the framework has not been as widely tested as FOCUS- PDCA (find, organise, clarify, understand, select - plan, do, check, act) and other frameworks to which the TQIS framework is compared. It is proposed that if team projects are to be the main vehicle for quality improvement, then their work must be made more cost effective. The article aims to stimulate research into the conditions necessary for different quality teams to be successful in health care, and draws on the research to propose a 'risk of team failure index' to improve the management of such teams.

Original languageEnglish
Pages (from-to)239-246
Number of pages8
JournalQuality in Health Care
Issue number4
Publication statusPublished - Dec 1999
Externally publishedYes


  • Change
  • Evaluation
  • Improvement
  • Multidisciplinary teams


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