The foundation in quality improvement work is to work systematically, what works and what does not, progressively changing the plan until it’s perfect. Initially you need to answer:
                    -	What is it that we want to accomplish? 
                    -	How do we know that a change really means improvement? Can you notice it, is it measurable?
                    -	What changes can we make that result in an improvement? List all suggestions, pick a few  processes to prioritize and focus on.
                    
                    Then commences a cycle called PDSA, every point has its own cycle. 
                    P.	PLAN – Create a plan. Process description, who does what, when and how?
                    D.	DO - Act according to the plan during a predetermined time period. 
                    S.	STUDY - Follow up, measure and analyze the result. 
                    A.	ACT – Draw conclusions, discuss what went well and what didn't work. Suggest improvements of the plan that restart from the first point. 
                    A PDSA cycle is often relatively short, about 2-20 weeks. These steps make up the foundation for quality improvement work. What a predetermined time-frame you go back to the initial three questions, list new suggestions and pick new prioritized processes to work with.