Continuous Quality Improvement (CQI)

In the healthcare system, there are always opportunities to optimize, streamline, develop and test processes. Quality improvement (QI) is a proven, effective way to improve care for patients, residents, and clients, and improve practice for staff[1]. QI utilizes structured improvement methods and models, such as Model for Improvement and a testing model called Plan-Do-Study-Act[2] (PDSA, see Figure 1 below). The principles of CQI involve using the PDSA cycles to continuously improve an aspect of practice.


  • Residents may partake in CQI projects as a continuation of the R1 project or as a new project, where you gather data after implementing a quality improvement intervention and measure whether that intervention has had its desired effect in practice.
  • Examples:
    • E.g. interviewing patient experience before and after implementation of increased time allocation in doctor’s office
    • E.g. number of healthcare associated infections before and after implementation of hand hygiene posters in hospital



The goal of CQI is to learn how to identify and address safety, efficiency and/or quality concerns in practice.

Eligible projects should meet all the requirements for a Resident Scholar Project (see Requirements) in addition to the following criteria.

  1. Evidence-based: A thorough health literature search must be undertaken to find evidence for and against the performance standard and the improvement plan. This evidence should be summarized in the written report.
  2. Evaluative: An evaluation of the Quality Improvement Project must be included. This means evaluating the practice before the improvement is implemented and repeating the evaluation at a reasonable time afterwards with a summary and comparison of the results.


Method and Written Report Guidelines

(based on instructions for authors, Canadian Family Physician journal, July 12, 2011)

 Continuous Quality Improvement (CQI)

Manuscripts must be prepared in accordance with the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals” available on the International Committee of Medical Journal Editors (ICMJE) website.

Data request/Resident Access Residents may request access to Family Practice resident data or request access to fellow family practice residents (e.g. distribute surveys, conduct interviews) for their resident scholar project.

 Please review the guidelines under ‘Data request/Resident Access’ and submit completed Data request/Resident access application form to Data Concierge Committee. For all other inquiries related to Data request/Resident access please contact the Data Concierge Committee at:


Abstract: Include Introduction (problem being addressed and objective of program), Description, Evaluation and Conclusion and should not exceed 300 words. Up to 4 key words (MeSH headings) should be included.

CQI studies should not exceed 2500 words, excluding abstract, tables and references.

Introduction: Clearly state the problem being addressed and why it is important to family physicians. Specific objectives of the program should be described and appropriate literature should be cited concisely.

Description: Provide sufficient detail for someone else to reproduce it. The original problem should be addressed by the program. A concise evaluation of the program should be described along with any data available.

Evaluation: Data should be presented concisely. Choice of mode of program evaluation (e.g. logic model, etc) should be justified and described.

Discussion: Compare the program with others in the field and indicate why it is an improvement over existing programs.

Limitations: Planned improvements should be presented. Conclusion should summarize the main components of the program, relate to the problem addressed, and be justified by the information presented.

References: Must be current and complete. Check references for accuracy, completeness, and proper format (according to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals; References should be numbered in the order they appear in the text and should be limited to works cited in the article. List all authors when there are 6 or fewer; when there are 7 or more, list the first 6, followed by et al.

Key Points: Include a short, point-form “key points” section including 1 to 4 points in 50 to 100 words. Key points should not duplicate the abstract or summarize the article; they should highlight what is new, different, unexpected or surprising in the article.

Tables and figures: Attached separately from the main manuscript. Tables and figures should clarify and supplement, but not duplicate, the text. Tables must be self-explanatory and concise. Prepare each table or figure on a separate page. Give titles to tables and captions to figures and other illustrations. Ensure that all tables, figures, and illustrations are cited at appropriate places in the text. Prepare tables in Word; not in spreadsheets. Use table structure, not spaces and tabs to format tables.

Images and any other visual material: Attach as separate electronic files (do not paste them into the manuscript). These may include photographs, digital illustrations or extra photographs for use if space is available. Images should be sent in a JPG file format.

Authorship: Include a description in written report of what each resident/author contributed to their Resident Scholar Project. In addition, if several residents are involved in one Resident Scholar Project, include a statement to describe the processes they underwent to decide the order of the authors on the Resident Scholar Project written report.

Acknowledgements: Name everyone (e.g. faculty, professionals, research assistants) who contributed to the work of the Resident Scholar Project who are not authors in the Acknowledgements section, describing what they did. Also, describe all financial support of the Resident Project in the acknowledgements.


Guidelines for Authorship and Acknowledgements

Please follow the latest authorship definition provided by the Uniform Requirements for Manuscripts Submitted to Biomedical Journals listed below from the website: as follows:

“All persons designated as authors should qualify for authorship, and all those who qualify should be listed. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. One or more authors should take responsibility for the integrity of the work as a whole, from inception to published article. Authorship credit should be based only on 1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published. Conditions 1, 2, and 3 must all be met. Acquisition of funding, the collection of data, or general supervision of the research group, by themselves, do not justify authorship.”

In addition, all residents and faculty should refer to the Department of Family Practice Authorship and Collaboration policy that was approved by the Post-Graduate Education Committee in 2003. This policy guides the order of authors for faculty and residents who work together on a Resident Scholar Project.

[1] Health Quality Ontario, “Quality Improvement Guide 2012”

[2] Langley, Nolan, Nolan, Norman, Provost. The improvement guide: A practical approach to enhancing organizational performance. San Francisco: Jossey-Bass, 1996