The South Dakota Quality Improvement Toolkit can help you get familiar with quality improvement processes as a way of improving clinical quality. This toolkit was created through a partnership between the South Dakota Department of Health and the South Dakota Cardiovascular Collaborative.

Quality improvement, or QI (also known as continuous quality improvement or quality management), is an organizational approach to managing and improving the systems that support the work of an organization. It focuses on creating system-level changes so that the organization’s work meets or exceeds the needs and expectations of everyone who depends on that work.

“This toolkit describes a step-by-step general quality improvement approach that is easily adaptable to any QI effort in any type of organization.”

Find key resources that explain what QI is and information and tools to assist with implementing QI strategies. While many of the examples are related to cardiovascular disease, quality improvement initiatives can be applied to any process or condition where improvements are needed.

Step-By-Step Quality Improvement

Decide whether you and your organization should take a lead in cardiovascular care quality improvement efforts, and outline your tasks in leading this QI effort.

Lay the Groundwork

Identifying the opportunity will allow the team to gain a clear and common understanding of the destination. Objectives include:

  • Describing the current process in your organization.
  • Defining the charge of the QI team.
  • Introducing the team and establishing roles.
  • Seeking consensus on the opportunity statement.

Identify Opportunity

Some data will be needed to gain an understanding of the issues with the current care system that are impeding optimal cardiovascular care. This step will provide the team with a foundation on which to proceed. It will also supply comparative data for evaluating the benefits of any changes the team makes.

Collect Data

By translating the data collected into useful information, the team will be able to make key observations about the process they are focusing on and determine the root causes. 

Analyze the Data

Select an approach for making changes that will address the root causes you identified in Step 3. The team will have to decide the scope and direction needed to make improvements.

Choose an Approach

Build your proposed approach into a workable process that leads to systematic improvements, and test your plan. These are the kind of changes that have a good chance of working long-term. In Step 5 you will outline the improvement process(es), and test and refine them in preparation for implementation.

Implement the Plan

After monitoring the implementation of your improvements in your pilot test, you will have some sense of the short-term results of your changes. Confirm your observations by thoroughly assessing the impact of the changes and whether the desired outcomes are being achieved.

Evaluate the Plan

If your team determined the improvement was a success during the pilot phase, you will want to implement it widely across the entire system. 

If your team determined the plan did not result in the improvements you were hoping for, you will need to go back to Step 4 and begin the process over again.

Improve the Plan

The true test of system change is whether it can be sustained over time. Too often teams assume that once an improvement has been successfully implemented, nothing more needs to be done. 

QI should become a standard operating procedure, incorporating it as a way of moving forward, expanding to other areas of opportunity, and holding your gains.

Hold the Gains


  • Find more resources and webinars in the QI Resource Guide.
    Access Resource Guide & Webinars

  • Browse QI appendices with further guidance on meeting templates, managing techniques, and more.
    Browse Appendices

  • Access resources to help guide your quality improvement efforts. Find additional initiatives, other helpful QI methods, and specific South Dakota cardiovascular health and QI organizations.
    Find Additional Resources

Case Studies

These case studies break down how specific healthcare teams in South Dakota implemented quality improvement steps at their own facilities.