Performance improvement (PI) is a continuous, cyclical process. The model shown identifies an opportunity for improvement but omits the critical subsequent steps of implementing a change and then reassessing its effectiveness. A complete PI cycle, such as the widely used Plan-Do-Check-Act (PDCA) model, requires that after an improvement is implemented (the "Do" phase), its results must be monitored and evaluated ("Check" phase) to determine if the desired outcome was achieved. This reassessment is essential to validate the change before the cycle repeats. The provided model lacks this explicit reassessment step.

A. are missing a step requiring regular employee input into the process.

While employee input is a best practice for successful PI, it is not considered a discrete, mandatory step in foundational PI models themselves.

B. are missing a step requiring reporting to the board of directors.

Reporting is a communication or governance function that is an output of the PI process, not a core operational step within the improvement cycle.

D. aren't missing any steps; the model is a good one.

The model is fundamentally incomplete because it fails to include the implementation of a solution and the subsequent evaluation of that solution's effectiveness.

1. Sayles

N. B.

& Trawick

M. H. (2021). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In Chapter 25

"Quality and Performance Improvement

" the text describes the PDCA (Plan-Do-Check-Act) cycle

emphasizing that after implementing a change ("Do")

the organization must "Check" the results and "Act" on the findings. The model in the question omits these crucial "Do

" "Check

" and "Act" components

which are encompassed by the concept of ongoing monitoring and reassessment of an implemented change.

2. Agency for Healthcare Research and Quality (AHRQ). (2020

January). Plan-Do-Study-Act (PDSA) Cycle. U.S. Department of Health & Human Services. Retrieved from https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html. This official resource outlines the standard four-stage cycle for improvement. It explicitly states that the "Study" (or Check) phase involves analyzing data to determine if the change was effective

a step of reassessment missing from the question's diagram.

3. McLaughlin

C. P.

& Kaluzny

A. D. (2006). Continuous Quality Improvement in Health Care: Theory

Implementations

and Applications (3rd ed.). Jones and Bartlett Publishers. Chapter 4

"Tools and Techniques for Continuous Improvement

" details the Shewhart Cycle (PDCA)

noting that the cycle is not complete without studying the results of a test (Check/Study) and taking action based on those results (Act). This confirms the need for a reassessment phase.