Continuous quality improvement: An ongoing effort to improve the efficiency, effectiveness, quality, or performance of services, processes, capacities, outcomes. These efforts can seek “incremental” improvement over time or “breakthrough” improvement all at once. Among the most widely used tools for continuous improvement is a four-step quality model, the Plan-Do-Check-Act (PDCA) cycle. ~ (National Public Health Performance Standards Program, Acronyms, Glossary and Reference Terms, CDC, 2007)