Quality improvement (QI) is a key part of improving outcomes and services. QI methodology uses cycles of change with continuous monitoring of process outcomes with methods such as Plan-Do-Study-Act (PDSA) or Six Sigma. Key to improving services is measuring outcome with high quality simple data and a local culture open to change and focusing on care quality. The Institutional Competences are addressed in ‘Who’, ’Where’, ‘When’, ‘What’ and ‘How’ need to be identified to achieve an optimal outcome for vulnerable children.

It begins with the Rights of the Child (10R) – the foundation that ensures every child is protected, respected, and cared for
in the right environment. Itis carried forward through Competence (5W) – defining’ who should care for the child, where that care should take place and ensuring the team has the training and experience
needed to deliver it safely. It is sustained by Quality (10N) – maintaining physiological balance, because even small deviations during anesthesia can
have significant consequences for a child’s outcome. And when critical moments arise, Crisis (1oC) provides structured, immediate responses – helping teams recognize,
act and protect when seconds matter most. These are not just principles. They are the building blocks of safe pediatric anesthesia – applied every day, in every
setting, for every child.
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