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January 31, 2019

By Tim Koba, MS, ATC

“Quality improvement (QI) is a systematic, formal approach to the analysis of practice performance and efforts to improve performance.”1 Adopting a QI process involves an assessment of where the practice is and the identification of future goals with actionable steps. When QI was brought to Greenville, South Carolina schools, the goal was to examine the patterns of injuries seen in the school, what treatments were performed and the identification of trends regarding the needs of the athletes and the access to care.2

In order to accomplish their goals, the team collected and reviewed past athletic injury data leading to a baseline of athletic participants, injuries, treatments and referrals.2 Once the data was collected it was able to be evaluated to identify areas where improvements could be made, such as overuse injuries. Based on their data, they determined that males had the greatest incidence of injuries and the 5 sports with the most injuries were football, basketball, soccer, wrestling and track. The implementation of their QI process was a 22% reduction in injuries and a 50% reduction in school healthcare premium costs.

The process utilized by the authors had 6 steps:

1. Identify the problem

2. Collect data

3. Implement the improvement

4. Collect data

5. Analyze the data

6. Provide feedback with the improvement results.

In order to have a successful improvement process, the hospital system collaborated with the school Athletic Trainers (ATs), coaches and administration to foster strong communication and build relationships.

The successful implementation of a QI process underscores the importance of having strong relationships that incorporate the role of the AT as a member of the healthcare team. By initiating injury prevention programs, collaborating with coaches and improving treatments, the athletes had improvements in their outcomes. The financial success of the reduction in healthcare premiums also addresses one of the main concerns that Athletic Directors have in hiring ATs, cost.3

Other school districts, ATs and clinics can also adopt their own QI process to improve care. The keys to success are documenting injuries that lead to data collection and analysis with communication occurring between administrations, coaches and ATs. As ATs are a primary source of care, their role is expanded to actively engage in the improvement process to reduce injuries and costs and improve care, which is something all ATs are devoted to.


1. American Academy of Family Physicians. (2018). Basics of quality improvement.

2. Shanley, E., et al. (2018). Athletic trainers’ effect on population health: Improving access to and quality of care. Journal of Athletic Training, 53(11).

3. Mazerolle, S, M., Raso, S. R., Pagnotta, K, D., Stearns, R. L. & Casa, D. J. (2015). Athletic directors’ barriers to hiring athletic trainers in high schools. Journal of Athletic Training, 50(10), 1059-1068.


About the Author

Koba 1

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.
