In college health, we often focus on the individual student — helping them manage stress, navigate mental health challenges, or access needed care. But behind every student encounter is a system: a web of workflows, policies, technologies, spaces, and cultures that shape how care is delivered. When these systems aren’t functioning well, even our best efforts can fall short.
That’s where quality improvement (QI) frameworks come in.
Structured QI frameworks offer a way to step back and evaluate not just what care we provide but how and where we provide it. By focusing on “systems and settings,” colleges can create environments that better support student wellbeing — not just in the health center, but across campus.
What do we mean by “Systems and Settings”?
“Systems” refer to the interconnected processes, structures, and people that make up a service or organization — think workflows, staffing models, communication channels, and decision-making processes.
“Settings” refer to the physical and organizational contexts in which care or health promotion happens — the health center, residence halls, dining services, or even academic advising offices.
In a campus environment, students move fluidly between settings. They may access therapy at the counseling center, seek accommodations through disability services, and attend workshops hosted by a Health Promotion Office. The better coordinated these systems are, the better the outcomes our students will achieve. The Role of Quality Improvement (QI) Frameworks
Structured QI frameworks provide tools and models to systematically assess opportunities for improvement, test solutions, and scale up what works. Two commonly used frameworks in healthcare — both adaptable to college health settings are:
- The Model for Improvement (MFI) – This approach asks three key questions:
- What are we trying to accomplish?
- How will we know a change is an improvement?
- What change can we make that will result in improvement?
It uses Plan-Do-Study-Act (PDSA) cycles to test small changes, measure results, and refine approaches before broader implementation.
- Lean and Six Sigma – These methods focus on reducing waste and variation in processes, aiming to improve efficiency, consistency, and user experience.
By applying these frameworks, college health professionals can move from reactive problem-solving to proactive systems design.
Systems change in action: An example
Let’s take a common scenario: long wait times for mental health services.
On the surface, the solution might seem simple: hire more counselors. But what if a quality improvement lens revealed deeper systems issues? Maybe:
- The intake process is inefficient.
- Students are unclear on how to access care, leading to drop-offs or no-shows.
- There’s no triage system to prioritize urgent cases.
- Clinicians spend time on administrative tasks that could be automated.
A QI team might map out the current workflow, collect data on service bottlenecks, and pilot a new triage model using a PDSA cycle. They might create cross-functional teams that include student voices to design more user-centered processes. Over time, this systems-based approach could significantly reduce wait times — and improve outcomes.
Why systems thinking matters in college health
College campuses are complex ecosystems. Students’ health outcomes aren’t shaped solely by the care they receive in clinics, but by their experiences in classrooms, residence halls, and social settings.
Structured QI frameworks help bridge those divides. For example:
- Collaborating with residence life to develop protocols for responding to student distress.
- Partnering with dining services to align food options with nutrition education.
- Working with academic departments to incorporate well-being strategies into the curriculum.
These aren’t just “add-ons.” They’re essential parts of a systems-based approach to health.
Building a culture of improvement
For QI to be successful, it has to be embedded into the culture of campus health and well-being. That means:
- Leadership support – Leaders must model and prioritize systems thinking.
- Staff training – Everyone should be equipped with basic QI skills.
- Data transparency – Sharing data on key metrics promotes accountability and shared learning.
- Student engagement – Students should be involved not just as participants but as co-designers of change.
At its core, quality improvement is about learning — not just fixing what’s broken, but continuously evolving toward better outcomes.
Moving forward
The challenges facing college health are significant — rising mental health needs, workforce shortages, financial pressures, and shifting student expectations. But by focusing on the systems and settings in which care is delivered, we can create more resilient, responsive, and equitable environments for all students. Structured QI frameworks give us the tools to make those changes thoughtfully, collaboratively, and effectively. One of my favorite resources to learn about QI is the Institute for Healthcare Improvement’s website, I encourage you to check it out.
Let’s build systems that don’t just respond to crisis — but proactively promote wellbeing, connection, and success.
Click here to subscribe and join colleagues from leading institutions who keep up with the latest trends and make informed decisions regarding student health.
Disclosure:
Wellfleet, Wellfleet Student, Wellfleet Special Risk, and Wellfleet Workplace are marketing names used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC (known in California only as Wellfleet Group, LLC dba Wellfleet Administrators, LLC). All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among states.
CSR-SHIP-MAY-2025-02
