In any given organization, adherence to authority structure is critical for an effective management and control of organization functions. Therefore, the implementation of the quality improvement plan will require adequate authorization by the board of directors and organization’s leadership.

• Board of directors. The board of directors will determine the viability of the quality improvement plan through determination of whether the quality improvement plan will have significant short-term and long-term benefits. This will be done to evaluate the implementation and maintenance costs. When the board is adequately satisfied, it will give authorization to the executive leadership for the implementation of the quality improvement plan.
• Executive leadership. Once the board has approved the implementation of a quality improvement plan, the executive leadership will determine the implementation parameters including duration and costs.
• Quality improvement committee. The committee is given the responsibility to develop the strategy for quality improvement. Therefore, it has authority in identifying quality improvement areas and giving appropriate recommendations for implementation. Furthermore, the committee has authority to oversee the implementation phase to completion.
• Medical staff. The organization’s medical staff will have the authority to test the new system and give recommendations for improvement to the quality improvement committee.
• Middle management department staff. This group will have the authority to maintain and ensure that the new system is fully functional while executing routine maintenance tasks.

The direct users will predict the outcomes of the performance activity; they include nurses, physicians, and clinicians. Therefore, their observations, experiences, and outcomes of the new system will be communicated to the quality improvement committee. The committee will evaluate user feedback and determine whether performance is optimal or further improvements are required.

The implementation of the quality improvement plan requires adequate training on the part of direct users of the new system. Therefore, prior to the implementation of the quality improvement plan, respective employees and staff should be trained on the impending quality improvement, and any expected changes will be explained. This will ensure that staff and employees are not caught unaware or are unable to function accordingly.

Once the change has been implemented, the staff and employees will be trained on how to use or operate the new system in a progressive manner. The implementation of quality improvement might have made significant changes to the system and mode of operations. Therefore, education on how to use the new system is essential; this can be done before initial use of the improved system or during routine operations.

The effectiveness of the quality improvement plan will be evaluated annually to determine its impact on performance, morale, and outcomes. As such, the annual evaluation of the new system will aim at determining the impact of the new system in improving health care service delivery, efficiency of operations in the organization, and outcomes observed after its implementation. This evaluation will determine to what extent the new system contributes towards the realization of organizational goals.

External agencies have a great impact in the implementation of a quality improvement plan because the changes may influence them in one way or another. For instance, government agencies have a stake in the implementation of a quality improvement plan because they determine the parameters within which a healthcare organization is expected to operate. Therefore, government agencies contribute towards the development of initiatives and best practices programs. These enable healthcare organizations to make appropriate decisions on the quality improvements that are required as per the provisions of the respective government agencies.

Professional interest groups ensure the contribution towards the implementation of quality improvement plans regarding professional improvements and best practices that aim at improving the efficiency of the organization's employees and staff. Therefore, they identify areas of professional conduct, workplace policies and new methods of conducting various tasks and recommending their implementation to the quality improvement committee.

These groups are critical since they influence decision making processes developing standards and policies which the healthcare organization and its staff is obliged to implement. Therefore, any initiative for the implementation of a quality improvement plan must consider the recommendations and provisions stipulated by such external bodies.