"Continuous Quality Improvement" or "CQI" means a method of evaluation that is composed of structure, process, and outcome evaluations which focus on improvement efforts to identify root causes of problems, intervene to reduce or eliminate these causes, and take steps to correct the process. With its proactive systems evaluation approach, CQI at Sacramento Metropolitan Fire District has changed the way quality of service is assessed and improved. CQI recognizes that the majority of problems result from a failure in the process of providing the service, as opposed to being attributable to the providers themselves.

The American River College EMS Training Program and the Peer Review Committee are the driving forces behind the Continuous Quality Improvement Process at Sacramento Metropolitan Fire District. The Peer Review Committee reviews all PCRs (Patient Care Reports) produced by district personnel and identifies individual, agency, and system trends. The committee then works as a team in helping to reduce or eliminate any actions or items that do meet district standards.

Rather than focusing on individual problems or working in a crisis management mode, CQI focuses on providing quality service that meets the customer's needs by emphasizing Prospective Training and identifying System Issues. The review and work in the CQI process involves Prospective, Immediate, and Retrospective supervision and review.

The essence of the CQI Process at Sacramento Metropolitan Fire District is proactive training, immediate and proactive feedback, and non-punitive respective review of medical care delivered by District Personnel leading to constant review and improvement of EMS Policies and Procedures. This process is successful only through the cooperation of management and line personnel (Team Effort) working to improve the system.