The process improvement quality system essential details the processes for identifying opportunities for improvement and assessing the effectiveness of implemented improvement solutions. Process improvement can be a heavy lift for clinical laboratory personnel. It requires time and energy away from routine work, and it introduces change to the laboratory environment on a routine basis. A written process improvement plan should be developed as part of the process improvement program. The quality indicators assessed as part of process improvement will include the same indicators used for assessment, and any others the laboratory develops that are reliable, measurable, trackable, actionable, and relevant to the process being assessed. Fishbone diagram analysis may also be referred to as a cause-effect analysis. It can be used reactively in a root cause analysis, as well as proactively to brainstorm during process improvement.