The Model For

ImprovementWhat is it?

Three fundamental questions for improvement;

1. What are we trying to accomplish?

2. How will we know that a change is an improvement?

3. What changes can we make that will result in improvement?

When you

combine the

three

questions with

the…

PDSA cycle

you get…

The Model for

Improvement

– A model for

learning and

change

G. Langley, et al The

Improvement Guide.

Jossey-Bass Publishe

San Francisco, 1996:

Question 1: Aim Statement

� What is expected to happen

� The system to be improved or the population of patients

� Specific numerical goals

� Time frame

� Guidance for activities, such as strategies for the effort, or limitations

Value of aim statements

� Answers and clarifies “What are we

trying to accomplish?

� Creates a common language to

communicate about the improvement

project

� Provides opportunity to engage others

in conversations and understanding of

the improvement work

“Some is not a number, soon is not a

time”

- Don Berwick, CEO, Institute for

Healthcare Improvement

Examples: Aim

• We aim to reduce harm and improve patient safety for all of our internal and

external customers.

• By June 2013 management requires us to reduce the incidence of pressure

injuries in A & R by 50%

• Our most recent data shows we only complete med rec on 35% of patients.

We intend to increase this average to 50% by 5/1/13.

Question 2: Measurement

• Requires measurement

• Can collect qualitative &

quantitative data

• Usually a “family” of measures

• Outcome

• Process

• Balancing

Question 3: Changes

"All improvement will require

change, but not all change

will result in improvement!”

G. Langley, et al The Improvement Guide. Jossey-Bass Publishers,

San Francisco, 1996: xxi.

Change ideas

� Key Changes for improved care based on:

• The best available evidence

• Knowledge of front line workers

• Experiences of experts

• Creative thinking

Steal shamelessly (but always acknowledge)

PDSA: Testing

• Not just one large test

• Why test?

•Increase degree of belief

•Document expectations

•Minimize resistance

•Learn and adapt

•Evaluate costs and side effects

Tips for testing

� Identify changes that will assist the team to reach goals

� Harvest good ideas and adapt them to your setting

� Solicit team members ideas

� Start with changes that are easy to test

� Collect and study useful data during each test

� Learn from ““““failed”””” tests

� Eventually test over a wide range of conditions

References / resources

• The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. G. Langley, K. Nolan, T. Nolan, C. Norman, L. Provost. Jossey-Bass Publishers., San Francisco, 1996.

• Quality Improvement Through Planned Experimentation. 2nd edition. R. Moen, T. Nolan, L. Provost, McGraw-Hill, NY, 1998.

• “Understanding Variation”, Quality Progress, Vol. 13, No. 5, T. W. Nolan and L. P. Provost, May, 1990.

• A Primer on Leading the Improvement of Systems,” Don M. Berwick, BMJ, 312: pp 619-622, 1996.

• “Accelerating the Pace of Improvement - An Interview with Thomas Nolan,” Journal of Quality Improvement, Volume 23, No. 4, The Joint Commission, April, 1997.

• http://www.IHI.org/IHI/Improvement/ImprovementMethods provides information on improvement methods, strategies, and changes

• First Do No Harm website (Falls specific)

http://www.firstdonoharm.org.nz/index.php?option=com_content&view=article&id=68:falls-and-pressure-injuries&catid=20&Itemid=257