1. IHI Breakthrough Series (6 to 18 Months Time Frame) Select Topic (Develop Mission) Planning Group Develop Framework & Changes Participants (10-100 Teams) Prework LS 1 P S AD P S AD LS 3 LS 2 Supports Email Phone Conferences Extranet Visits Assessments Sponsors Monthly Team Reports Dissemination Publications, Congress, etc. AD P S Expert Meeting AP1AP2 AP3* LS – Learning Session AP – Action Period *AP3 – continue reporting data as needed to document success Holding the Gains

2. Degree of belief that the changes will result in improvement High Getting Ideas Idealized Design or other methods Testing: Prototype (in simulated environment) or Pilot (in work setting) Spread Adapt to new locations or populations Successful changes Unsuccessful proposed changes Low Moder- ate When Are We Ready To Run a BTS Collaborative? Start a Collaborative when degree of belief is moderate to high Adapted from IG Pg 145 Implement: Make the change a permanent part of the system in location where testing

3. Relationship Between Factor Ratings and % 4’s in BTS Seven Factors Rated 1-5 (Score of 21 = Middle ratings of factor) Great Change Package Measures that Work Focused topic Results focused chair, faculty Individualized support Leverage Early Adopters Teams are motivated Worst 9 performing BTS’s Best 9 performing BTS’s = 3 Collaboratives 4 = Significant improvement on BTS assessment scale