1. The Model for Improvement Dannie Currie SIA for the SHN Atlantic Node

2. Model For Improvement *
A simple yet powerful tool for accelerating improvement
The model has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes
*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP
**The Plan-Do-Study-Act cycle was developed by W. E. Deming

3. Model For Improvement *
The model has two parts:
Three fundamental questions,
Used to establish AIM; MEASURES, AND CHANGE IDEAS.
The Plan-Do-Study-Act (PDSA) cycle** to test and implement changes in real work settings. The PDSA cycle guides the test of change to determine if the change is an improvement.
*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP
**The Plan-Do-Study-Act cycle was developed by W. E. Deming

4. Model For Improvement
Action Oriented
Trial and Learning
Leadership

5. Aim
What are you going to do?
How much?
By when?

6. Bold Aim, Firm Deadlines
Align aim with strategic goals of the organization
Write a clear and concise statement of aim
Make the target for improvement bold and unambiguous
Include deadline
Include scope, boundaries, constraints and anything else that is needed to keep the team focused

7. Bold Aim, Firm Deadlines
“Some is not a number. Soon is not a time”
Donald Berwick, MD
Institute for Healthcare Improvement

8. Measures Three Main Types : Outcome Measures Process Measures
Balancing Measures

9. Model For Improvement Outcome measures:
Are driven by the specific objectives identified in the AIM statement, e.g. # of medication discrepancies
Are understood from the consumer’s perspective eg. Reduced discrepancies
Process measures
Indicate whether a specific change is having the intended effect, e.g. % of residents with a BPMH on admission
Indicate if process changes are leading to improvements

10. Model For Improvement Balancing measures:
Are related measures to understand the impact of changes on the broader system, e.g resident/staff satisfaction
They can be the other effects of planned changes e.g. Increased admission time; decreased rework

11. Measures Choose 2-6 measures that are useful and manageable
Should be operationally defined e.g. rework
Should be integrated into clinical documentation
Include a balanced set of measures to avoid sub-optimization
Purpose is for learning not judgment

12. Measures Outcome; Process; Balancing ?
Mean number of undocumented intentional discrepancies
Mean number of unintentional discrepancies
Percentage of LTC residents reconciled on admission
Other

13. Change Concept
A general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement.
Creatively combing these change concepts with knowledge about the specific work can help generate ideas for tests of change. PDSAs are used to test the specific ideas.
Change concepts are usually at a high level of abstraction, but evoke multiple ideas for a specific process.
Examples:
Reduce handoffs
Consider all parties as part of the same system
Improve work flow
Eliminate waste
Berwick, Boushon,& Roessner, 2007

14. Aim: Assure customers do not leave bank cards behind
Change Concept
Aim: Assure customers do not leave bank cards behind

15. Aim: Assure customers do not leave bank cards behind
Change Concept
Idea: Beeping sound
Concept:
Use reminders
Aim: Assure customers do not leave bank cards behind
Idea: Beeping sound

16. Change Concept Voice reminders Electric shock Siren Concept:
Aim: Assure customers do not leave bank cards behind
Idea: Beeping sound
Concept:
Use reminders
Electric shock
Voice reminders
Siren
Based on Edward DeBono’s Concept Fan

17. Change Ideas Change Package Getting Started Kits
Creative and Critical thinking
Hunches
Best practices
Asking process users and subject matter experts for ideas
Community of Practice
Insight from research and benchmarking

18. Change
While all changes do not lead to improvement, all improvement requires change.
Berwick, Boushon,& Roessner, 2007

19. Rapid Cycle Change Cycle- A structured trial of a process change.
Plan- a specific planning phase
Do- a time to try the change and observe what happens
Study- an analysis of the results of the trial
Act- devising next steps based on analysis
One PDSA cycle should lead to the Plan of a subsequent cycle.
Berwick, Boushon,& Roessner, 2007

20. Moving From Testing to Implementing
Changes Result in Improvement A P S D
Learning From Data A P S D
Implementation of Change A P S D
Wide Scale tests of change A P S D
Follow up tests
Change Ideas
Very Small test

21. Rapid Cycle Change
Initiation of Rapid Cycle tests is dependent on getting the first test of change started
Do Not try to Perfect the change then implement…consider your work a masterpiece in progress
Failure is a great Opportunity to plan to do better next time…
Frequency of Testing determines the speed of the process improvement ie daily testing = improvement in weeks; weekly = improvement in 3-4 months

22. Model for improvement Act Plan Study Do Aims Measurement Change Ideas
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will
result in an improvement?
Aims
Measurement
Change Ideas
Act
Plan
Study Do
Trial & Learning
Langley, Nolan et al 1996

23. Acknowledgements
Berwick, D.,Boushon, B., & Roessner, J.(2007). “The Improvement Model,: A Powerful Engine for Change” IHI Web Based Training at:
Harris, B. (2007). Change Concepts.
Murray, M (2006). “Small Steps, Big Changes” workshop.
Reasear, R. (2007). Institute for Healthcare Improvement “Designing Reliability Into Healthcare Processes: Based on the work of the Institute for Healthcare Improvement Innovation”