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The Model for Improvement,* developed by Associates in Process Improvement, is a simple yet powerful tool for accelerating improvement. The model is not meant to replace change models that organizations may already be using, but rather to accelerate improvement. This model has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes. The model has two parts:
- Three fundamental questions, which can be addressed in any order.
- The Plan-Do-Study-Act (PDSA) cycle** to test and implement changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.
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Safe and Reliable Care: Improve the quality and safety of patient care on medical and surgical units
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Vitality and Teamwork: Increase the vitality and retention of nurses
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Patient-Centered Care: Engage and improve the patient’s and family members’ experience of care
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Value-Added Care Processes: Improve the effectiveness of the entire care team
These four improvement areas provide a framework for organizing and focusing the work. Additionally, they help teams to develop an aim statement, select changes for testing, and determine measures to track improvement. Other key components of transforming medical-surgical care include linking the unit’s aims to the hospital’s strategic plan and obtaining senior leadership buy-in, generating new ideas for prototype testing through “snorkel” sessions (in snorkel exercises, staff generate new and innovative ideas for a specified design challenge to target patient safety, patient- and family-centered care, staff vitality, and value-added care), adapting strategies from other industries such as manufacturing and service, adapting “best practices,” and creating a formal learning community (for example, using site visits and storyboard sessions) for shared learning and support.
Support from key hospital leaders, including the Chief Nursing Officer, Chief Medical Officer, Vice President of Patient Care, Clinical Director, and Unit Manager, is essential for transforming the medical-surgical unit.
Including the right people on a process improvement team is critical to a successful improvement effort. Teams vary in size and composition. Each organization builds teams to suit its own needs. Forming the Team
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Setting Aims
Improvement requires setting aims. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected. |
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Establishing Measures
Teams use quantitative measures to determine if a specific change actually leads to an improvement. |
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Selecting Changes
All improvement requires making changes, but not all changes result in improvement. Organizations therefore must identify the changes that are most likely to result in improvement. |
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Testing Changes
The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning. |
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Implementing Changes
After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the team can implement the change on a broader scale — for example, for an entire pilot population or on an entire unit.
Spreading Changes
After successful implementation of a change or package of changes for a pilot population or an entire unit, the team can spread the changes to other parts of the organization or in other organizations.
Sources:
*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
**The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "Check" with "Study."
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