The Model for Improvement

Making improvements to products, systems or services requires change. Although change can seem threatening or overwhelming for busy people, it can be successfully managed if well planned. The Model for Improvement* provides a framework for developing, testing and implementing changes. It helps to break down the change effort into small, manageable chunks which are then tested to ensure that things are improving and that no effort is wasted. It is always worth remembering that while every improvement is certainly a change, every change is not an improvement.

The Model for Improvement consists of two equal parts; the first part, the "thinking part", consists of three fundamental questions to guide improvement work:

  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 an improvement?

 

Model for Improvement Example  

What are we trying to accomplish? (Goal)

Our goal is: to ensure that we have an up to date and accurate register of patients with CHD

How will we know that a change is an improvement? (Measures)

We will measure:

  • the number of patients on the CHD register before the improvement effort
  • The number of patients on the CHD register after the improvement effort

What changes can we make that will lead to an improvement? (Ideas)

Ideas for change:

  • review patient lists with GPs to identify deceased patients
  • check for inactive patients with CHD who have not been to the practice in over 2 years
  • search for patients on CHD medication

The second part, the "doing part", is made up of rapid, small Plan, Do, Study, Act (PDSA) cycles to test and implement change in real work settings. The PDSA cycle provides a framework for testing ideas and assessing the results to determine if the change is an improvement.

 

What is a PDSA?

PDSA (Plan, Do, Study, Act) Is a model for testing ideas that you think may create an improvement. It can be used to test ideas for improvement quickly and easily based on existing ideas, research, feedback, theory, review, audit, etc or practical ideas that have been proven to work elsewhere.

The answer (or answers) to the third fundamental question "What changes can we make that will result in an improvement?" will form the 'Change Ideas' (or objective) to lead each PDSA. It is important to remember that a number of PDSA cycles may be required to take a project from start to finish.

 

PDSA Example

Idea: Identify deceased patients from the practice's medical software

Plan - What: Run a search of database for CHD patients and give each GP a copy of the register to identify  deceased patients. Who: Kathy. When: Friday 21st Feb. Where: at the practice. Prediction: That a number of deceased patients will be identified for removal. Data to be collected: List of deceased patients to be removed from the register.

Do - Plan was completed

Study - 42 patients were identified as deceased. GPs were surprised to see they were still 'active' on the system.

Act - Kathy to inactivate the patients in the practice's medical software and hence remove them form the register.

You can continue to use PDSA cycles to test ideas from the 3rd fundamental question until you are satisfied that you have achieved your goal.

 

Model for Improvement templates

Click here to open and download the Model for Improvement Guide for the Access, Diabetes and CHD topics

Click here to open and download the Model for Improvement Guide for the COPD & CDPSM topics

 

*Langley, Nolan, Nolan, Norman & Provost (1996) "The Improvement Guide" Jossey Bass, USA.


 

Last Updated 11 March 2010