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The Model for Improvement was developed by Associates in Process Improvement. 

Why use the Model for Improvement?

"The model for improvement provides a framework for developing, testing and implementing changes leading to improvement. It is based in scientific method and moderates the impulse to take immediate action with the wisdom of careful study." (NHS, n.d.)

Model for Improvement

The Model for Improvement begins with three key questions:

1.      Aim: What are we trying to accomplish?

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

3.      Changes: What change can we make that will result in improvement?

"When planning any improvement or change to work processes, it is essential to know what you want to achieve, how you will measure improvement and to be explicit about the idea to be tested. You may not get the results you expect so it is safer and more effective to test out improvements on a small scale before implementing them across the board." (NHS, n.d.)

Plan-Do-Study-Act Cycle

After establishing the changes, applying the Plan-Do-Study-Act (PDSA) cycle helps to develop, test and implement changes. The four-phase process is a way to quickly test changes as necessary, and then test again – before implementing anything on a broad scale. Instead of spending weeks or months planning out a comprehensive change, then putting it into practice, only to find that it’s fundamentally flawed, the PDSA cycle enables rapid testing and learning.

Image: Associates in Process Improvement. (n.d.). https://www.apiweb.org/

What is the model for improvement? (3 mins)

This brief clip from the Institute for Healthcare Improvement introduces the Model for Improvement and PDSA cycles.

Visit the IHI YouTube channel to view more videos.

IHI on YouTube

PDSA Cycles

 More information about each phase of the Plan-Do-Study-Act cycle can be found in the image below. Visit the Getting Started page for toolkits and templates.

Principles and Models of Quality Improvement: Plan-Do-Study-Act | Anesthesia Key

The PDSA Cycle: Part 2 (3 mins 48 secs)

This video demonstrates how you would use a PDSA cycle to improve discharge planning as part of a hypothetical improvement project. From the Institute for Healthcare Improvement's Open School.

PDSA cycles are often run sequentially, so that knowledge gained over time can be used to refine each subsequent cycle until the aim is achieved.

Image: https://wcwpds.wisc.edu/organizational-development/organizational-process-improvement/plan-do-study-act-pdsa-collaborative/stage-5-act/

Further reading

What is co-design?

Put simply, co-design involves partnering with those who have direct experience with the problem that you are trying to solve. The principles below guide co-design in healthcare. 

"1. There is an equal and reciprocal relationship between all stakeholders, enabling them to design and deliver services in partnership with one another.
2. Planning, designing and producing services with people that have experience of the problem or service means the final solution is more likely to meet their needs.
3. This way of working demonstrates a shift from seeking involvement or participation after an agenda has already been set, to seeking consumer and clinician leadership from the outset so that consumers and clinicians are involved in defining the problem and designing the solution."

-- Agency for Clinical Innovation. (n.d.). What is co-design? https://aci.health.nsw.gov.au/projects/co-design

 

What is co-design?

Image: Metro North Health. (n.d.). https://metronorth.health.qld.gov.au/get-involved/co-design/what-is-co-design

Monash Health frameworks

Below are links to download relevant documents directly from PROMPT. These links will only work while onsite or via Citrix while offsite. Login with your Monash Health username and password when prompted.

Consumer, Carer and Community Partnerships Framework

Health Literacy Framework

Co-Design 101 (1 min 25 secs)

This short video from VicHealth explains what co-design is and its benefits.

Further reading

Resources & toolkits

What is design thinking (DT)?

Design thinking methods focus on understanding users' perspectives, needs, and behaviours, and taking these into account when designing and testing creative solutions. It asks three core questions:

  • Desirability: What makes sense to people and for people?
  • Feasibility: What is technically possible within the foreseeable future?
  • Viability: What is likely to become part of a sustainable business model?
     

 

Image on left: B. McWeeney. (2017). https://medium.theuxblog.com/my-user-centered-design-mashup-defining-process-and-communicating-value-65df72f5648a
Image on right: S. Abookire et al. (2020). https://www.frontiersin.org/articles/10.3389/fpubh.2020.00459/full

 

"...DT methods are specifically designed to capture the human perspective in a system, generating deep insights into how users feel and act, identifying unmet emotional needs that drive behaviour and designing solutions directly addressing those needs. Moreover, DT methods foster dialogue and creativity among teams in powerful ways, leading to better alignment around the contribution of emotions and behaviours to systems issues and generating human-centred solutions." (Crowe et al., 2022, p. 70)

Design thinking for quality improvement (22 mins 10 secs)

In this webinar from the California Primary Care Association, Stephen Horan, PhD, introduces design thinking and demonstrates how it can be used to improve healthcare quality.

Recommended resources

What is Lean thinking?

The principles behind Lean thinking arose from the Toyota Production System, developed by Toyota in the 1950s, but are thought to apply to all industries including healthcare. In healthcare, Lean thinking aims to identify all possible sources of organisational 'waste' and eliminate anything that does not add value for patients (NEJM, 2018).

The Five Principles of Lean

The University of Cambridge (n.d.) describes the principles of Lean thinking in healthcare.

"Lean thinking is founded on five principles designed to:

  • Specify the value desired by the patient,
  • Map the value stream and identify those steps that do not create value,
  • Create a smooth flow through the value-added steps,
  • Establish pull between the steps,
  • Seek perfection so that the number of steps and the amount of time and information needed to serve the patient are minimised.

In essence, it focuses on improving patient flow, reducing opportunities for error, developing standards and engaging teams in improvement...". 
 

Image source: University of Cambridge. (n.d.). Lean Thinking.

The Eight Wastes of Lean

Lean methodology seeks to minimise 8 areas of waste, as illustrated in the image below (NEJM, 2018).

Image source: NEJM Catalyst. (2018). The Eight Wastes of Lean. What is Lean healthcare?

Recommended resources

  • Examples of applying Lean thinking in healthcare
  • Questions & activities to support Lean improvement

What is Six Sigma?

"Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in processes. It uses a set of quality management methods and creates a special infrastructure of people within the organization who are experts in these methods ("Champions," "Black Belts," "Green Belts," "Yellow Belts," etc.). ... A key focus of Six Sigma is the use of statistical tools and analysis to identify and correct the root causes of variation." (AHRQ, n.d.)

Six Sigma's DMAIC Process 

DMAIC Process

Image source: https://www.sixsigmaonline.org/six-sigma-decision-making/

Lean Six Sigma

Lean thinking and Six Sigma are increasingly used in conjunction with one another, drawing on the strengths in each approach. This combination is known as Lean Six Sigma. The NHS Institute for Innovation and Improvement discusses their approach to Lean Six Sigma in their white paper.

"Lean is an approach that seeks to improve flow in the value stream and eliminate waste. It’s about doing things quickly. Six Sigma uses a powerful framework (DMAIC) and statistical tools to uncover root causes to understand and reduce variation. It’s about doing things right (defect free). A combination of both provides an over-arching improvement philosophy that incorporates powerful data-driven tools to solve problems and create rapid transformational improvement at lower cost." (NHS Institute for Innovation and Improvement, 2017)

Recommended resources on Lean Six Sigma

   

View more eBooks & books

What is human factors?

'Human Factors is about looking at a task you are doing, observing the person doing that task and the physical and socio-cultural environment that person is doing the task in. Essentially, it is “using observation to gather information to improve workplaces” ...' (ACHS, n.d.)

Human factors & quality improvement

In healthcare, human factors theories, principles, and methods can be applied to quality improvement through:  

  • The analysis of errors, near misses, and adverse events, to understand causal and contributory factors better.
  • The development of preventive interventions in response to an error or an adverse event, and through design of improved work environments, processes, and equipment.
  • Proactive prevention of medical errors.
  • Improvement in efficiency, timeliness, and accuracy of work processes in health care, and decrease in stress.
  • Implementation of best practices or potentially better practices, and change management during QI projects.

(Handyside & Suresh, 2010)

The Dirty Dozen

The 'Dirty Dozen' refers to 12 common preconditions for human error. They were identified by Gordon Dupont, an aircraft maintenance engineer and accident investigator, and have since spread to industries outside of aviation.  

Human factors in aviation maintenance, naviminds critical industries human resource training

Image source: https://naviminds.com/dirty-dozen-aviation/

Recommended resources

Human Factors and the Dirty Dozen (10 mins 21 secs)

This video from the NSW Clinical Excellence Commission provides an overview of human factors, the Dirty Dozen, and some strategies to combat them.

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