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The Model for Improvement provides a framework for developing, testing, and implementing changes to drive improvement, using scientific methods to balance action with careful study. It starts with three key questions:

  1. Aim: What are we trying to accomplish?
  2. Measures: How will we know if a change is an improvement?
  3. Changes: What change will lead to improvement?

The approach emphasizes knowing your goals, measuring progress, and explicitly testing changes on a small scale before widespread implementation. The Plan-Do-Study-Act (PDSA) cycle is used to rapidly test, evaluate, and refine changes, ensuring effective and efficient improvement without committing to large-scale changes prematurely.


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The Plan-Do-Study-Act (PDSA) cycle is a four-phase process used to test and implement changes in healthcare quality improvement projects. It helps teams quickly evaluate small-scale changes before implementing them broadly, ensuring more effective and efficient improvements.

  1. Plan: Identify the change to be tested, establish objectives, and decide how to measure success.
  2. Do: Implement the change on a small scale, gathering data and observations.
  3. Study: Analyze the results to determine whether the change led to improvement.
  4. Act: Based on the analysis, refine the change, standardize it if successful, or plan further tests if needed.

In healthcare, the PDSA cycle allows teams to quickly test and adapt changes, ensuring that interventions lead to better patient outcomes, improved processes, and efficient care delivery before broader implementation.


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Co-design is a collaborative approach that involves patients, healthcare providers, and other stakeholders in the design and improvement of healthcare services. It ensures that the perspectives and needs of those directly affected by healthcare processes are integrated into decision-making, leading to more effective and patient-centered improvements.

In the context of QI projects, co-design involves:

  1. Engaging stakeholders: Involving patients, caregivers, healthcare staff, and other relevant parties in the process.
  2. Identifying needs: Gathering input from stakeholders to understand the challenges and needs within the system.
  3. Collaborative design: Co-developing solutions with stakeholders to ensure the changes address real issues and are feasible.
  4. Testing and feedback: Implementing and evaluating the changes in collaboration with stakeholders, iterating based on their feedback.

By involving the people who experience and provide care, co-design helps ensure that quality improvements are practical, sustainable, and aligned with the needs of both patients and providers, leading to more effective healthcare services.


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


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Design thinking (DT) methods prioritize understanding users' perspectives, needs, and behaviors to create and test innovative solutions. These methods revolve around three key questions:

  1. Desirability: What aligns with people’s needs and preferences?
  2. Feasibility: What is technically achievable in the near future?
  3. Viability: What can support a sustainable business model?

DT emphasizes capturing the human experience within systems, uncovering unmet emotional needs that drive behavior, and designing solutions to address these needs. It also promotes team collaboration, creativity, and alignment, resulting in human-centered, emotionally resonant solutions (Crowe et al., 2022).


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Lean thinking has been adapted for healthcare to reduce organisational waste and enhance value for patients. The five core principles are:

  1. Specify value from the patient’s perspective.
  2. Map the value stream to identify and eliminate non-value-adding steps.
  3. Create smooth flow through value-added processes.
  4. Establish pull between steps to ensure efficient resource use.
  5. Pursue perfection by minimising steps, time, and information needed to serve patients.

This approach focuses on improving patient flow, minimising errors, standardising processes, and fostering team collaboration to drive continuous improvement.


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Six Sigma is a quality improvement methodology focused on reducing defects and minimising process variability. It employs statistical tools and analysis to identify and address root causes of variation. Six Sigma relies on a structured hierarchy of trained experts (e.g., Champions, Black Belts, Green Belts, Yellow Belts) to implement its quality management techniques and improve process outputs systematically.

The Six Sigma DMAIC process is a structured methodology for improving processes and enhancing quality. It stands for Define, Measure, Analyse, Improve, and Control, and is widely applicable in healthcare for quality improvement.

DMAIC Process

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


Lean Six Sigma

Lean Six Sigma combines the strengths of Lean and Six Sigma methodologies to enhance process improvement. Lean focuses on improving flow and eliminating waste for faster operations, while Six Sigma uses the DMAIC framework and statistical tools to reduce defects and minimize variation. Together, they form a data-driven approach that promotes rapid, cost-effective, and high-quality transformational improvements (NHS Institute for Innovation and Improvement, 2017).


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Human Factors involves analysng tasks, the people performing them, and their physical and socio-cultural environments to improve workplace systems. In healthcare, human factors principles enhance quality improvement by:

  • Analysing errors, near misses, and adverse events to identify root causes.
  • Designing preventive interventions and optimizing work environments, processes, and equipment.
  • Preventing medical errors proactively.
  • Enhancing efficiency, timeliness, accuracy, and reducing stress in healthcare workflows.
  • Supporting best practices and managing change during quality improvement (QI) initiatives.

The "Dirty Dozen" highlights 12 common contributors to human error and serves as a tool for identifying and addressing risk factors across industries, including healthcare.

  • Lack of Communication
  • Complacency
  • Lack of Knowledge
  • Distraction
  • Lack of Teamwork
  • Fatigue
  • Lack of Resources
  • Pressure
  • Lack of Assertiveness
  • Stress
  • Lack of Awareness
  • Norms

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Monash Health acknowledges the Traditional Custodians of the land, the Wurundjeri and Boonwurrung peoples, and we pay our respects to them, their culture and their Elders past, present and future.

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