Keeping Improvement Simple

After a break from posting over the Christmas period, we wanted to make the first blog of 2016 something that is simple and digestible; but also something that we hope will be really useful for everyone involved in quality improvement (QI).

The start of a new year is also a good time to see things with a fresh pair of eyes, so if you have an idea for an improvement and you are just starting your QI journey, we hope this will be helpful too.


We have been running a number of QI Open Sessions in the organisation since November 2015 and we have now had over 50 members of staff attend these half-day sessions. (The dates for January and February can be found here)

We have been using the sessions to talk about why we should do QI, how to get started; as well as the importance of keeping the improvement methodology simple.

Healthcare is a complex environment to do quality improvement in and the multi-professional and multifaceted workforce can sometimes make the ‘human side of change’ challenging.  With this in mind, we have been trying to emphasise that, whatever the size of the change or improvement we are trying to make, we shouldn’t be over-complicating the methodology.  In fact we should be looking for every opportunity to simplify it.

By far the most simple and effective tool for accelerating improvement, and the one we have been teaching in our QI open sessions, is the Model for Improvement (as developed by Associates in Process Improvement).

The Model for Improvement

The model is used extensively in a number of healthcare and other organisations and it is also the go-to tool for the Institute for Healthcare Improvement (IHI) who say that the model is “not meant to replace change models that organizations may already be using, but rather to accelerate improvement”.

The model has two parts – i) Three fundamental questions; and ii) The Plan-Do-Study-Act (PDSA) cycle that is used to test changes in the real world

Model for improvement

The Three Fundamental Questions

Question 1 – What are we trying to improve? (Here we are setting an aim)
If we have identified a problem by getting to the root-cause we should be able to define what we are going to improve, and then set our aim.  The aim should be time-specific and measurable.

Question 2 – How will we know if we are making an improvement? (Here we are establishing our measures)
Once we have set our aim, we need to establish measures to know if the changes we make lead to an improvement.  Use quantitative measures to determine if a specific change actually leads to an improvement.

Question 3 – What changes can we test to make the improvement? (Here we are selecting our changes)
Ideas for change can come from many different sources, including those who work in the system or from borrowing from the experience of others who have successfully improved.

The Plan-Do-Study-Act (PDSA) cycle

Using the PDSA cycle is about testing changes in the real world.  Testing the change by planning it, trying it, observing the results, and acting on what is learned.

There are some handy tips for applying the model for improvement here and we would be really happy to help and advise anyone who is interested in trying this approach.

The IHI have also created some short whiteboard videos that explain the Model for Improvement in more detail and the introductory video is here.


The best way to learn the Model for Improvement is to use it.  By starting with small, incremental changes we can get better at making improvements; start to be more curious about what more we could improve around us; and hopefully start to spread the learning too.

If you would like to start the new year with an idea for improvement, or a change that you would like support with, you can use the change portal here.

We hope this is useful and please let us know what you think in the comments section below.

Thanks,

Mark – @MarkH_Work


2 thoughts on “Keeping Improvement Simple

  1. I have to admit I’m definitely guilty of over complicating things. This blog lays out how simple it is to begin making an improvement and that when it comes to the methodology ‘we should be looking for every opportunity to simplify it.’ I definitely agree with the notion that ‘by starting with small, incremental changes we can get better at making improvements.’
    It starts with an idea, and I look forward to using the PDSA cycle on an improvement idea I have.
    Thought provoking and insightful – great blog.
    #justdoit #keepitsimple

    1. Thanks Amara.
      Glad you agree and we will continue to spread the word about keeping-it-simple!
      Look forward to hearing about any ideas for QI that you may have or ideas that you can support others with.
      Thanks again.
      Mark

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