Basic framework for quality improvement, based on three questions and then a process of learning from PDSA cycles

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What is the Model for Improvement?
The Model for Improvement is a powerful tool for accelerating improvement. It is a simple framework
that asks 3 questions and utilises PDSA (Plan, Do, Study, Act) cycles to test your changes to improve
processes. It has been adopted as the improvement framework for NHS Wales.
When would you use this framework?
The Model for Improvement framework should be used for all your improvement work as it is
comprised of core principles that should inform the change process.
Who needs to be involved?
Improvement is all about the team. Make sure that you involve all the right people in your work,
initially this may only be a small team which will expand as changes are tested and spread to other
areas.
What are the benefits of using this framework?
Using the Model for Improvement as a framework for change enables staff to achieve the goals that
they set for their services whilst avoiding those bear traps that may delay or even damage
improvement efforts. This is because the framework is comprised of core principles that underpin all
improvement work, setting an aim, measuring progress in real-time, developing creative ideas for
change and testing these via PDSA cycles. The Model for Improvement functions by melding
improvement science with local expert knowledge and experience, thus enabling staff to feel
ownership and commitment to improving the services they provide.
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2. © ABCi 2019
Running PDSA cycles
• Initial PDSA tests should start small, e.g. one clinician, one patient, one form. Adapt your test based
on what you have learnt and only spread to another two or three people once your test is successful.
• When you are planning your PDSA cycles, think about your theory, who is doing what, where and
when, document it on a PDSA form.
• Talk about what you think may happen before you do it (your prediction) and then compare the
results to your prediction, does your theory hold up or do you need to adapt it? You will learn
something about how things work in reality that you would not have known, except by testing it out.
• Record your PDSA cycles as you go (the plan, results, what you have learnt, what you plan to do next)
so you can see the results of what you have tried (this will help to build belief in your PDSA idea). It
will also help you to gather information about your systems and share this learning with others.
• Think about testing your change in different contexts with different people, there is always something
else to learn. Try to spread involvement across both clinical and non-clinical teams to obtain a range
of different perspectives.
Next Steps
Use PDSA cycles to build knowledge about your system or process and use this information in your daily
work. PDSA cycles do not operate alone, there should be a series of them leading you to achieving your
aim.
How do you use it?
Before undertaking any improvement work, you should endeavour to understand your system and any
underlying problems that are associated with it. You may do this by understanding your processes, any
patterns in your data, by canvassing opinion from patients and staff and by being clear about the
purpose of the service you are providing. The Model for Improvement is comprised of:
Setting Aims – before any improvement journey begins you need set an aim. The aim should be time-
specific and measurable (how much, by when). It should also define the specific population that will be
affected e.g. To reduce falls on ward A by 25% within 6 months.
Source: Langley GL, Nolan KM, Nolan TW, Normal CL, Provost LP. The Improvement Guide: A Practical Approach to
Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.
Establishing Measures – Clearly define (operational
definition) your key outcome and process measures
and collect data to assess progress towards
improvement. Use runcharts and control charts to
plot your improvement over time.
Selecting Changes – all improvement requires
making changes, but not all changes will result in an
improvement. It is therefore important be creative
and to build knowledge of those changes that are
most likely to result in an improvement.
Testing Changes – a PDSA cycle is how you test a
change in practice, e.g. planning it, trying it,
observing the results and acting upon what you
have learnt.