Quality Improvement Zone

The model for improvement is a simple framework for accelerating improvement. The model has two key components:

• 3 fundamental questions that help teams define what they want to achieve, how they will measure success and what changes they could make.
• the Plan-Do-Study-Act (PDSA) cycle, which provides a structured approach for testing changes and learning from the results.

Together, the three questions and the PDSA cycle create a framework for continuous improvement.

An improvement team would use the tool as a framework for applying the five fundamental principles of improvement:

1. Knowing why there is a need to improve
2. Being able to interpret whether improvement is happening through measurement
3. Developing an effective change theory which will result in improvement
4. Testing a change before moving to implementation
5. Knowing when and how to implement a change

The Model for Improvement starts with three questions. These help an improvement team understand what they want to achieve, how they will measure success and what changes they should test. This is sometimes referred to as the "thinking" part of the model.

1.      What are we trying to accomplish?

Having identified an opportunity for improvement, the team should develop an aim statement that clearly describes what they want to achieve. An effective aim statement should be:

• Specific
• Time-bound
• Aligned to organisational priorities
• Numeric or measurable

For more information, visit the Developing project aims page

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

Teams should identify a family of measures that will help them understand whether their changes are leading to improvement. These are grouped into:

• Outcome measures: measures that relate directly to the project aim and reflect the performance of the system
• Process measures: measures that track whether key processes are being carried out as intended
• Balancing measures: measures that help identify any unintended consequences of improvement efforts

Together, these measures help teams understand the impact of their work.

3.      What changes can we make that will result in improvement?

Improvement is most effective when teams work together to understand the system and generate ideas for change. A variety of tools can help with this, including:

• process mapping
• empathy mapping
• cause and effect diagram
• pareto charts

We would also recommend the development of a driver diagram to organise and communicate the theory of change.

Using PDSA cycles to test change

Once a team has identified a change idea, they can use a Plan-Do-Study-Act (PDSA) cycle to test it. This is sometimes referred to as the "doing" part of the model.

• Plan: decide what you will test, make predictions and plan how data will be collected.
• Do: carry out the test and document what happened.
• Study: review the results and compare them with your predictions.
• Act: decide whether to adapt, adopt or abandon the change before the next cycle.

By starting small, learning from each test and building on what works, teams can reduce risk and increase confidence that changes will lead to improvement.