The Model for Improvement is an approach for process improvement, which helps teams accelerate the adoption of proven and effective changes. This method can also be used to test measures, strategies, and tools; and to ultimately make improvements in practice.
The planning phase consists of three components/questions:
- What are we trying to accomplish?
- How will we know the change is an improvement?
- What changes can we make that will result in an improvement?
As a first project, a practice might want to select a topic that is "low hanging fruit" for a greater likelihood of measureable improvement and to generate enthusiasm among staff. Topics might also include areas where the practice is performing less than optimally, or where payers are asking the practice to submit data to calculate incentive payments. As staff become more experienced with quality improvement, topics that are more challenging to measure could be selected.
One easy way of selecting a topic for improvement is through AAP EQIPP modules. EQIPP will help your practice with regular review of performance data and evaluation of performance against goals or benchmarks.
3a. Develop an Aim Statement
An aim statement is the practice's written, measurable, and time-sensitive statement of the expected results of the improvement process. Review the AIM Statement for the components of a SMAART objective (Specific, Measureable, Actionable, Achievable, Realistic and Timely).
Sample Aim Statement
By September 2013, Pediatric Practice, Inc. will improve the assessment and identification of genetic conditions for all of our patients aged 0‐21 years old, as part of the health supervision visit by:
- Creating or updating/maintaining multi‐generational family histories at health supervision visits, using the family history components defined by the project, for 90% of our patients
- Discussing current family histories with 90% of our patients/families
Utilize the AIM worksheet to develop practice's goals for quality improvement measures.
3b. Determine the Measures
Have the practice set goals and benchmarks for expected achievement that the practice has set themselves. Create measures that are "just enough" instead of "just in case", which can increase data collection burden. Keep it simple with 4-8 measures, a combination of the types of measures listed below:
- Process Measures: Measures how services are provided
- Outcome Measures: Measures the results of health care. This could include whether the patient's health improved or whether the patient was satisfied with the services received.
- Balancing Measures: Ensures that if changes are made to one part of the system, it doesn't cause problems in another part of the system.
Characteristics of a Good Measure:
- Relates to the aim and key changes
- Shows improvement quickly
- Easy to collect
- Meaningful and understandable to participants
- Creates a tension for change
- Can be graphically displayed over time
3c. Select your Ideas for Change to Address the Quality Gap
Specify the steps that it will take and identify who will be responsible for what, when, where and how. The current state of the practice will be the benchmark for your QI initiatives. Benchmarks can also be generated from similar practices in the same area or by comparing them to a larger group of practices from across the country. Change ideas can be determined through brainstorming, reviewing the literature, speaking with colleagues, and process mapping. Key questions to ask include: What specific change concepts will achieve the aim? What theories and predictions can you make about how these change concepts will cause improvement?