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The Model for Improvement is a method to test measures, strategies, and tools; and to ultimately make improvements in practice. The Model for Improvement consists of 2 parts - the planning and the doing. The planning phase consists of 3 components/questions:
AIM: What are we trying to accomplish?
The Aim Statement is carefully worded to include a description of how much improvement is desired, a description of the specific patient population that is the focus, and the amount of time it should take to achieve an aim.
MEASURES: How will we know that a change is an improvement? Measurement allows one to objectively see how a process is performing and whether gaps exist. Once a change is implemented into practice, measurement helps to determine if the change actually resulted in an improvement and it provides information about next steps.
IDEAS: What changes can we make that will result in an improvement?
Practice teams come up with ideas for what changes can be made in order to accomplish the aim. Ideas for the basis for the next step in the Model for Improvement, PDSA cycles.
Once a practice selects an idea, the next step is the "doing" phase, which involves testing the idea using PDSA cycles. The Plan, Do, Study, Act cycle is used to conduct rapid tests of change on a small scale, learn from the results, and apply the learning to the next test cycle.
PLAN: make a blueprint for what to change; predict the results of the test; specify action steps; identify who is responsible for what, when, where, and how; and determine what will be measured.
DO: carry out the change or test for a short period of time or with a few patients. Collect data and begin analysis.
STUDY: complete analysis of data. Check to see if the planned change was made and if it resulted in an improvement. Summarize what was learned.
ACT: Based on the results of the study phase, decide what to do differently. Plan for the next cycle.
Helpful Web Sites
Agency for Healthcare Research and Quality (AHRQ): AHRQ is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision-making.
Institute for Healthcare Improvement (IHI): IHI is a not-for-profit organization leading the improvement of healthcare throughout the world. IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action.
National Initiative for Children's Healthcare Quality (NICHQ): NICHQ is an action-oriented organization dedicated solely to improving the quality of health care provided to children. Founded in 1999, NICHQ's mission is to eliminate the gap between what is and what can be in health care for all children.
National Committee for Quality Assurance (NCQA): NCQA is a not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.
National Quality Forum (NQF): NQF is a not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.
*Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass;1996