Understanding the Model for Improvement
The Model for Improvement provides a framework to structure improvement efforts. The model is based on three key questions:
- What are we trying to accomplish?
- How will we know that a change is an improvement?
- What changes can we make that will result in improvement?
These questions are then used in conjunction with small scale testing, the 'doing component' known as Plan, Do, Study, Act (PDSA) cycles.
1. What are we trying to accomplish?
Improvement requires effort, so it is important to direct our efforts to the right problem. The first thing we have to do is be clear about what we want to achieve. For example, is the aim to reduce errors, save time, reduce risk or improve the way in which we work?
This sounds obvious, but is often hard to answer precisely. Without this clarity, it is impossible to decide what action to take or to know whether the outcome is an improvement. So the vital question is: “What outcome do we want?”
2. How will we know that a change is an improvement?
Once we are clear about the desired outcome, the next task is to choose a standard to measure the outcome against. At best, this measurement will be simple and easy to use, but it is often difficult to find a perfect measurement. We may need to accept that our measures are not perfect and that collecting the necessary information may be difficult.
Use a measure which:
- is well-defined;
- allows comparison between sites and over time; and
- is already in use, if possible.
Whether using an existing measure or creating new ones, be clear about how they are defined. If using an existing measure, it is likely to have been developed for a different purpose, so take time to understand how it was put together.
Make sure that everyone involved in collecting information for new measures knows why they are doing it.
Improvement work is not an experiment trying to prove the value of an action; it is about adopting and adapting practice, based on evidence. For this reason, and also because it can take a long time for any change in outcome to be recognised, we should also have at least one process measure in place.
3. What changes can we make that will result in improvement?
It is essential to link outcome measures to ‘interventions’ – the systems and processes that will help us achieve the desired outcome. We will not make consistent progress towards improving outcomes by focusing on outcome measures alone.
There are two parts to this question – “What is wrong with the system now?” and “What works?”
What is wrong with the system now?
The experience of our staff, the evidence of our own eyes, and feedback from our service users will all help us identify what we need to focus and concentrate our efforts on. We need to consider the following:
What will deliver the biggest benefit? This is often addressing the things that are done most often or the area where most waste is incurred.
What do typical cases tell us about the system?
Are demand and need understood properly? How much demand is repeat work or work caused by another part of the service?
What is the high-value part of the system (the part that delivers real benefit)? Is it the same as the part which has the highest costs?
What can simplify the process?
How can we use the knowledge of service users and people in other parts of the process?
To find out what works we first need to gather evidence of how a good system should work. Don’t make this too difficult by going into too much detail. We use the evidence gathered to produce driver diagrams to summarise desired outcomes and how they can be achieved.
Answering the three questions raised by the Model for Improvement will help you see ways that you can begin to make positive changes.