Improvement Science

At NICHQ, improvement science is our “bread and butter.” We use quality improvement methods and tools in everything we do and are experts in how to continuously improve system performance.

The Model for Improvement

The Model for Improvement is at the heart of our approach. This robust improvement framework was developed by Associates in Process Improvement and has been used successfully by hundreds of healthcare organizations to improve healthcare processes and outcomes. The model consists of two cornerstone steps: (1) answering three fundamental questions and (2) testing changes through Plan-Do-Study-Act (PDSA) cycles.

Part 1: Three Fundamental Questions

Successful improvement efforts begin with a solid foundation to set up the project. The Model for Improvement poses three fundamental questions to guide the work:

  1. What are we trying to accomplish? The team develops an aim statement that outlines what it is trying to accomplish, how much, and by when.
    Example: By next February, we will cut our wait time in half for all 250 of our pediatric patients

  2. How will we know if a change is an improvement? The team identifies process and outcome measures it will collect over time to track improvement and evaluate progress
    Example: The average amount of time patients spend in the waiting room or patient satisfaction with waiting time

  3. What changes can we make that will result in improvement? The team brainstorms ideas and selects changes to test.
    Example: Use a new sign-in system or schedule new patients earlier in the morning

The answers to the first two questions (aim and measures) should remain constant, while the ideas for potential changes will constantly evolve as the team repeatedly tests and improves on new ideas.

Part 2: Testing Change through Plan-Do-Study-Act (PDSA) Cycles

Improvement teams turn ideas into action using small tests of change to rapidly test and implement improvements in real settings. The process generally involves four steps:

  • PLAN the test and predict results
  • DO the change and observe outcomes
  • STUDY the data and compare with predictions
  • ACT on the learnings to develop the next test

The PDSA cycle guides the test of a change to determine if the change is an improvement. Sequential tests build on one another as changes that show promise are expanded for testing on larger scales and in multiple setting until the team is confident that the change should be adopted widely.

 

Diagram of the Model for Improvement

Diagram of successive PDSA cycles