The Model For Improvement


Chapter Purpose

Aim. To understand and apply the model for improvement in conducting disciplined, sequential tests of change for the purpose of making measurable improvements that can be sustained.

Objectives. At the completion of this unit, you will be able to

• Define the model for improvement.

• Describe the two components of the model for improvement.

List the detailed steps of PDSA model.

Develop a clear plan to test a change.

Describe the point at which a PDSA cycle becomes a SDSA cycle. State where PDSA ^ SDSA cycles fit in the improvement process. Use the PDSA ^ SDSA worksheet to guide actions.

It is important for all microsystem members to see the road ahead in the improvement journey. The improvement model discussed in this chapter is the method of choice for testing ideas for change leading to improvement. Figure 14.1 shows where you are now in the Dartmouth Microsystem Improvement Curriculum. With this focus on the model for improvement, we bring the scientific method explicitly into the improvement process.



Example Pdsa Ramp Cauti

Tom Nolan and his colleagues at Associates in Process Improvement and the Institute for Healthcare Improvement have popularized the model for improvement (Langley, Nolan, Norman, Provost, & Nolan, 1996). This model, by incorporating the PDSA model, uses the scientific method for disciplined improvement. It also reminds improvement teams of the questions they should answer before starting their tests of change (Langley et al., 1996).

The modelfor improvement (diagrammed in Figure 14.2) provides an overarching framework for testing change ideas that are expected to make improvements. The model has two parts. It starts with three questions to focus your improvement work, and then it leads you to run tests of change using the scientific method, or plan-do-study-act (PDSA) method. This process is shown in more detail in the following list:

1. Fundamental questions come first and clarify the improvement to be tested.

• Aim. What are we trying to accomplish? Setting a clear aim with specific measurable targets.

• Measures. How will we know that a change is an improvement? Qualitative and quantitative measures support real improvement and inform the progress of the change toward the stated aim.

• Changes. What changes can we make that will result in an improvement? We need to create a statement of what we believe we can change to effect improvement. This change idea reflects our hypothesis about causes and effects.

2. Next, the changes are tested using the four steps known as plan, do, study, and act. FIGURE 14.2. MODEL FOR IMPROVEMENT.

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