The Model for Improvement A Method to Adapt, Implement, and Spread Changes

1
The Model for ImprovementA Method to Adapt,
Implement, and Spread Changes
Donna M. Daniel, PhD, Qualis Health National
Nursing Home Improvement Collaborative October
20, 2003 Prepared with assistance from Lloyd
Provost, Associates in Process Improvement and
the Institute for Healthcare Improvement.
2
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
3
Q What are we trying to accomplish? A Aim
Statement
A written statement of the accomplishments
expected from each pilot teams improvement
effort.
Contains useful information

• A general description of the goal
• Specific population
• Numerical goals
• A general description of spread

4
Spread
National Nursing Home
NNHIC Teams
Improvement Collaborative
5
Sample Aim Statement

• State the aim clearly Implement the improvement
  strategies from the Pressure Ulcer Prevention and
  Treatment change package
• Use numerical goals so that the percentage of
  admissions who have an assessment within one
  calendar day is 100...
• State the site at General Nursing Home
• State spread and will continue to spread
  improvements by working closely with the QIO on
  statewide interventions.

6
Q How Do We Know That Change Is an
Improvement? A Measurement

• Each PDSA cycle
• Each monthly key measure
• Each spread measure

7
Minimum Standard for Monthly Reporting in the
CollaborativeAnnotated Run Chart
Wound Care RN
WC RN leaves
8
Improvement in Pressure Reducing Support Surfaces
in Beds NH A
9
Improvement in Pressure Reducing Support Surfaces
in Beds NH A
10
Improvement in Pressure Reducing Support Surfaces
in Beds NH B
11
Improvement in Pressure Reducing Support Surfaces
in Beds NH B
12
Improvement in Pressure Reducing Support Surfaces
in Beds NH C
13
Family of Measures Pressure Ulcer Prevention
Treatment
14
Q What changes can we make that will result in
an improvement? A Improvement Strategies
15
Ingredients for an Effective Team
System Leadership
Clinical Leadership
Day-to-day Leadership
16
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
17
References

• The Improvement Guide A Practical Approach to
  Enhancing Organizational Performance. G. Langley,
  K. Nolan, T. Nolan, C. Norman, L. Provost.
  Jossey-Bass Publishers., San Francisco, 1996.
• Eleven Worthy Aims for Clinical Leadership of
  Health System Reform, Don M. Berwick, JAMA,
  September 14, 1994, Vol. 272, 10, p. 797-802.
• The Foundation of Improvement. Langley, G. J.,
  Nolan, K. M., Nolan, T. W., 1994. Quality
  Progress, ASQC, June,1994, pp. 81-86.
• A Primer on Leading the Improvement of Systems,
  Don M. Berwick, BMJ, 312 pp 619-622, 1996.