IHI Model for Improvement

The IHI Model is a tool for accelerating improvement, based on three fundamental questions and the Plan-Do-Study-Act cycle to test changes in real work ... skiptoprimarynavigation skiptocontent StudyatCambridge AbouttheUniversity ResearchatCambridge Searchsite Home StudyatCambridge Undergraduate Courses Applying Eventsandopendays Feesandfinance Studentblogsandvideos Graduate WhyCambridge Coursedirectory Howtoapply Feesandfunding Frequentlyaskedquestions Internationalstudents Continuingeducation Executiveandprofessionaleducation Coursesineducation AbouttheUniversity HowtheUniversityandCollegeswork History VisitingtheUniversity Termdatesandcalendars Map Formedia Videoandaudio Findanexpert Publications GlobalCambridge News Events Publicengagement Jobs GivetoCambridge ResearchatCambridge GivetoCambridge Forstaff Forcurrentstudents Foralumni Forbusiness Colleges&departments Libraries&facilities Museums&collections Email&phonesearch ImprovingImprovement AtoolkitforEngineeringBetterCare Home Starthere ExecutiveSummary QuickStartGuide Howtousethistoolkit Acknowledgements ImprovingImprovement Improvement:Overview Introduction IHIModelforImprovement LeanThinking SixSigma EngineeringBetterCare ImportantTopics ThisToolkit CaseStudies Questions Questions:Overview Introduction ManagingImprovement DescribingPeople MappingSystems InspiringDesign AssessingRisk CaseStudies Process Process:Overview Introduction UnderstandtheContext DefinetheProblem DeveloptheSolution CollecttheEvidence MaketheCase ManagethePlan AgreetheScope CaseStudies Resources Resources:Overview Introduction Posters Worksheets Cards ServiceUsers ServiceStakeholders ServiceImprovers ImprovementTools DefinitionOfTerms Training TrainingResources TrainingCourses ContactUs   IHIModelforImprovement Improvement:Overview Introduction IHIModelforImprovement LeanThinking SixSigma EngineeringBetterCare ImportantTopics ThisToolkit CaseStudies TheIHIModelisatoolforacceleratingimprovement,basedonthreefundamentalquestionsandthePlan-Do-Study-Actcycletotestchangesinrealworksettings. Contents Introduction GettingStarted Comparison Literature   Backtotop Introduction ThemodelforimprovementwasdevelopedbytheAssociatesinProcessImprovementasatoolforacceleratingimprovementandhasbeenadoptedbytheInstituteofHealthcareImprovementasitsprimaryframeworkforimprovementinhealthcare.Themodelhastwoparts:threefundamentalquestions,whichcanbeaddressedinanyorder;andthePlan-Do-Study-Actcycletotestchangesinrealworksettingsinordertodetermineifthechangeisanimprovement. UseofthemodeliswidespreadwithintheNHSduetoitssimplicityandabilitytobringaboutrapidtestingofideas.Somecriticismofitseffectivenesshasbeenraised,suggestingthatitispoorlyappliedandoftenpursuedthroughtime-limited,small-scaleprojects,ledbyprofessionalswhomaylacktheexpertise,powerorresourcestoinstigatethechangesrequired. Themodelforimprovementensuresthatteamsknowthepurposebehindwhattheyaretryingtoaccomplish,understandwhatsuccesswilllooklikeandidentifythosechangesthatwillresultinimprovement.Italsoguidesthemthroughtheprocessofestablishingappropriatemeasures,creatingchanges,evaluatingchanges,implementingchangesandspreadingchanges.Followingtheinitialquestions,multiplePlan-Do-Study-Actcyclesmaybeusedtoachievethelevelofimprovementdesired. Footnotes Seealso:TheImprovementGuide:APracticalApproachtoEnhancingOrganizationalPerformance.Langley,Moen,Nolan,Nolan,NormanandProvost,JohnWiley&Sons(2ndedition),2009. Backtotop GettingStarted Improvementteamsinhealthandcarealreadyhavearangeoftheoriesofchangeandimprovementapproachesavailable:theIHImodelforimprovement,humanfactorsinhealthcare,leaninhealthcare,experience-basedco-design,rootcauseanalysis,andsixsigmatonameafew. Whileanumberoftheseapproachesalreadyincludetools,suchasFailureModesandEffectAnalysis(FMEA)andmappingtechniquesthatmaybefoundinengineeringmethods,thesystemsapproachpresentedinthistoolkithasthepotentialtoaddfurthervaluetotheimprovementagendaintwodistinctforms.Theprovisionofnewtoolsandwaysofthinkingcansupplementexistingapproachesandtheadoptionofasystemsapproachcanguideadesignfromasetofcomplexneedsthroughtovalidated,effectiveoperationalsystems. Thereareotherkeyareasinwhichnewwaysofthinking,derivedfromasystemsapproach,cansupplementexistingmethods.Thisincludes,measuringanddesigningsysteminterfacestoalleviateserviceintegrationissuesandusingsystemssafetyassessmenttoproactivelydesignriskoutofsystemsandavoidincidentsratherthanmerelyreactivelypreventingarecurrence.Insuchcases,existingimprovementapproachesmaybeenhancedbyusingtechniquesfromasystemsapproach. TheSystemsApproachisalsoamethodinitsownrightthatappliestoolstoansweraseriesofquestionsinaniterativeandsystematicwayinordertoguideadesignfromasetofcomplexneedsthroughtovalidated,effectiveoperationalsystems. Duringthisprocess,experiencedimproverscanusetheirowntools,frameworksandexperiencesofchangetohelpteamsunderstandpeople,deliversystems,facilitatedesignandmanagerisk.Asystemsapproachcanenhanceexistingapproachesthroughadditionaltoolsandtechniques,encouragingimprovementstobeguidedbyaseriesofcriticalquestionsorsimplestagegateprocesses. ThefollowingmapcanbeusedtounderstandthecoverageoftheIHImodelandtosuggestareaswhereasystemsapproachmayassistintheprovisionofadditionalquestions,activitiesandtoolstosupplementexistingpractice. Backtotop Comparison Thequestions,activitiesandtoolsfromthistoolkitcanbemappedtotheIHIModelforImprovementtobetterunderstandtherelativecoverageofthetwoapproaches.ResourcematerialfortheIHImodelhasbeenanalysedindetailtoascertainhowitrelatestothesystemsapproachinthistoolkit,bothintermsofthementionofcommontopicsandintermsoftheprovisionofdetaileddescriptionsoradvicerelatingtothesametopics. Questions,activitiesandtoolsthathaveparticularpotentialtoaddvaluetotheIHImodel: Whatarewetryingtoaccomplish? ThefocusofthefirstquestionintheIHIModelofImprovementistheagreementofaSMARTaimstatementthatismeaningfultotheusersandstakeholders,andalignedwithorganisationalgoals.Generalprojectissuesarealsoaddressedatthisstage,suchascreationoftheteam,initialexplorationoftheproblemareaandneeds,definitionofaclearscopefortheimprovement,andengagementofkeystakeholders. Activitiesfromthesystemsapproach,notfrequentlymentionedintheliteratureontheIHIModelofImprovementrelatingtothisquestion,thatmayaddvalueinclude:DescribeClinicalProcesses,DescribePatientJourneys,CreateStakeholderMap,UnderstandPatientDiversity,GeneratePersonas,GenerateScenarios,DescribeStakeholderExperiences,PrioritiseStakeholderNeeds,PresentCaseforChangeandReviewProjectPerformance. Toolsfromthesystemsapproachthatmaybeusefulinclude:LiteratureReview,EntityRelationshipDiagram,DataFlowDiagram,StateTransitionDiagram,SwimlaneDiagram,ValueStreamMapping,DependencyStructureMatrix,FacilitatedDiscussion,DelphiStudy,ParticipantObservation,DesigningPersonas,DesigningScenarios,LifeCafé,PEST(LE)Analysis,SWOTAnalysis,StakeholderAnalysis,TheFiveWsandtwoHs,WardleyMap,GanttChart,ActivityDependencyDiagramandLoMo. Howwillweknowthatachangeisanimprovement? Thesecondquestionrelatestotheidentificationanddefinitionofappropriatemeasurestotestideasforimprovementandstudied.Thesemayincludeoutcome,processandbalancingmeasures,proposedbythestakeholders,toensuretheagreedimprovementaimismet. Activitiesfromthesystemsapproachthatmayaddvalueinclude:AnalyseRelevantDocuments. Toolsfromthesystemsapproachthatmaybeusefulinclude:LiteratureReview,FacilitatedDiscussion,DelphiStudy,MoSCoWandLoMo. Whatchangecanwemakethatwillresultinimprovement? Thethirdquestionaddressesthedevelopmentofchangeideas,linkedtousers’andstakeholders’needsandtheagreedaimandmeasures.Theuseofcreativethinkingandexploration,alongwiththevisualisationofcurrentprocessesandevidence,areproposedasameanstostimulateideation,conceptdevelopmentandselection. Activitiesfromthesystemsapproachthatmayaddvalueinclude:DescribeClinicalProcesses;GeneratePersonas;GenerateScenarios;DescribeStakeholderExperiences;MakeModels;ReviewEffectiveness;ReviewSafety;ReviewExperience;DemonstrateFutureImprovement;PredictStakeholderBenefits;CalculateResourcesRequired;EstimateTimeRequired;PresentCaseforChange;andReviewProjectPerformance. Toolsfromthesystemsapproachthatmaybeusefulinclude:SoftSystemsMethod;EntityRelationshipDiagram;DataFlowDiagram;StateTransitionDiagram;SwimlaneDiagram;ValueStreamMapping;DependencyStructureMatrix;DelphiStudy;ParticipantObservation;DesigningPersonas;DesigningScenarios;LifeCaféStoryboarding;Disney;SixThinkingHats;MorphologicalChart;ExclusionAudit;ExpertReview;UserTrials;FailureModeandEffectsAnalysis;FaultTreeAnalysis;HazardandOperabilityAnalysis;StructuredWhat-ifTechnique;RiskMatrix;andLoMo. Plan-Do-Study-Act Plan-Do-Study-Act(PDSA)initiallyfocusesontestingtheproposedchangesatlimitedscaletoreducerisk,andthenonlearningfromsubsequentcyclestoinformthescale-upofthechanges.Hence,PDSAcyclesalsorelatetosecondquestiononmeasures,measurementanddata,andtothethirdregardingthecurrentsystemandprocesses. Activitiesfromthesystemsapproachthatmayaddvalueinclude:AnalyseRelevantDocuments,DescribeClinicalProcesses,DescribePatientJourneys,CreateStakeholderMap,GeneratePersonas,GenerateScenarios,DescribeStakeholderExperiences,DescribePatientExperiences,BenchmarkCurrentPerformance,ReviewSafety,PresentCaseforChangeandEnsureSharedUnderstanding. Toolsfromthesystemsapproachthatmaybeusefulinclude:EntityRelationshipDiagram,DataFlowDiagram,StateTransitionDiagram,SwimlaneDiagram,ValueStreamMapping,DependencyStructureMatrix,FacilitatedDiscussion,DelphiStudy,ParticipantObservation,DesigningPersonas,DesigningScenarios,Storyboarding,FishboneDiagram,ExclusionAudit,ExpertReview,UserTrials,RootCauseAnalysis,FailureModeandEffectsAnalysis,FaultTreeAnalysis,HazardandOperabilityAnalysis,StructuredWhat-ifTechnique,RiskMatrix,PEST(LE)Analysis,SWOTAnalysis,WardleyMapandLoMo. Backtotop Literature Dixon-WoodsM&MartinG(2016)Doesqualityimprovementimprovequality?FutureHospitalJournal,3(3):191-194. LangleyGL,MoenR,NolanKM,NolanTW,NormanCL,ProvostLP(2009).TheImprovementGuide:APracticalApproachtoEnhancingOrganizationalPerformance(2ndedition).SanFrancisco:Jossey-BassPublishers. 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