The Improvement Model

In addition to the Care Model the Collaborative uses an Improvement Model developed by the Associates in Process Improvement and tested and used in many IHI-sponsored Collaborative. When used in conjunction with the Care Model, the Improvement Model provides a process to improve the quality of care at an accelerated pace.

The Improvement Model is based on three fundamental questions:

1. What are we trying to accomplish?

This question is meant to establish an AIM STATEMENT for improvement that focuses the organization's effort. It helps to focus on specific actions or elements of the Care Model, and to define which patients and providers will participate. The AIM STATEMENT should be time-specific, measurable, and as concise as possible - sometimes it takes a few trials of testing an AIM before it becomes truly focused.

2. How will we know that a change is an improvement?

Measures and definitions are necessary to answer this question. Data is needed to assess and understand the impact of changes designed to meet an AIM. When shared AIMS and data are used, learning is further enhanced because it can be shared with other organizations in the Collaborative. In this way, superior performance and best practices are more quickly identified and disseminated through benchmarking.

3. What changes can we make that will result in an improvement?

Testing and learning for the testing is necessary to conclude that a result is an improvement. The PDSA Cycle (PDSA stands for Plan, Do, Study, Act) is a trial-and-learning method to discover what is an effective and efficient way to change a process. The "study" part of the cycle is the key to learning what change leads to improvement. "Study" compels the team to learn from the data collected, to look at effects on other part of the system and on patients and staff, and under different conditions, such as different practice teams or different sites. Most importantly, the "study" phase is an ideal time to think through how the Chronic Disease Model helps to generate new ideas and approaches to positive change. PDSA cycles are short and quick. Typically, they need only hours, days or at most, a few weeks to complete.

Monitoring Progress

Measurement is essential to be convinced that changes are leading to improvement. There are national shared measures and measures chosen by each health center organization. Measures are collected prior to beginning the Collaborative and continue on a monthly basis throughout the twelve months of the Collaborative. 

A registry of patients in a Collaborative is created by the health center organization to keep all relevant information handy; to schedule visits, labs, education sessions; and to generate reminders and guidance for the care of patients (both in groups and individually). The Collaborative places heavy data gathering and reporting requirements on health center organizations, asking them to track and report monthly on the core measures used by all participating clinics as well as the additional goals that each clinic selects.

For a registry to be efficient for tracking data for the Collaborative, it should be in an electronic form (on a computer). In past years of the Collaborative, many health center organizations designed their own registries. This was very time consuming and required the expertise of an information systems person with strong technical skills. The Bureau now offers a registry template or program that centers can use, if they so choose. This electronic registry, called PECS Patient Electronic Care System, is available only to Collaborative participants.

Why do we test instead of just implementing a change?

• To build support that the change will result in improvement in your environment
• To better predict the improvement resulting from a change
• To learn how to adapt a change to the conditions within your local environment
• To determine the costs and side-effects of the change
• To minimize resistance to the change upon implementation

Testing on a Small Scale

• Ask others who are knowledgeable to review the change and comment on its feasibility
• Test the change with team members who are developing it before introducing it to others
• Test the change side-by-side with the existing system to illustrate improvements
• Conduct the test in one facility, with one provider, with one patient
• Test the change over a short period of time
• Test the change on a small group of volunteers
• Try to develop a plan to simulate the change if possible