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To get answers to these questions, a CQI initiative uses the PDSA (Plan-Do-Study-Act) cycle to test a suggested change or CQI initiative in the healthcare work setting so that changes are rapidly deployed and tested. The cycle involves the following seven phases.
Assemble the team. Including the right people on a process improvement team is essential to a successful effort. Leaders must determine the team’s members and size. Those who are experts in the process that needs to be improved, usually practice staff, are critical team members. They should be involved in identifying and planning the implementation of every CQI initiative.
Set goals. To answer the question of “What are we trying to accomplish?”, specific aims should be established. They should have a defined time period and be measurable. Goal setting should also include determining who will be affected, whether it be the patient population or staff members. For every implemented improvement, the purpose should ideally be consistent with one of the “triple aims” of CQI in healthcare:
Establish measures. The next step addresses the question of how the organization will know that a change is an improvement. Outcome measures must be evaluated if goals are met. Healthcare organizations should select measures using data that is available for collection.
Select changes. To answer the question “What changes can we make that will result in improvement?”, the team should consider suggestions from multiple sources and choose the opportunities for improvement that make the most sense.
Test changes. Once changes are planned, the downstream impacts should be analyzed to determine whether they had the desired outcome or output. After the changes are implemented, the results should be observed so that leaders can capture best practices and lessons learned to drive future improvements.
Implement changes. After a change is successful on a small scale and refined through several PDSA cycles, the team can consider implementing the change on a broader scale, perhaps a pilot population or an entire unit.
Spread changes. Once a change is successfully implemented for a distinct population or unit, it can be spread to other parts of the organization.
Healthcare organizations have several structured CQI strategies to choose from. In addition to the IHI Model for Improvement, healthcare leaders look to Lean, Six Sigma, and the Baldridge Award Criteria. Leaders can mix elements from each strategy depending on the needs of the organization.
The IHI Model is ideally suited for specific problems with solutions that can be refined over time. It is a gradual, incremental approach to improvement that is practiced daily. It is perfect for achieving small, quick wins and applying lessons learned to new targets for improvement.
While the Institute for Healthcare Improvement Model for Improvement elements are simple, successful implementation depends on several factors.
Culture. The model depends on staff becoming invested and engaged in improvement. The approach must be bolstered by a culture that recognizes and rewards positive change. The focus should always be on solving process problems, not blaming individuals for failure.
Technology. Coordination and communication are crucial elements of the IHI approach. Improvement management software for healthcare streamlines communication, provides a method for measuring results, and ensures that projects stay on track.
Consistency. Because improvements in this model are incremental, significant improvement requires consistent attention and effort. With dedication, small changes will grow into substantial improvements that will move the needle on patient outcomes, population health, and efficient healthcare resource deployment.
Each practice should choose a quality improvement strategy based on its goals and objectives for adoption and implementation. The IHI model offers a straightforward path to meaningful change.