Do You Genuinely Understand the Problem You Are Trying to Solve? The Model for Improvement

Learning objectives:

  • Recognize early barriers that can prevent interprofessional teams from making sustainable improvement
  • Gain insight into an established framework to organize and systematically align interprofessional groups in shared improvement goals

Traditional research is about discovery. Quality improvement is about… improvement. We need to study the evidence for best practices and apply them consistently in our own healthcare delivery sphere in order to achieve the best possible outcomes for our patients. How do we get there? Too often, we see opportunities for improvement and we struggle to organize the work in a systematic, goal driven way. We bog down in a series of efforts that center on fixing imperfect processes without clear, measurable outcome targets. We sense we have a problem, but we don’t know our true baseline data and we don’t develop a measurement plan or a methodology to guide us to our goal.

Improvement science provides us with a way out of this rabbit hole. One simple and effective model to understand the problem we are trying to solve is promoted by the Institute for Healthcare Improvement and was developed by Associates in Process Improvement. Appropriately, it is called the Model For Improvement (MFI).1

MFI parses an improvement project into three simple components. The first one is your vision. What are you trying to achieve? What outcomes are desired? By setting targets and keeping them as the focus for your improvement team, the effort always has a true north. The processes that are implemented in order to achieve the desired outcome can always be connected to the goal and the scope of the project can be efficiently conserved. The second two components comprise the mission – measurement and interventions. How will you know you achieved your desired outcome? You will know because you quantified it and you measured all along your journey. And how will you get there? What changes will you make? You will get there through application of the fundamental unit of quality improvement – the PDSA (Plan-Do-Study-Act) cycle. With PDSA, improvement teams attack a problem through iterative rapid cycle changes that are measureable, each one resulting in either an improved process or another idea for change.

Model for Improvement: Act, Plan, Do, Study
Figure reproduced from reference 2 (Langley GL, et al.) with permission for John Wiley and Sons, publisher, 2019.

MFI is sometimes confused as an alternative methodology to Lean, the approach which is perhaps most familiar to practitioners of quality improvement. The Lean methodology promotes elimination of waste and optimization of efficiency. MFI and Lean, in fact, are complimentary.2 MFI provides a framework to think about improvement and relies on Lean principles in the execution of the work.

In the coming months, quality and safety colleagues from across our organization will share their insights and tips for QI/PS Hot Topic. They will reveal many pearls in Quality and Safety. A unifying theme will emerge that is one of the most effective strategies in my work as an Improvement Advisor – namely, in healthcare improvement efforts, always circle a team back to the fundamental question: What are you trying to achieve?

References

  1. Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.
  2. Scoville R, Little K. Comparing Lean and Quality Improvement. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2014. (Available at ihi.org)