Model for improvement

Having used process mapping, shadowing and driver diagrams to identify what you want to change and having identified how you will measure it, the model for improvement, developed by the Associates in Process Improvement, is the approach through which you will identify, implement and evaluate the changes you make.

An important part of the model for improvement is Plan, Do, Study, Act (PDSA) – a tried and tested method that helps teams plan their chosen intervention, test it on a small scale and then review it before deciding how to proceed. It comprises four steps.

  • Plan – planning the change that you want to put in place and predicting what will happen through the cycle. Detailed work here includes deciding what data will be collected, who will do what, when and where the change will be implemented.
  • Do – implementing the change, measuring and gathering data as planned.
  • Study – analysing before-and-after data to see what can be learned.
  • Act – returning to the start, to plan how to amend the next cycle or, if it is ready, to roll out the change.

Confidence grows quickly and major mistakes can be rectified early on through small-scale testing. For example, imagine a project that focuses on improving the admissions process for patients. The team has devised a new assessment package for staff to use and ask one member of staff to use it for one day, or with one patient. They then report back on what went well and what needs further work. The team can then revise it, and repeat this process, on an increasingly wide scale, until 90 per cent of feedback states that the package is effective.

PDSA was developed within an industry context where prototypes are always developed and tested before an item goes into production. The approach reminds us that improvement is not about having the perfect solution: it is about trying things out. If something does work, then you can build on it. If it doesn’t, you can tweak it or go back to the drawing board without having committed significant resources to an unworkable change.

Key points

  • The model for improvement enables us to test change on a small scale to see whether it helps us achieve our aims and, if not, provides us with an opportunity for learning why it does not.
  • Staff are more open to trying out new ways of working if they don’t have to sign up to a long-term scheme that might not be effective – especially if they are reassured that their views will be taken into account.
  • Staff are more likely to feel ownership and commitment to the programme if they are responsible for creating the ideas for improvement, based on daily reality.
  • If you have trouble recruiting staff to take part, think about involving a wide range of people in the areas where they can make the greatest contribution. Try to spread involvement across clinical and non-clinical teams to invite a range of perspectives.

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