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Model for Improvement

Additional Resources

Download our worksheet to document your own Aim Statements and PDSA cycles.

View introductory webinars created by the Institute for Healthcare Improvement.

The Model for Improvement is a time-tested method of quality improvement that is simple, highly effective, and supports a bottom-up approach to change.

The Model for Improvement reduces risk by starting small. At its most basic level, the model has two parts: three fundamental questions and the Plan-Do-Study-Act (PDSA) cycle.

The three fundamental questions include:

  1. What are we trying to accomplish?
     
  2. How will we know that a change is an improvement?
     
  3. What changes can we make that will result in improvement?

     

Aim Statements

Developing an aim statement helps to address these three questions. The aim statement should:

  • State the aim clearly
  • Use numerical goals
  • State the timeframe and site of the work

 

Example Aim Statements:

  • Nursing home:  "We will use the INTERACT II toolkit with all residents, starting with the east wing's dayshift staff on June 1. We expect that by the end of the year, our facility will decrease returns to ED or hospital by 10%."
     
  • Nursing home: "By September 30, we will reduce the UTI rate among long-stay residents to 8% by standardizing the process of assessing and treating incontinence. We will maintain a UTI rate of 8% or below for 6 months afterward. The standards will first be implemented with the residents who are cared for by Trish and Alex."
     
  • Primary care: "By March 31, 90% of our Medicare Part B-eligible patients will have tobacco use status recorded in the EHR problem list during a visit to our office. This study will begin with Dr. Smith's care team on November 1."
     
  • Primary care: "By June 30, 90% of our patients on insulin therapy will be asked about adverse drug events; any ADEs or pADEs will be documented in the EHR. This study will begin with Dr. Lee's care team on January 1. We expect to have developed baseline rates for ADE and pADE by June 1, after which we will set goals for reducing those measures."
     

Plan-Do-Study-Act (PDSA)

The Plan-Do-Study-Act (PDSA) cycle is used to test changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement. (Read about the development of the PDSA cycle.)

Multiple PDSAs lead to substantial improvements

Graphic representation of multiple PDSA cycles

To use this process most effectively, a small-scale change cycle should be repeated and refined several times on a daily or weekly basis. Changes are best tested initially with a small team—i.e., one provider and care team, one change at a time, on the smallest scale possible.

Stable, successful projects can be expanded to other innovators within the organization for further testing before an organization-wide process change is adopted. Download our PDSA worksheet.
 

Example PDSA Cycles