What is the Model for Improvement?

The Model for Improvement (MFI) provides a framework for developing, testing and implementing changes leading to improvement. The model provides an easily understandable scientific method which acts to moderate the impulse to take immediate action with the wisdom of careful study.

As a consequence of its simplicity and widespread applications, it is the most commonly use QI approach in healthcare.

History

The MFI was developed by Associates in Process Improvement (API) and published in The Improvement Guide by Langley et al. (1996).  The model was adopted by the Institute for Healthcare Improvement (IHI) who applied it widely in healthcare settings and popularised its application.

It is commonly referred to as the “IHI model”, or in some cases just the “Plan-Do-Study-Act (PDSA) method”.

Fundamentals of the method

The model can be broken down into two parts, often thought of as a “thinking” part and a “doing” part. The first of those is a systematic evaluation of the problem and identification of potential solutions is achieved by asking three key questions…

1. What are we trying to accomplish?

Before making any attempts to improve, it is important to define exactly what it is that you aim to achieve – this is done by constructing an Aim Statement. It might sound obvious, but setting a clear aim ensures that everyone is pulling in the same direction and that effort is directed at the right problem. As a minimum, an aim statement should be time-specific and measurable.  You can read more about constructing a good aim statement here.

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

Without measurement it is impossible to know whether things have improved.  Setting appropriate quantitative measures allows you to determine if a specific change actually leads to an improvement. Measures come in 3 principle types; Outcome, Process and Balancing – you can read more about them here.

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

There are likely to be many changes that could be made to improve a process or system.  This question encourages the team to identify specific, practical changes that could be readily tested – these are called Change Ideas (or sometimes Interventions).  Some change ideas will be tested in the next phase of the MFI method, using the PDSA cycle approach.

The second (“thinking”) part of the MFI process involves the small-scale testing of change ideas in a real world setting through Plan-Do-Study-Act (PDSA) cycles.  The PDSA cycle guides the test of a change to determine if the change is an improvement. Learning from each small test and refining the PDSA through multiple cycles aims to optimise the change for implementation on a broader scale.  You can learn about PDSA and its applications here.

Key Benefits

The MFI is the most widely used improvement method in healthcare.  Some of the key benefits are:

• It is a simple approach that can be applied by anyone
• It has applications for many types of project and at any scale
• It reduces risk by starting small and systematically testing change before implementing change on a wider scale
• It is proven to be highly effective, particularly in the healthcare setting

Should I use the Model for Improvement?

The choice of which improvement method to use can be divisive. Each of the main improvement methods strive for sustained change through defining clear goals, using structured processes and maximising the use of data.

The MFI supports improvement efforts in a full range from the very informal to the most complex.  The simplicity of the model makes it attractive for many, and the systematic use of PDSAs give good assurance that changes can be implemented effectively, and improvements sustained.

When working on large projects with broad reach, the MFI approach may require the project to be broken down to into several components. Whilst this is sometimes viewed as a negative, it can help to provide focus to each element.

The Model for Improvement is a simple tool that can be used across a variety of healthcare systems to improve quality within an organisation. By focusing on small tests to create and measure change, improvement is seen faster within an organisation, compared with use of a typical research approach.

References

The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. G. Langley, K. Nolan, T. Nolan, C. Norman, L. Provost. Jossey-Bass Publishers., San Francisco, 1996.

Scoville R, Little K. Comparing Lean and Quality Improvement. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2014. (Available at ihi.org)