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IHI Model For Improvement: How To Measure The Key Concepts
In this article, we get down to brass tacks about the IHI Model for Improvement and how its fundamental mechanics help you drive change.
A few weeks ago, we wrote about how to measure quality improvement and included some of the most common frameworks used by healthcare organizations. As you can probably imagine, one article isn’t enough to cover all the nitty-gritty details. There was one framework in particular we thought needed more airtime: the Institute for Healthcare Improvement’s (IHI) Model for Improvement. In this article, we’ll get down to brass tacks about this model and its fundamental mechanics.
The IHI model is a calculated, controlled approach to improvement—it’s more about quiet victories than big wins. Click To Tweet
Your Improvement Team
Before you can implement the IHI model (or any framework), you need to create an improvement team. This group of people will act as champions, experts, and decision makers for the framework. The team should have a leader who’s respected within the organization and has the power to drive change. The other team members support this leader and represent stakeholders in the healthcare organization. The team’s size will vary based on the scope of change you’re trying to implement.
While the improvement team leader doesn’t need to be a senior executive, they should have sponsorship from the leadership team to ensure any changes they make will be supported by the organization.
The Three Steps Of The IHI Model For Improvement
The IHI model is simple, but that’s not to say it lacks depth. It can be expanded or contracted to suit any healthcare organization’s needs and is flexible enough to be paired with other improvement frameworks, such as Lean Six Sigma. Large healthcare networks, such as England’s National Health Service (NHS), use this model for improvement. At the core of the IHI model are these three steps:
1. Identify the aim.
The aim is a high-level statement that clearly outlines the desired change. Because it will drive all actions, it should be measurable, time-bound, and address a specific population of patients. Think of it as defining how much, by when, for whom. For example, an aim could be to “reduce adverse drug events in critical care by 75 percent within 1 year” or “reduce wait time to see a physician to less than 15 minutes in 9 months.” This helps your team understand what needs to be improved by when, and how it will be measured.
Please note that you can and will have more than one aim for your organization. These are similar to Balanced Scorecard objectives, so expect to have several aim statements for each part of your organization or strategy, such as patient safety, clinic operations, critical care, etc.
2. Brainstorm drivers of change.
In this step, the improvement team comes together to think through which system changes will impact the aim. Which changes will deliver the biggest improvements for the organization? What are your current levels of performance? How will you measure progress? What changes can be “easy wins”? How will you choose your evaluation design? Answering these questions takes collaboration and deliberation—the process could take days, weeks, or even months depending on the scope of your aim. But it’s important to take the time to brainstorm because it generates a substantial list of ideas that will drive the next step.
Some of the ideas will look like measures (for tracking progress) and others will look like initiatives (for improving performance). During the brainstorming phase, don’t worry about the difference between these. Down the road, you can separate the items included in your changes into the two different areas.
Bring some ideas to your first brainstorm. Here are 108 healthcare KPIs and measures that might help you drive change.
3. Initiate PDSA cycles.
You have your aim and brainstormed how to best reach it. Now, you’ll begin to take action. The IHI Model for Improvement approach uses Plan, Do, Study, Act (PDSA) cycles. These cycles make small changes to avoid any disruption in care and ensure success before change is implemented on a grand scale. It’s an iterative process:
- Plan—The improvement team plans the test or observation, including stating the objective, making predictions, and determining how to collect data.
- Do—The test launches on a small scale, over a short interval (for example, one to two weeks). Observations and challenges are documented.
- Study—What are the test results? Analyze the data, comparing results to your predictions and summarizing learnings.
- Act—Based on the results, the improvement team will proceed in one of these ways:
- Adapt—Tweak the test in the hopes of improving the outcomes.
- Adopt—Ratify the new process and apply it on a larger scale.
- Again—Repeat or extend the test if the results are unclear and more data is needed.
- Abandon—Discard the test if the results seem unlikely to lead to improvement. Relaunch the PDSA cycle, even returning to the brainstorm step if necessary.
Remember that PDSA cycles are based on small changes. The IHI model is a calculated, controlled approach to improvement—it’s more about quiet victories than big wins.
Measurement In The IHI Model For Improvement
How will you know if something changed, or if a change was an improvement? You have to create standards of measurement—this is critical to successfully implementing change in an organization.
Keep in mind that measuring for improvement (learning and process improvement) is not the same as measuring for research. Improvement measurements are designed to bring new knowledge into daily practices via multiple, sequential tests that gather small batches of data. Research measurements are geared toward discovering new knowledge in one large “blind” test over a longer period of time, collecting as much data as possible.
The IHI model is centered on measurement for improvement, and there are four standard types of measures:
1. Outcome Measures
Outcome measures focus on the impact of a change (the result), such as how a new system affects patients or staff. For example, an outcome measure for medication systems would be “adverse drug events per 1,000 doses.”
2. Process Measures
Process measures evaluate change in a daily system or practice, including whether a test is on track and whether the performance is going as planned. One example would be measuring the “average daily clinician hours available for appointments.”
3. Balancing Measures
Balancing measures analyze a system from different angles to determine if changes are having unintentional or unexpected results in other areas (otherwise known as the ripple effect). It’s a balance of outcome and process. For example, you would measure whether readmission rates increase after reducing patient length of stay in the hospital.
4. Structural Measures
Structural measures give consumers a sense of a healthcare provider’s capacity, systems, and processes to provide high-quality care. These measures would be public knowledge, such as the facility’s number or proportion of board-certified physicians, or a provider-to-patient ratio.
Final note: You don’t have to have all four types of measures for every “aim” or goal. Some will be more relevant than others, depending on the type of aim you’re trying to improve upon.
IHI Model Measurements In ClearPoint
ClearPoint’s strategy software is built on a flexible foundation that can adapt to any change management framework you’re using, including the IHI improvement model. Using ClearPoint allows you to easily (and often, automatically) track and measure all changes you’re testing. For example:
- The process or outcome can be an objective that links to measures, showing the interrelation. Custom fields indicate the type (outcome, process, balancing, or structural) and purpose of each measure.
- Reports can be generated easily to show your performance on high-level objectives, with the ability to drill down into each support measure to track performance on a more detailed level. Monthly, quarterly, or even annual analysis can be made, but you’ll likely create reports even more frequently when implementing change within an improvement framework.
That’s not even half of it. ClearPoint is designed to help you manage your strategy, which includes both built-in features that are a natural fit for your needs and the ability to configure the system to support your change management initiatives. Contact us for more information on how ClearPoint’s software can be tailored to the IHI model.