The IHI Model for Improvement is a simple but powerful tool for making improvement in healthcare. The model has two steps:

• Three fundamental questions that must be answered before we start an improvement
• The Plan-Do-Study-Act (PDSA) cycle to test changes in the real world

Question 1 - What are we trying to improve?

If we have identified the problem by getting to the root-cause we should be able to define what we are going to improve, and then set our aim.  Improvement requires setting aims. The aim should be time-specific and measurable. It should also define the specific population of patients or other systems that will be affected.

Remember that ‘some is not a number and soon is not a time’

Tips for setting aims

1. State the aim clearly and keep it simple

2. Include a numerical goal to help focus the effort and identify measures

3. Make sure the aim is time and location- specific:
“Reduce drug errors” - is not an effective aim.
”Reduce adverse drug events in critical care by 75 percent within 1 year” - is a more effective aim.

4. Don’t become distracted from your aim as you start to test changes

Question 2 - How will we know if we are making an improvement?

Once we have defined what we are going to improve and then set our aim, we need to establish measures to know if the changes we make lead to an improvement.

Use quantitative measures to determine if a specific change actually leads to an improvement.

Tips for establishing measures:

1. Limit the number of measures and keep it simple

2. Remember that measurement is not the goal and the measure doesn’t have to be perfect; we just need to know ‘are we making an improvement?’

3. Audit and sampling is ok if you are dealing with large volumes of activity

4. Qualitative measures can be very effective as long as they are repeatable and reliable

5. Try to make data collection part of the daily routine and try not to rely on information systems or external teams (by keeping it simple)

Question 3 - What changes can we test to make the improvement?

Once we have set our aim and established how we will measure improvement, we can select the changes we are going to try.

Ideas for change may come from those who work in or outside the system, or by borrowing from the experience of others who have successfully improved.

Tips for selecting changes to test:

1. Make sure the changes you are going to test are in your control and keep it simple

2. Make sure you change something - Not all changes lead to improvement, but all improvement requires change

3. Select the changes you are going to test based on the root-cause of the problem

Now it's time to try the changes out in the real world with a Plan-Do-Study-Act (PDSA) cycle.