MODULE 0 - INTRODUCTION
Module 1: Personality Preferences and Performance in Teams
Module 2: Fundamentals of Quality Improvement
Module 3: Presentation of Self - Presence and Impact
Module 4: Using your authority and Influencing change
Module 5: Co-consulting

IN2.4 – The Model for Improvement: Aims and Measures

If like Sarah we have found something that we really want to improve, it can still be difficult to know how to get started. A really helpful approach is to use the Model for Improvement, a tool to help us systematically find and tackle problems so that we make the changes that will lead to improvement.

The model is formed of three questions that we should ask ourselves before we start any change or improvement project, and a process for testing out our ideas called the PDSA cycle. This is designed to make our changes more successful, safe, and manageable, by helping us to focus on the right things.

Click on each section of the image to find out more.

[H5P – MFI with purple dots]

[VIDEO – MFI Overview]

What are we trying to accomplish

[IMAGE – MFI With what are we trying to accomplish highlighted]

Once we know broadly what the problem is and we have understood what really happens, we have a better idea about what it is we want to improve and can start to describe our aim: exactly what it is we are trying to accomplish. This first question is really important, because it helps ensure we stay on track and focused, helps others understand what we are trying to do, and helps us identify what our measure of success might be.

It’s not always as easy as it sounds though!

Developing your Aim

[VIDEO – Developing your aim original from HCSW]

Make sure your aim includes:
• WHAT you are improving
• HOW much you want to improve it by
• WHERE you are starting from
• WHEN you are aiming to see the improvement by

[IMAGE – SMART model]

Use SMART criteria to make sure your aim is:
S = specific: state exactly what you want to achieve
M = measurable (how much, compared to what)
A = achievable (something you are able to act on)
R = relevant (to you, your patients, your organization)
T = timebound: when you will achieve it by
For more tips on developing an aim statement watch this clip: https://learn.nes.nhs.scot/52125/quality-improvement-zone/quality-improvement-journey/developing-aims/quality-improvement-developing-aims

[H5P – Flipcards Getting the aim statement right from HCSW course]

Sarah’s aim

Having done her observation and created her Fishbone diagram Sarah is confident there is value in an improvement project to reduce possible medication errors on her ward. She has seen the effects of one such error and wants to make sure the risk of future errors is reduced. She decides that she will suggest the aim for their improvement project should be: To reduce medication related errors

Sarah wants to make her aim SMARTer. Consider how you might refine her aim and then click the box to see how what changes Sarah makes.

[H5P Flip cards

Box 1
Reduce medication related errors

Box 2
To reduce the number of drug administration errors each month on Ward 5 from [x] in November 2021 to 0 by March 2022]

Sarah realizes that to make the aim relevant and specific she will need to find out what happens now, consider how she will know whether things are improving and what she might measure. Then she will come up with some ideas to get things started.

How can we find out what happens now?

If the improvement you are trying to make relates to a process that you use often – admitting a patient, for example – process mapping is a useful QI tool that can help uncover where there may be scope to improve speed, efficiency, reliability, or quality. It makes visible any differences that may exist between what we should do, think we do, say we do and actually really do, most of the time. To find out more about process mapping watch the clip below.

Improvement Tool: Process Mapping

Process mapping NHSE/I https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/ILG-1.2-Process-Mapping-Analysis-and-Redesign.pdf

You may find it helpful as you are developing your aim to record your thoughts on a prompt sheet like this one.

[PDF – Cathering sending Worksheet: Developing an aim statement]

How will we know a change is an improvement?

[IMAGE – MFI WITH SECOND BIT HIGHLIGHTED]

Once we have an aim we can think about the next questions in the Model for Improvement:
o How will I know if a change is an improvement?
o What changes can I make that will lead to the improvement I want to see?
Remember, it’s important to know how things are before you start making changes, so that you have something to compare with and can see whether or not the changes you make are having the desired effect.

[VIDEO – Measuring for Improvement from original HCSW course]

Sarah’s measures

[VIDEO – Sarah with slides and images]

Understanding measurement for improvement

Measurement for improvement is different to other types of measurement we may be more familiar with.
In healthcare we often come across Measurement for Judgement or Accountability – are we performing to a required standard or target? – or Measurement for Research, generating new knowledge through huge datasets. Measurement for Improvement is based in the real world and is focused on whether the changes we make and the things we are doing are actually leading to improvement.

Watch the clip below to learn more about how what measurement for improvement means and how we can use it.

Link to Mike Davidge clip on Measurement for Improvement https://www.youtube.com/watch?v=OzvDXoBB9Ps&t=2s

Faces of measurement

Now that you are familiar with the different faces of measurement, see if you can match the questions and the types of data to the face of measurement (judgement, research, or improvement) where they might best be used:

[H5P – Drag and Drop
Are we hitting the target? = Judgement
Average from last year = Judgement
Huge, controlled data set – Research
Is this drug safe? – Research
Is the problem getting better over time? – Improvement
Just enough data collected over time – Improvement]

Types of measure to consider

Sometimes we also need to think about more than one measure for our improvement work. Our aim should give us a clear measure – for example in Sarah’s project, her aim is to reduce drug administration errors, so her outcome measure will be the number or frequency of drug errors on her ward.

But sometimes – especially if our outcome or our goal is some way off or will take time to achieve or dependent on a variety of factors – we may also want to include process measures – measures of the things we are doing in service of our aim. For example, if we are trying to reduce drug errors, and we know that one of the factors is interruptions on the drug round, we might measure the number of times we are interrupted on each round.

And lastly, we might also want to think about measuring any unintended consequences – positive or negative – of our improvement work. We don’t want to improve one area at the expense of another so we might also want to measure for example the time taken to complete the drug round: does it take longer or less time, when we try to do things differently?

Find out more about outcome, process, and balancing measures by watching this clip: https://www.youtube.com/watch?v=uow7mzrFif4

What next?

By this stage, like Sarah, you should have identified an aim and decided what to measure. Make sure you carefully define your measures so it is clear what, how, where, when how often and who will collect the data. Once you have started to collect your data and have a baseline you can start to test some changes – and we will look at that in the next section.

[PADLET – what will you measure?]

Additional Resources

Institute for Health Improvement setting and aim statement http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTipsforSettingAims.aspx

NHS Scotland measurement https://learn.nes.nhs.scot/41626/quality-improvement-zone/qi-tools/last-10-patients-data-collection-tool

Measurement for Improvement Mike Davidge https://www.youtube.com/watch?v=Za1o77jAnbw

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