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

IN2.5 – The Model for Improvement: Generating and testing ideas for change

Change Ideas


When you are starting an improvement project remember that it is important not to jump to solutions too quickly. This is why we take time to really understand what the problem is, what our aim might be and how we will know things have improved, rather than just changed.

Then we can start to think about ideas for change. But how do we come up with good ideas or know which ideas to try? You are probably already familiar with the concept of brainstorming, but there are other things we can do to come up with good ideas to try.”

[VIDEO – Change Ideas from HCSWs course]

You can find out more about brainstorming techniques here

You could also use the Fresh Eyes technique that we introduced as an observation tool as a means to generate new ideas:

Fresh Eyes


  • Define the problem or issue.
  • Each member of the team takes on a random alternative perspective and views the problem from their new perspective. Go and observe what happens in practice from this viewpoint if you can. Ask the following questions of yourself from this new perspective:
    • What would be important to me here?
    • What would I focus on or notice?
    • What questions would I ask?
    • What ideas and approaches do I have that could be helpful?
  • Reflect on the observations and ideas that are generated and think about how they might be adapted for your situation. If there is a particularly useful concept, you might want to carry out a brainstorming session focusing on that concept to explore it further.

Adapted from
Thinking Differently, NHS Institute for Innovation & Improvement, 2017
Further resource Improvement Hub » Through the Eyes of…Observation DVD and Card Pack ( (Link to come from Catherine)

Sarah’s Change Ideas

Sarah’s Fishbone

[IMAGE – Same fishbone as drag and drop before]

Sarah’s fishbone diagram highlighted that some of things that could be contributing to medication errors were about the number of drugs in use, the complexity of dosing and the difficulty in getting information about the different drugs on an already busy ward.

[IMAGE – Search for two nurses handing over from shifts]

At handover she asked colleagues for a quick 5 minute brainstorm of ideas for how to tackle the problems she had identified. Some were a bit wild, but one that really stood out as being relatively easy to do and very useful was to create a drug information board.

Sarah decided to start with that…

Selecting your change idea

[VIDEO – Prioritising ideas New video, needs editing]

Prioritising Ideas – An example

[H5P Interactive slideshow with drag and drop and redrawn images – In folder (need image of nurse asking for ideas)]

Testing your change

[IMAGE – PDSA Cycle from HCSW – Just the circle bit of the MFI]

Once you have selected your first idea, you can begin your first PDSA cycle. Remember, we are testing out of curiosity to see whether our idea works or not. We aim to test small and fast, so that we can learn quickly what works and respond accordingly. It also helps you see if there are any problems with the approach you have planned so you can correct them early on.

Watch the video to find out more about the PDSA cycle

What change do you want to make?


  • What question do you want to answer with this first change test?
  • What ideas do you have?
  • Start small and easy (maybe don’t start with confronting the consultant!)
  • Think about the specific components of your plan (for example, who will do what, when, how, how often, using what, what do you think will happen?)

When you are running your first cycle remember:


[Everything from here to the end exactly mimics HCSW just remove Elizabeth references]

Sarah’s first PDSA Cycle

[IMAGE – Board provided on master doc. Remove “Russell Ward” from top]

She set it up in the treatment room near the medications cupboard, so it was easily viewable. She expected that all staff would see it and that half would have read the info by the end of the week.

She checked in with staff at the next handover to see if people had noticed the board yet and found it helpful. Everyone said they had seen it and all but one had read the information already.

Sarah updated the board the following week with another drug.

[IMAGE – Sarah looking up drug info]

She then asked her colleagues if anyone else wanted to contribute. The team agreed that each member of staff would take it in turns to research a relevant drug and provide information for the board.
They found this created lots of opportunities to involve their students and support their learning.

[IMAGE – Days without error board: 98 days without, 98 days record]

She kept a record of the medication errors reported on the ward over the next few months and was delighted that there were no drug errors!

Sarah’s next test is developing ways to help with drug calculations at the request of staff. She continues to collect data so that the team can keep track of how well they are doing and identify problems quickly if they emerge.

Additional resources

NHS England using PDSAs

Agency for Healthcare Research and Quality practical ways to use PDSAs

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