Quality Improvement
Principles, Methods and Tools
Marlene “Marni” Mason
MCPP Healthcare Consulting
Marni Mason BSN, MBA
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Thirty+ years in healthcare as clinician, manager
and consultant
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Primary & specialty care clinic nurse and nursing
director – 15 years
Consultant in healthcare performance measurement
and improvement – 18 years
Public health performance management – since 2000
Surveyor for NCQA (10 years) and Senior Examiner
for state Baldrige Quality Award (late 1990s)
Consultant for PHAB Standards Development (20082009)
2
Learning Objectives
In today’s learning session, the participants will
develop a better understanding of:
Principles of Quality Improvement
Selected Quality Improvement Methods
Selected Quality Planning Tools
Learn about Rapid Cycle Improvement (RCI)
And
Start development of QI team AIM statement
3
Collaborative with a Capital “C”
Systems are perfectly designed
to produce the results they
achieve
4
IHI’s* Breakthrough Series
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Also known as the Collaborative Method
It is an improvement method that relies on
spread and adaptation of existing knowledge
to multiple settings to accomplish a common
aim
Methodology to accomplish organizational
system change
*Institute for Healthcare Improvement www.ihi.org
5
The Advantage of a Learning
Collaborative for Improvement
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Learning collaborative: a group of multidisciplinary teams from multiple organizations
which come together over the course of a
year in structured meetings and phone
contacts to accomplish specific learning
objectives.
National experience demonstrates significant
boost in pace and level of achievement of
outcomes by sharing lessons learned.
6
Collaborative Process (IHI)
Participants
Select
Topic
Planning
Group
Prework
Identify
Change
Concepts
P
A
P
D
A
S
LS 1
P
D
A
S
LS 2
D
S
LS 3
Outcomes
Congress
Supports
E-mail
Visits
Web-site Phone
Assessments
Senior Leader Reports
7
Characteristics of a Collaborative
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Team approach
Performance measures
Teams from multiple organizations
One for all, all for one
Promotes a culture of change
Standardizes practice
Sustainable change
8
MLC-3 Collaborative Targets
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In Illinois, participation in the MLC-3 Learning
Collaborative is focused on improvement in
two target areas for MLC-3:
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Community Health Improvement Plans
Chronic Disease Prevention-Obesity/Physical
Activity (reduce preventable risk factors that
predispose to chronic disease)
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MLC-3 Collaborative Approach
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All sites receive training in:
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Quality Improvement Methods & Tools
Data Analysis Tools
Rapid Cycle Improvement Method
Site-based teams develop implementation
plan for improvement
Series of web-based phone sessions with
coaching from consultant
10
Principles of Quality Improvement
“Quality is never an accident; it is always the result
of high intention, sincere effort, intelligent direction
and skillful execution; it represents the wise choice
of many alternatives.”
William Foster
(many variations attributed to others)
11
Performance Management
Source: Turning Point
Performance
Management
Collaborative, 2003.
12
The Quality Environment
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Do you have an organization-wide commitment to
assessing and continuously improving quality over
time?
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Are your system decisions based
on data?
Do you know if your agency is
achieving its goals?
Do you use data to decide on improvement initiatives
and to know if the improvements are successful?
13
Change vs. Improvement

W. Edwards Deming stated “Of all changes
I’ve observed, about 5% were improvements,
the rest, at best, were illusions of progress.”
 We must become masters of improvement
 We must learn how to improve rapidly
 We must learn to discern the difference
between improvement and illusions of
progress
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Principles of Quality Management
1.
2.
3.
4.
5.
6.
7.
Know your stakeholders and what they need
Focus on processes
Use data for making decisions
Understand variation in processes
Use teamwork to improve work
Make quality improvement continuous
Demonstrate leadership commitment
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1. Know Your Stakeholders
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Identify stakeholders and
their needs
Set goals based on
stakeholder needs
Monitor performance and
satisfaction to target
performance improvement
opportunities
Improve or redesign how
work is done
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Sector Maps for Planning –
Example of Public Sector
Health & Human Services
•Center for Disease
Control & Prev.
•Center-Medicaid
&Medicare Srvcs
•Fed. Drug
•Administration
Dept. of Social & Human
Services
Office of the Insurance
Commissioner
Governor / Legislature
Employment Security
Department
Department of Health
•Community & Family
Health
•Women, Infants &
Children
•Licensing Boards
Tribal Government
Health Care Authority
School Boards
•Public Schools (K-12)
•Private Schools (K-12)
Local Health Jurisdictions
Rural & Community
Health Centers
Local Government
Public Library System
Indian Health Service
State Board of Health
Bullets refer to examples of organizations and are not a comprehensive listing.
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Example of Private Sector
Consulting
Foundations
Professional
Organizations
Purchasers
Hospitals
Home Health Care
Funding Foundations
Pharmaceutical
Companies
•Rob’t Wood Johnson
Health Plans
Providers
Business and
worksite programs
SNF and Nursing
Homes
Insurance Brokers
Primary/Specialty
Medical Groups
Ancillary Service
Practitioners and
Groups
Media
Bullets refer to examples of organizations and are not a comprehensive listing.
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Example of CommunityBased Sector
Service Organizations
•Thousands of
community-based
agencies: specific partners
will be identified in each
community
Communities of Color
Organizations
United Way
Senior Centers
Faith-based Community
Organizations
Community Centers
Youth Associations
•YMCA / YWCA
•Boys & Girls Club
•Boy & Girl Scouts of
America
•Campfire Girls and Boys
American Association
of Retired Persons
Community Health
Alliances
Youth Sports Associations
Churches, Temples &
Mosques
•Little League
•Pop Warner
•Soccer, etc
Community Health
Centers
•Federally Qualified
Health Centers
•Migrant Health Centers
Community-based
Daycare Sites
•All ages
•Birth to 3 childcare
Bullets refer to examples of organizations and is not a comprehensive listing.
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Example of
Academic/Research Sector
State Universities
Tribal
Colleges
Community
Colleges
Private Universities
Allied Health Professional
Schools & Training
Nursing
Schools
Private Research Centers\
Pharmacy Schools
Bullets refer to examples of organizations and is not a comprehensive listing.
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Example of Target Populations
CONDITION
Diagnosed
Public:
Private:
Community:
Academic:
Age
Racial/ethnic
Communities
Socio-economic/low literacy
General Population
 Center for Medicaid &
Medicare Services (CMS)
 DOH -- CDRRP/DPCP
 Public Hospital Districts
 Tribal Associations
 Veteran’s Admin.
 Dept. of Defense
 Medicaid
 Qualis Health
 Health plans
 Media
 Inland NW Business Coal.
 Alternative health providers
 Home health
 Student health centers
 DOH-Chronic Disease Risk
Reduction (CDRRP)
 DOH- Diabetes Prevention
& Control Program (DPCP)
 Tribal Assns.
 Indian Health Services
 DOH-Chronic Disease Risk
Reduction (CDRRP)
 DOH- Diabetes Prevention
& Control Program (DPCP)
 Dept. of Veterans Affairs
 Maternal Support Services
 Community Health Plans of
WA – (CHPW)
 Association of Black Health
Care Professionals
 Association of American
Indian Physicians “Move It”
program
 Amer. Diabetes Assoc.
 Juvenile Diabetes Research
Foundation (JDRF)
 Senior centers
 Service organizations
 Community Aging Service
Providers
 WSU Extension
 Focused research programs,
e.g. SEARCH for Diabetes
in Youth
 Communities of color
organizations
 Amer. Diabetes Assoc.
(ADA)
 CHOICE Health
 Commu. Health Centers
(CHCs)
 WSU Extension
 Focused research programs,
e.g. SEARCH for Diabetes
in Youth
 Molina health plan
 Community Health Plans of
WA (CHPW)
 Disease management
vendors
 Critical access hospitals
 Home Health
 Washington Health
Foundation
 CHOICE Health
 Commu. Health Centers
(CHCs)
 Centers for Disease Control
& Prevention (CDC)
 Office of Insurance
 Governor/Legislature
 Dept. of Corrections
 Public Employees Benefit
Board
 Local Health Jurisdictions
 Professional orgs
 Pharmaceutical. Co
 Medical Supply Co.
 Purchasers
 Disease mgt
 Hospitals
 Critical access hospitals
 Primary/specialty groups
 WA StateUniv. Extension
 Commu. Health Centers
 Amer. Diabetes Assoc.
(ADA)
 Nutrition & Cultures
 Disease Management
Education Centers
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Allied health training
UW Med school
Bastyr University
Nursing Schools
Private Universities
Pharmacology Schools
Community Colleges
Tribal Colleges
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2. Focus on Processes
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85% of poor quality is a result of
poor work processes, not of staff
doing a bad job
Processes often “go wrong” at the
point of the “handoff”
Attend to improving the overall
process, not just one part—some
of the most complex processes are
the result of creating a “work
around”
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Focus on Processes
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Advice from NCQA, JCAHO and others—
measure processes that are
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High-risk
High-volume
Problem-prone
And
Can be tracked and reported as summary or
aggregate statistics
23
Develop Process Flow Charts
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High level flow charts [6-12 steps] initially
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Identify customer-supplier relationships
More detailed flow charts as project unfolds
[client flow, information flow, materials flow,
decision making flow]
Use for process redesign
Use for adapting or adopting best practices
24
We inspect
restaurants
So that
# of inspections
Conditions in the
restaurant don’t
create unsafe food
So that
# of critical violations
Public is sold
food that is
safe to eat
The Logic of
Public Health
% of critical
violations corrected
within 24 hours
So that
There are fewer
incidents of
foodborne illness
rate of foodborne illness
25
Logic Models (Many Shapes/Sizes)
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Connect what we do every day to why we do it
Show logical links between activities and goals
Link our process objectives to our outcome
objectives
As long as the format is legible, logical, and it
works for you, it’s probably fine
Boxes and arrows are not required
New computer software is not required
26
Logic Model:
Any Public Health Program
Inputs
Resources
Money
Staff
Outputs
Short Term
Outcomes
Intermediate
Outcomes
Long Term
Outcomes
Activities
Program
Development
Program
Planning
Materials
Development,
Distribution
Informed,
Targeted
Program
Appropriate,
Targeted
Materials
Reduced
Morbidity
Improved
knowledge,
beliefs,
attitudes
Improved
Behaviors
Reduced
Mortality
Improved
Quality of
Life
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3. Use Data to Make Decisions
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Use performance
assessment data to target
improvement
Use data analysis tools to
develop information
Analyze data to identify root
cause
Use data to monitor
performance outcomes
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Use Data to Make Decisions
Conceptual Tools
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Affinity Diagram
Brainstorming
Process Flow Chart
Interrelational Diagraph
Matrix Diagram
Tree Diagram
Cause and Effect
Diagram
Numerical Tools
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Check Sheet
Bar Chart
Histogram
Pareto Chart
Control Chart
Run Chart
[See Goal/QPC PH Memory Joggers]
30
Use Data to Make Decisions
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Brainstorming for root causes—theory
generation relies on divergent thinking, no
idea is a bad one…
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What can go wrong in the process we are
studying?
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Problems in hand-offs between steps
Problems in execution within steps
Look at machines, materials, methods,
measurements, and people
31
Cause-effect or Fishbone Diagram
Exercise: Constructing a Fishbone Diagram
 Organizes and displays theories
 Encourages divergent thinking
 Demonstrates the complexity of the problem
 Encourages scientific analysis (rule-out)
Turn to page 23 in the PH Memory Jogger.
32
4. Understand Variation
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Sources of variation include: machines, materials,
methods, measurements, people, environment
Common cause variation occurs if the process is
stable—variation in data points will be random
and obey a mathematical law—it is said to be in
statistical control, with a large number of small
sources of variation
Reacting to random variation in a process that is
stable/in statistical control, it is called tampering
and leads to further complexity, increasing
variation and mistakes
33
Understand Variation
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Special cause variation arises because of
specific circumstances which are not part of
the process all the time and may or may not
ever recur—if the recurrence is periodic,
clues to the root cause may emerge
Variation can be shown in control charts with
mean and standard deviation
Control charts are pictures of trend data with
an extra feature—the range of variation built
into the system
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Understand Variation
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A sentinel event is a special cause variation
requiring root cause analysis
Examine specific incident(s) of special cause
variation and make changes to a single
element only after very careful analysis
Need to investigate special cause variation
before making any conclusions about
performance level
Failure to distinguish between common
and special cause variation can be
hazardous to organizational performance!
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Variation Exercise
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Joiner Associates – Hunter Conference
exercise
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Attributed to Brian Joiner’s 9 year-old son
36
5. Use Teamwork
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QI efforts need buy-in from
all stakeholders
Creative ideas are needed
Division of labor is needed
Process often crosses
functions
Solution generally affects
many
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Use Teamwork
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Teams should develop a clear charge and
support resources
Teams should adopt working agreements
(cell phone etiquette to decision procedures)
Teams should assign roles of facilitators and
recorders
Team process has predictable stages that are
useful to keep in mind:

Forming, Storming, Norming, Performing
38
Example of Alignment Wheel
Public Health and Partners Aligned with the 10 Essential Services
ES 10: Research
Goal
Statement
ES 9: Evaluate
ES 1: M onitor
Health Status
Pharm.
Co., N.I.H.
ES 2: Diagnose
LHJs and Investigate
CDC
FQHC,
Qualis
,
Health
U.W.,
V.A
DSHS /
MAA
WADE
ES 8: Assure a
U.W.
Competent Workforce Pharm W.S.U
.
Goal
Statement
Health
Plans
ES 7: Link People to
Needed Services
LHJs
Health
Care
DM Ed
Center
PH
Program
DSHS /
MAA
OIC,
Legislature,
Govern
ES 6: Enforce Laws
and Regulations
Goal
Statement
HH
S
ADA
,
WADEES 3: Inform, Educate
Pharm.and Empower
Assoc
Qualis
FQHC
Faith-based,
Goal
Schools,
Educ. Assoc.
Statement
Profession (AARP
etc),
ES 4:
M obilize
al Assoc.,
Community
OIC,
Partnerships
Feds,
ES 5: Develop
Policies and Plans
39
6. Make QI Continuous
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QI is a system-wide approach to assessing
and continuously improving quality of the
processes and services over time
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See inter-relationships, not parts
Understand the flow of work, not the one-time
snapshot
Detail the work processes
Determine cause and effect relationships
Identify points of highest leverage
Improve and innovate, not just change for
change’s sake
40
PDCA/PDSA Cycle definition
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The Plan Do Check/Study Act Cycle is a trialand-learning method to discover what is an
effective and efficient way to design or change a
process
The “check” part of the cycle may require some
clarification; after all, we are used to planning,
doing/acting. It compels the team to learn from
the data collected, its effects on other parts of the
system, and under different conditions, such as
different communities
41
Act
• What changes
are to be made?
The PDSA
Cycle for
Learning and
Improvement
• Next cycle?
Study
• Complete the
analysis of the data
• Compare data to
predictions
• Summarize
what was
learned
Plan
• Objective
• Questions and
predictions (why)
• Plan to carry out the cycle
(who, what, where, when)
• Plan for data collection
Do
• Carry out the plan
• Document problems
and unexpected
observations
• Begin analysis
of the data
42
Ongoing PDSA Cycles
PLAN
PLAN
PLAN
Target Improvements
Accreditation
Accreditation
ACT
Areas for
Improvement
DO
Evaluate
CHECK
Report/Recommend
Self-Assessment
or Accreditation
DO
ACT
Improvement
work
Recommend
Improvement
ACT
DO
Areas for
Improvement
Evaluate
CHECK
CHECK
Study Improvement
Results
Report/Recommend
Performance
Improvement
Cycle
Self-Assessment
or Accreditation
43
Make QI Continuous
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Use assessment to identify areas for
improvement
Charge QI team and provide support
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Provide QI training
Use tools to understand root causes
Use data for baseline and analysis
Design process improvement to address root
causes
Train…train…train… staff on the newly
designed process improvement
44
Adopt or Adapt Model Practices
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Use data to identify need for improvement
Identify exemplary practices in:
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other local departments,
Michigan state programs and other states,
CDC and other national organizations,
www.naccho.org/topics/modelpractices
other industries
Describe your process (Logic Model)
Study the exemplary practice process
Adopt or adapt as appropriate
45
7. Demonstrate Leadership
Commitment
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Build a QI culture
Connect the organization’s
strategic plan to performance
improvement
Know and use quality principles
Encourage all staff to use quality
improvement in daily work
Reward improvements
Assure adequate QI infrastructure
for quality assessment and
improvement activities
46
What questions do you have?
47
Rapid Cycle Improvement (RCI)
and PDSA Cycles
48
Why do we need a systematic
model for improvement?
“All improvements require change but not all
change will result in improvement. A primary
aim of the science of improvement is to
increase the chance that a change will actually
result in sustained improvement from the
viewpoint of those affected by the change.”
--The Improvement Guide, 1996
49
Rapid Cycle Improvement
Model for Improvement
The idea behind rapid cycle
improvement is to first try a
change idea on a small scale
to see how it works, and then
modify it and try it again until
it works very well for staff and
customers. Then, and only
then, does a change become
a permanent improvement.
What are we trying
to ac c omplish?
How will we know that a
c hange is an improvement?
Ac t
Study
Plan
Do
50
Testing a Change: Why Test?
Low
Confidence in success
-Smaller Scale Tests
-More of them prior
to implementation
High
Minor
Level of risk
Major
51
Modified from Jane Taylor PhD
Testing a Change: Why Test?
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Minimize risks of potential failure and of
potential adverse or unanticipated side
effects
Predict how much improvement can be
expected from the change
Learn how to adapt the change to conditions
in the local environment
Evaluate costs and side-effects of the change
Minimize resistance to implementation
52
Rapid Cycle Improvement
Mod el for Im p rovem ent
What are we trying
to ac c om plish?
How will we know that a
c hange is an im provem ent?
Ac t
Stud y
Pla n
Do
53
What Are We Trying to Accomplish?
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The first question is meant to establish an aim
for improvement that focuses group effort.
Aims should be as concise as possible –
sometimes it takes a few trials of testing an
aim before it becomes truly focused
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Focus on what matters to the organization, staff
and patients
Use numerical goals wherever possible
Guidance and resources (e.g. tools to be used,
methods and systems to be changed)
54
How Will We Know That a
Change is an Improvement?

Measures and definitions are necessary to
answer this question.
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Data is needed to evaluate and understand the
impact of changes designed to meet an aim.
When shared aims and data are used, learning is
further enhanced because it can be shared. In this
way, superior performance and best practices are
more quickly identified and disseminated through
benchmarking.
55
What Change Can We Make that
Will Result in an Improvement?
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This step is also known as “How will we get
there?”
Formulate change concepts that may improve the
process outcomes
This is the who, what, when, and how of doing
the actual test
It compels the team to learn from the data
collected, its effects on other parts of the system,
and under different conditions
56
Consolidation of Relevant
Knowledge and Experience

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Develop a set of change concepts
Definition of Change Concepts - Ideas for
interventions and actions for improvement
with a greater likelihood of working based on
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evidence,
quantitatively documented experience, and/or
internal data.
57
Some Sources for Improvement
Interventions and Actions
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Published literature in scientific journals
Documented (with data) experience from other
public health agencies
Internal qualitative analysis of work processes
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Internal quantitative analysis of work processes
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Use qualitative analysis tools (e.g. fishbone diagrams,
root cause concepts) to identify barriers
e.g. Pareto analysis
National experts (e.g. IHI, NACCHO, PHF, ASQ,
Goal/QPC, MLC states and many others)
58
Sequential Building of Knowledge
Includes a Wide Range of Conditions in
the Sequence of Tests
A P
S D
Breakthrough
Results
A P
S D
A P
S D
Theories,
hunches,
& best practices
A
S
P
D
Spread
Implement
Test new conditions
Test a wider group
Test on a small scale
59
Sequential Testing….when do you
move to implementation?

After each PDSA…
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Implement as is
Abandon it
Increase in scope
 e.g. more clients, more programs
Modify it and test again
Test under different conditions
60
Testing Done in Multiple Change
Areas in Parallel
A P
A P
RCI Team #4
Or 4th Change
S D
A P
S D
Change
RCI Team #1
Or 1st Change
A P
S D
S D
S D
S D
S D
A P
S D
S D
A P
S D
S D
A P
A P
S D
A P
A P
3rd
A P
A P
A P
RCI Team #2
or 2nd Change
S D
S D
A P
RCI Team #3 or
A P
A P
A P
S D
A P
S D
A P
A P
S D
S D
Aims:
Productivity
Quality
Coordination
Access
S D
S D
61
Testing a Change

Testing – Trying and adapting existing
knowledge on small scale. Learning what
works in your system
Testing is not permanent
 Often we have more failures than successes
Test on a small scale over a short period of time
Have experts comment on feasibility
Anticipate a sequence of tests on one change idea
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62
Testing a Change: Tips
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Move from ideas to action quickly
Decrease the scope of the test
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Test of oneness
 One stakeholder, one program, one day
As you are designing the test, ask ‘What design
would enable us to do this test now, tomorrow or
next week
63
Implementing a Change

Implementation – Making this change a
part of the day-to-day operation of the
system


Implement a change ONLY if it will lead to
improvement
Involves more people and conditions: you will
run into more resistance and factors which
require “design tweaks”
64
What Can We Do Now…
… by Next Week,
…by Tuesday,
…by Tomorrow
…that we can learn from without
harming clients or burdening staff?
Modified from Jane Taylor PhD
65
Rapid Cycle Improvement–Example
66
What are We Trying to
Accomplish?

Increase accurate and complete reporting of
CD to 80% or more of all reports by 10/07,
and more than 95% by 2/08 with clear
definition of complete reports. We do this in
order to provide valid data for planning and
program improvement
67
How Will We Know When We Get
There?: Measurements
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Increase (trended) in percent of accurately
completed CD reports
Decrease in staff time to input incomplete
information
Trend in overall measures in right direction
(direction of goodness indicated by arrow)


Other CD reporting measures
Other process measures
68
What Changes Can We Make?

Data analysis of reasons for incomplete
reports.






Identify reasons with definitions
Assure that database can capture each reason
Initiate data collection process
Train staff and providers in definition and reporting
process
Address lack of knowledge of providers
Create plan to identify high volume providers
and target for extra training
69
RCI Team Planning Tool
PROJECT: REDUCE PERCENT OF STAFF CANCELLATIONS (10-3-06)
Aim:
Reduce staff cancellations of patient appointments to 5% or less by Dec 2006 and less than 2% by March 2007 with clear
definitions of types of appointments considered staff cancellations.We do this in order to provide high quality, accessible
services to our clients.
Measures 1. Trend of staff cancellations in right direction.
2. Assess actual increase in productivity (measured by hours of direct service) that occur as a result of reducing the percent of
3. Trend in overall measures in right direction (e.g. hospitalizations, staff and patient satisfaction)
Cycle
Number
1
Change Tested
Person(s)
Responsible
1a
Data on staff cancellations to determine
reasons (Pareto analysis
Identify reasons for staff cancellations
Beth T., Margaret
1b
Establish definitions of staff cancellations
Bernie & Med Prov
1c
Train staff and providers in definitions
Donna, Beth T.
1d
Pilot test in all provider practices for 7 weeks Beth, Margaret
10/9- 11/24
WEEK. (1 = Sept 5)
1
2
3
4
(9/4)
5
(10/2)
6
7
8
9
10
11
(11/6)
12
13
(11/28)
70
Data Analysis- Pareto Chart
Non-Reporting Facilities by School Type
100
100.0%
90
90.0%
80
80.0%
70
70.0%
60
60.0%
50
50.0%
40
40.0%
30
30.0%
20
20.0%
10
10.0%
0
0.0%
CHILDCARE/PRESCHOOL Total
PUBLIC Total
PRIVATE Total
CHARTER Total
71
8
7
5
4
4
4
3
3
3
3
2
2
1
1
1
1
1
G
IS
D
8
AT
10
C
LI
O
H
ER
TO
B
N
EE
C
H
E
R
BE
N
TL
E
FE Y
N
TO
N
DA
VI
S
O
LA
KE N
W
V
IL
E
LE
ST
W
L
IN
O
O
D
D
EN
H
E
LA
IG
HT
K
E
FE S
N
TO
M
T
N
M
O
R
R
IS
B
EN
D
LE
FL
U
SH
IN
G
O
G
O
D
R
IC
KE
H
A
RS
L
M
EY
O
N
TR
O
SE
G
E
NE
S
EE
G
C
FL
AR R A
IN
N
M
EN D B T
LA
-A
IN
N
SW SW C
AR OR
TH
TZ
C
R
EE
K
Data Analysis- Pareto Chart
70
Non-Reporting Schools By District
100.0%
62
60
90.0%
80.0%
50
70.0%
40
60.0%
50.0%
30
40.0%
20
30.0%
11
20.0%
10.0%
0
0
0
0.0%
72
Results – Error Rate
73
Results – Time Study
74
Steps to Set Up a Rapid Cycle
Improvement






Establish a multi-disciplinary RCI team
Identify a positive opinion leader
Align leadership and administrative support
Consolidation of relevant knowledge and
experience (national) for multiple changes
Development of an overall aim statement
(using the three questions at a high level)
Decide where to start and develop a strategy
for a series of rapid cycles.
75
Guidance on Following the Steps


It is important not to try to write the perfect
AIM statement and develop the most
thorough rapid cycle strategy at the start. It is
more important to start small, rapid tests of
change through PDSA cycles as soon as
possible. The AIM statement and strategy
evolve continually as you learn from testing.
The major objective is to build organizational
learning from small tests of change.
76
Key Lessons from RCI





The rapid improvement work must be seen as
The Work and not a separate project
Implementation and holding the gains requires
integration into daily work and meetings
Start work with those interested in change
Communicate what is happening persistently
Provide support to providers and staff who take
on this new work
77
What questions do you have?
78