The Model for

Improvement

Fatemeh Lashgari
Chris Manaois
Chi Nguyen
Trishika Tabuena
 The Model for Improvement (MFI)

➢ The MFI is a tool widely used in

healthcare for a structured and
systematic approach to quality
improvement
➢ Developed by Associates in Process
Improvement in the 1990s (IHI, n.d.)
➢ Has 2 components:
○ “The Three Questions”
○ “The Plan-Do-Study-Act (PDSA) Cycles”
“The Three Questions”
➢ Added to the PDSA component with the goal of providing structure to improve
projects and forming the Model for Improvement (Raymond & Dawda, 2016)
➢ Answering the questions relate to the overall project, one of the drivers or the
change concept

1. What are we trying to accomplish?

➢ The overall objective
2. How will we know that a change is an improvement?
➢ Measurement
3. What change can we make that will result in improvement?
➢ Generating ideas for change
“The Plan-Do-Study-Act (PDSA) Cycles”

Plan
➢ Be clear about objective
➢ Check hypothesis and prediction
➢ Think about who, what where when and how
➢ Plan the STUDY part of the cycle
Do
➢ Execute the Plan
➢ Observe and document any problems or unexpected issues
➢ Conduct data analysis
Study
➢ Interpret the data analysis and compare to
prediction/hypothesis
➢ Consider the learnings and reflect on what worked and what
did not work
Act
➢ Is it ready for implementation?
➢ What further changes need to be made?
➢ Do we need to test it again either or a large scale or another
context?
Form the team: Involve all stakeholders, ideally 4-8
people.

Set the Aim: Time specific, measurable, clearly

stated population or system it addresses.

Establish measures: Quantitative measures that

indicate if a change leads to an improvement.

Selecting Changes: Take ideas for change from

those who work in the system, from the evidence, or
from the experience of others.
PDSA Cycle: Plan the change, test the change,
study the change and act on the results. The
proposed change is refined through multiple cycles
of PDSA.

Implement Change: Once the change has been

tested and studied, it can be implemented.

Spread Change: Once the change has been

refined and implemented, it is time to spread the
change. The PDSA cycle can be used here as well in
order to facilitate the spread to other units, larger
populations, or o whole organizations. Spread can
even mean sharing the change with other
organizations.
Several cycles of the PDSA can be
used to continue moving toward the
aim.

The PDSA cycle promotes detailed,

stepwise thinking, allows for making
predictions, forces thoughtful
deliberation, and facilitates change.
Technical Terms and Acronyms

1. QI plan: a strategy for identifying and implementing specific changes in

processes that may result in improved performance.

2. Balanced Scorecard
3. Performance measurement

4. SMART Aim:
5. Data collection: proven tools, techniques, processes, and frameworks, and often involves
automating parts of the data collection process

E.g. Simple Data Collection Planning (IHI), Sampling (IHI), NQC Quality Academy’s
Collecting Performance Data (New York State Department of Health AIDS Institute)

6. Randomized sampling: is a method in which all members of a group (population or

universe) have an equal and independent chance of being selected.

7. Data visualization

Run chart
 MFI Example

AIM
- The ABC Clinic will improve patient satisfaction through
patient satisfaction survey.

MEASURE
- >90% of patients seen will complete and submit the patient
feedback survey.

IDEA
- Establish procedure and guidelines for handout and collection
of patient feedback survey.
 MFI Example Cont.

PDSA Cycle 1
○ Plan
■ Display surveys at the checkout desk
■ Encourage to complete survey
■ 1 week trial
○ Do
■ Other things to do ie. schedule new appointment or pay for services
■ Busy / backed up check out area
■ Checkout attendant was consistent to remind about the survey
○ Study
■ 8 completed surveys
○ Act
■ Patients did not want to stay to fill out survey once their visit was over
■ Need to give patients a way to fill out the survey when they have time
 MFI Example Cont.

PDSA Cycle 2
○ Plan
■ Display surveys at the checkout desk
■ Encourage patient to take the survey at home and mail it back to the clinic
■ The patient will be given a return envelope
■ 2 week trial
○ Do
■ The checkout attendant offered the patient to take home survey and return envelope
■ The patient had other papers to manage at this time well
■ Only about 30% took a survey and envelop
○ Study
■ Only 3 completed surveys - the process did not work well.
○ Act
■ Some patients did not want to be bothered at this point in the visit. Majority were only interested in
getting checked out.
■ Once the patient steps out of the building, they will likely not remember to do the survey.
■ Need to approach patients at a different point in their visit when they are still with us - maybe while
waiting for the doctor and have nothing to do
 MFI Example Cont.

PDSA Cycle 3
○ Plan
■ Leave survey forms in the exam room next to survey box and writing materials
■ Nurse will instruct patients to complete survey prior to completion of appointment and put them in survey box
■ 1 week trial
○ Do
■ Most nurses were good on pointing out or handing the patient the survey
■ Some patients may need assistance in reading survey but nurses are busy to help
○ Study
■ 24 completed surveys - the process worked out better than the past 2 cycles
○ Act
■ Approaching patients while they are still in the clinic was more successful
■ We need to figure out how to help people who may need assistance in reading the survey
 Key Points/ Summary
The MFI is a common tool in healthcare that is used for quality
improvement.

2 Components:

- The 3 questions
- Overall Objective, Measurement, Ideas for Change
- The PDSA Cycle
- Plan, Do, Study, Act

It is important to Set the Team including Stakeholders in the process

Iterative Cycles

- Test idea in a small way, study outcome and inform next PDSA Cycle

Implement and Spread Change

References

Agency for Healthcare Research and Quality. (2020). Plan-Do-Study-Act (PDSA) Directions and
Examples. https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html

Institute for Healthcare Improvement. (n.d.). Science of Improvement: How to Improve: IHI. Retrieved
from
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.as
px

Raymond, M., & Dawda, P. (2016). Making quality improvement simple: The Model for Improvement.
InnovAiT, 9(12), 768-772.
https://journals.sagepub.com/doi/pdf/10.1177/1755738016659515.
Questions