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Improvement Methods

The Institute for Healthcare Improvement has developed and adapted a basic set of tools to help organizations accelerate improvement. These include tools for gathering information (e.g., Walk-through); analyzing processes (e.g., Cause and Effect Diagrams, Pareto Diagrams, Run Charts, Flowcharts); gathering data (e.g., Sampling); working in groups (e.g., Affinity Grouping, Multivoting); and documenting your work (e.g., Project Planning Forms, Plan-Do-Study-Act Worksheets, Storyboards).

 

In addition, many organizations have developed tools in the course of their improvement efforts — for example, successful protocols, order sets and forms, instructions and guidelines for implementing key changes — and are making them available on IHI.org for others to use or adapt in their own organizations. We invite you to submit tools you have found useful!

Documentation Tools
Failure Modes and Effects Analysis
General Tools
IHI Conference Presentation
Information Gathering Tools
Measurement and Feedback
Meeting Tools
Process Analysis Tools
Quality Resources

Tools Icon Key
PDF PDF (Downloadable) Power Point Powerpoint (Downloadable)
Word Doc Word (Downloadable) Access Access (Downloadable)
Excel Excel (Downloadable) Tool Interactive Tool (Online)

Documentation Tools

La ficha de planificación es útil para planificar proyectos de mejoramiento en su totalidad. Provee una representación global del proyecto. Dicha planilla tiene espacio para documentar todos los cambios que el equipo está llevando a cabo, hay lugar para indicar quienes son los responsables de cada uno de los cambios, y hay lugar para especificar las fechas límites y parámetros del proyecto.

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La planilla de Ciclos PHEA (Planificar, Hacer, Estudiar, Actuar) es útil para documentar cambios en etapa de prueba. El ciclo PHEA guía al usuario a cómo llevar a cabo un cambio de manera disciplinada y consiste en cuatro etapas fundamentales. Primero se planifica, luego se hace o se lleva a cabo el cambio planificado, después se estudian los resultados del cambio, y basado en lo aprendido se actúa, o se reinicia el ciclo.

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Storyboards are a useful tool for effectively presenting a team’s work to a variety of audiences — to other groups within the organization, to other organizations, and to the larger community.

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The Project Planning Form is a useful tool for planning an entire improvement project, including a list and schedule of all of the changes that the team is testing, and all of the Plan-Do-Study-Act cycles for each of those changes.

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Failure Modes and Effects Analysis

A systematic, proactive method for evaluating a process or product to identify where and how it might fail and to assess the relative impact of different failures, in order to identify the parts of the process that are most in need of change; developed by the Institute for Healthcare Improvement (Boston, Massachusetts, USA)

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General Tools

This booklet presents the essentials of quality improvement that every physician needs to know—a quick 15-minute read to engage busy practitioners in quality initiatives; developed by Manoj Jain, MD, MPH (Memphis, Tennessee, USA).

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This tool may be used to assess how your clinical microsystem compares to the 10 key "success" characteristics of high-performing clinical microsystems; developed by Dartmouth-Hitchcock Medical Center (Lebanon, New Hampshire, USA)

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This scale, adapted from the IHI Breakthrough Series Collaborative Assessment Scale, provides information on how to assess a team’s progress throughout a Collaborative-type improvement project.

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This scale gives information on how to assess a team’s progress throughout an IHI Breakthrough Series Collaborative improvement project.

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Singapore General Hospital offers primary angioplasty for patients with acute myocardial infarction 24 hours a day. Based on a survey of patients, a workgroup analyzed reasons for delay in "door-to-balloon time" and made a series of corrective changes. Results: reduction in delay from 146 minutes to 104 minutes.

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This NHQR report is a collaborative effort among the agencies of the Department of Health and Human Services (DHHS), and will include a broad set of performance measures that will be used to monitor the Nation’s progress toward improved health care quality.

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What conditions ensure a team's success? John Øvretveit developed a Risk of Quality Team Project Failure Index (RTFI) to help managers understand factors that can increase their teams' likelihood of success.

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A slide set providing you with a summary of the Institute of Medicine’s (IOM) report, Crossing the Quality Chasm: Health Care for the 21st Century; developed by the Institute for Healthcare Improvement (Boston, Massachusetts, USA).

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A worksheet that guides teams on setting goals that make a difference to patients, based on the six Institute of Medicine aims; developed by the Institute for Healthcare Improvement (Boston, Massachusetts, USA) for the Pursuing Perfection Program

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IHI Conference Presentation

This presentation articulates the problems that hinder physician involvement with safety and quality, describes a framework to improve physician involvement, and applies practical improvement ideas to help get physicians involved.

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Northwestern Memorial Hospital presented its tests of change at the Institute for Healthcare Improvement's IMPACT Learning Session. Through regular measurement, reporting, and employee feedback, Northwestern Memorial Hospital has developed strong talent management, personal development, and employee recruitment efforts, resulting in a vibrant, motivated, and skilled workforce.

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Information Gathering Tools

This manual gives guidance for district hospitals for introducing and developing a quality management system (QMS). This QMS has been developed for district hospitals where written standards and supervision are not widely or consistently practiced.

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This survey provides a template for testing provider and staff satisfaction within an organization.

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This tool is useful for anyone who plans to conduct interviews either as a way to learn about a topic, assess current knowledge around an improvement area, or simply to evaluate an improvement project. It is simple and generic enough that it applies to most disciplines.

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A guide for executives on how to channel senior management attention to quality projects; developed by the Leadership Innovation Team at the Institute for Healthcare Improvement.

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This assessment method checklist helps to assess to what extent an organization has taken the necessary actions to carry out a change successfully.

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Sampling is used to simplify the gathering of data for improvement and to prevent unnecessary data collection.

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Walk-throughs enable providers to better understand the experience of care from the patient’s and family’s points of view — by going through the experience themselves.

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Short surveys are intended to provide just enough simple and prompt feedback to tell you whether your attempts to improve are going in the right direction.

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Visiting another organization can be a great help to teams working on improvement. Use these guidelines to help you arrange and run a visit.

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Brainstorming, Affinity Grouping, and Multivoting are tools for generating, categorizing, and choosing among ideas in a group of people.

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Measurement and Feedback

This presentation and related articles discuss how measuring the time or number of cases between adverse events, such as the number of surgeries between surgical site infections, is more effective for detecting changes and verifying improvements.

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Meeting Tools

A defined method for running meetings is a vital project management tool. It standardizes the meeting process, minimizes waste, and promotes the effective execution of critical meeting tasks.

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The idea of using quick huddles, as opposed to the standard one-hour meeting, arose from a need to speed up the work of improvement teams. Huddles enable teams to have frequent but short briefings so that they can stay informed, review work, make plans, and move ahead rapidly.

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Process Analysis Tools

A scatter diagram is a graphic representation of the relationship between two variables. Scatter diagrams help teams identify and understand cause-effect relationships.

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Run charts are used to identify and display trends in data over time.

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A Pareto diagram helps identify the few, most important factors that contribute to an effect and, therefore, warrant the most attention.

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A histogram is a special type of bar chart used to display the variation in continuous data like time, weight, size, or temperature.

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A flowchart is a graphic representation of the sequence of steps in a process.

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A cause and effect diagram is a graphic tool used to explore and display the possible causes of a certain effect.

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Quality Resources

The Plan-Do-Study-Act (PDSA) Worksheet is a useful tool for documenting a test of change; developed by the Institute for Healthcare Improvement (Boston, Massachusetts, USA)

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A glossary of common improvement terminology; developed by the Institute for Healthcare Improvement (Boston, Massachusetts, USA)

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Simple data collection planning is a process to ensure that the data you collect for performance improvement are useful and reliable, without being unnecessarily costly and time-consuming to obtain; developed by the Institute for Healthcare Improvement (Boston, Massachusetts, USA)

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