Video Transcript: Everyone Has Two Jobs

Don Berwick, MD, MPP, FRCP, Institute for Healthcare Improvement

Now, the model for improvement offers a very useful roadmap to establish and guide your improvement efforts. But it's not the Bible; it's one among a large set of such guides to action. The best of those guides all share the four elements of that model, though. They'll have aims, they'll have measures, they'll be ideas for change, and some form of cumulative testing PDSA. They may have different acronyms, different emphases, different subparts. Most of my colleagues believe as I do that it really doesn't matter too much which of those models you choose, as long as those four elements are somewhere in them. But it does help in an organization if some model is used and stabilized as a support to concerted action and to make conversations easier.

In an ideal world, or in a very advanced learning organization, everyone is using improvement methods all the time. They're not special — they're part of the normal, daily work. One nurse, years ago, said in an IHI course something I've never forgotten. She said, “I get it now. In the world of improvement everybody has two jobs. They have their job, then they have the job of improving their job."