Science of Improvement: Selecting Changes

​Model for Improvement: What change can we make that will result in improvement?

While all changes do not lead to improvement, all improvement requires change. The ability to develop, test, and implement changes is essential for any individual, group, or organization that wants to continuously improve. There are many kinds of changes that will lead to improvement, but these specific changes are developed from a limited number of change concepts.

A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement. Creatively combining these change concepts with knowledge about specific subjects can help generate ideas for tests of change. After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to test a change or group of changes on a small scale to see if they result in improvement. If they do, expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely.

The change concepts included here were developed by Associates in Process Improvement. See The Improvement Guide (Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. San Francisco: Jossey-Bass Publishers, Inc.; 2009) for a list of hundreds of change concepts, as well as examples of how they were applied in process improvement, both inside and outside of health care.

Examples of Change Concepts 

For more detailed information on specific change concepts, see Using Change Concepts for Improvement and the Changes section.

See also: Testing Changes, Implementing Changes, Spreading Changes.


Eliminate Waste
Look for ways of eliminating any activity or resource in the organization that does not add value to an external customer.

Improve Work Flow
Improving the flow of work in processes is an important way to improve the quality of the goods and services produced by those processes.

Optimize Inventory

Inventory of all types is a possible source of waste in organizations; understanding where inventory is stored in a system is the first step in finding opportunities for improvement.

Change the Work Environment

Changing the work environment itself can be a high-leverage opportunity for making all other process changes more effective.

Producer/Customer Interface

To benefit from improvements in quality of products and services, the customer must recognize and appreciate the improvements.

Manage Time

An organization can gain a competitive advantage by reducing the time to develop new products, waiting times for services, lead times for orders and deliveries, and cycle times for all functions in the organization.

Focus on Variation

Reducing variation improves the predictability of outcomes and helps reduce the frequency of poor results.

Error Proofing

Organizations can reduce errors by redesigning the system to make it less likely for people in the system to make errors. One way to error proof a system is to make the information necessary to perform a task available in the external world, and not just in one's memory, by writing it down or by actually making it inherent in the product or process.

Focus on the Product or Service

Although many organizations focus on ways to improve processes, it is also important to address improvement of products and services.

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