The Model for Improvement: A Tool to Drive Perioperative Improvement

Background

Imagine you have just started working in a new department and have been asked to assist the Lead Clinician with a perioperative quality improvement (QI) project. The traditional audit review cycle of performance, followed by efforts to improve, has been completed twice now. It has become obvious that education, awareness, and telling people to do better has not worked. From past experience, you share that although information and training is needed and beneficial, it is not enough on its own to make improvement happen. To achieve meaningful change in a complex healthcare system, formal improvement methodology must be applied using, for example, the Model for Improvement (MFI).

“Every system is perfectly designed to get the results it gets” is a statement that has been widely popularized in the healthcare improvement world, originating from Paul Batalden of the Institute for Healthcare Improvement (IHI). IHI's work also suggests that to achieve meaningful change in a system, the change agent requires “will, ideas, and execution.”

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  The “will” to make the system better comes from creating emotion by demonstrating poor performance or less than optimal patient outcomes, as identified through patient experience and measurement of clinical outcomes. These findings provide the “ why” we should do this.

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  The change “ideas” come from those with a lived experience of the challenge who want to share their ideas and change things for the better. The ideas provide the “ what” to do.

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  The “execution” involves the skills required to make change happen. It is the “ how” to do it.