The Model for Improvement: Five Critical Components

The Model for Improvement, developed by Associates in Process Improvement (API), is a simple yet powerful tool for accelerating improvement in projects. API has partnered with the Institute of Healthcare Improvement Breakthrough Series Collaborative (IHI) to support IHI's innovation and improvement programs. With grant funding, the New York State Department of Health adapted and piloted it in three communities.

The Model for Improvement has two parts of equal importance

  1. Answers to three fundamental questions are essential for guiding improvement work
    • What are we trying to accomplish?
    • How will we know whether a change is an improvement?
    • What changes can we make that will result in improvement?
  2. The Plan, Do, Study, Act (PDSA) cycle tests and implements changes in actual work settings.

Five critical components are needed to apply the Model for Improvement

  1. An improvement project that can be:
    • process-focused related to saving time, money or improving quality of a service or system, or.
    • outcome-focused on improving health status, behavior, attitude,and/or knowledge.
  2. People who will test the interventions or changes.
  3. A family of measures, including impact and process measures. A few of the measures should have the potential of being tracked at least monthly.
  4. Interventions to be tested that are grounded in science.
  5. Time, usually 6 to 16 months, to allow for multiple tests of interventions.

Model for Improvement: Examples of potential projects

  • Increasing physical activity among fourth-graders by 20 minutes per week for six weeks.
  • Increase consumption of specific healthy menu offerings in a workplace cafeteria over 12 months.

Both projects are focused,though, in the second example, "healthy menu offerings" will need to be defined. The audience can be identified. The projects are time specific. Measures can be tracked and both are based in science.

Model for Improvement: Examples of projects that need to be reframed

  • A project to identify which tobacco prevention policies have community support in a 12-month project could use the Model for Improvement if the objective was to "increase advocates' knowledge of which tobacco prevention policies are most likely to have community support."
  • A project that aims to improve the quality of community health assessments over 12 months is broad, difficult to evaluate and has a weak evidence base. This project could be reframed to use the Model for Improvement if it was narrowed to a specific topic, and a particular aspect was identified for improvement such as "increasing the referral rate of women to the WIC clinic in the first trimester."
  • Gaining support for a specific policy. A challenge in applying the Model for Improvement is to define what is meant by improvement. In this example does "gaining support" mean that community leaders and media will embrace the issue for which the policy is directed or that legislation is passed? "Passing legislation" involves several improvement steps, and "improvement" needs to be broken down into these smaller components to be successful.

Interpreted from: Institute for Healthcare Improvement, How to Improve - Improvement Methods at