The Improvement Journey is rooted in improvement science, an applied science used by many industries, organizations, and groups that “emphasizes innovation, rapid-cycle testing in the field, and spread in order to generate learning about what changes, in which contexts, produce improvements. It is characterized by the combination of expert subject knowledge with improvement methods and tools. It is multidisciplinary — drawing on […], systems theory, psychology, statistics, and other fields.” (IHI).
Several quality improvement models exist (such as Lean and Six Sigma); the Network for Improvement and Innovation in College Health uses the Model for Improvement, as the framework for improvement and implementing changes in a sustainable way. We emphasize starting improvement efforts on a small scale, and leveraging all the generated learning to effectively implement and spread, and later scale up. The Model for Improvement can be used for all phases of your improvement efforts: developing ideas, testing, implementing, and spreading changes.
Improvement science is explicitly designed to accelerate learning-by-doing. It’s a more user-centered and problem-centered approached to improving college health. As iterative cycles of change proceed, previously invisible problems often emerge and improvement activities may need to tack off in some new directions. The objective here is quite different from the traditional pilot program that seeks to offer a proof of concept. Improvement, in contrast, is a focused learning journey. Since quality improvement is an iterative process often extending over considerable periods of time, it is also referred to as continuous improvement.
Watch this 11 minute video for an overview on quality improvement methods for improving health outcomes:
Overview of the 9 Steps of the Improvement Journey
The 9 steps of the Improvement Journey help facilitate the application of improvement science, through the use of the Model for Improvement, on your campus: from identifying an area to improve to spreading successful innovation throughout your department, campus, and even nationally. There are defined exercises and milestones at the end of each step to help guide you and your improvement team work through improving a real world problem and priority on your campus. Your journey is represented in the graphic below:
We know that there is variability in college health, both within and between campuses, on how improvement science is applied. Undertaking this journey helps all of us in college health to begin using a common language — the language of improvement science. With a common language sharing and spreading innovation within and between disciplines and campuses becomes much easier.
While it is important to work through each of the
Improvement Journey steps in order, the reality is that
pressing requests or needs may necessitate
you and your team to go out of order.
Real world improvement work is rarely linear, and this is okay.
Development of the Improvement Journey
Using the Model for Improvement as our core framework for developing, testing, implementing, and spreading change and improvement, we pulled from the expertise and experience of organizations focused on quality improvement from around the globe.
- East London NHS Foundation Trust. (n.d.). Quality Improvement Programme. Retrieved 2016, from http://qi.elft.nhs.uk/
- Honoree, P.A., Wright D., Berwick, D.M., Clancy, C.M., Lee P., Nowinski J., Koh H.K. Creating a Framework for Getting Quality Into the Public Health System. Health Affairs, 30, no.4 (2011): 737-745.
- IHI. Institute for Healthcare Improvement Website. Retrieved February 03, 2016, from http://www.ihi.org/
- Langley, G. J., Moen, R., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Hoboken: John Wiley & Sons, Inc.
- Michigan Public Health Institute. (2012, January). Embracing Quality in Public Health: A Practitioner’s Quality Improvement Guidebook. Retrieved February, 2016, from https://www.mphi.org/2013/12/03/embracing-quality-in-public-health-a-practitioners-quality-improvement-guidebook/
- NHS Education for Scotland. (n.d.). Quality Improvement Hub. Retrieved 2016, from http://www.qihub.scot.nhs.uk/
- Queen’s Printer for Ontario. (n.d.). Health Quality Ontario’s website. Retrieved 2016, from http://www.hqontario.ca/
The steps of the journey use approaches that have a proven track record and practical and effective in the college health setting, regardless of service model, resources, discipline, or role. We adapted certain components to be more relevant for a higher education setting. Knowing that there is an abundance of material and diversity of resources on improvement, we tried to distill the information into the most relevant and actionable tools and resources for individuals, teams, and institutions of higher education to begin improvement efforts as quickly and efficiently as possible.
For those with interest, we have added additional content in our “Resource Library” for those who would like to take a deeper dive into improvement science.