Common QI Models and Techniques
The Value Transformation Framework is a conceptual model developed by the National Association of Community Health Centers to help health centers move from volume-based to value-driven care. This framework is organized by three domains—infrastructure, care delivery, and people—and contains 15 change areas. The infrastructure domain refers to the components that build the foundation for delivering reliable, high-quality care. The care delivery domain is focused on the processes and approaches to care and services. The people domain refers to the individuals who receive, provide, and lead care and the organizations that support the care goals.
Plan-Do-Study-Act (PDSA) is an iterative four-stage problem solving model for improving a process or carrying out change. A PDSA cycle is used to plan a change, implement the change, analyze its results and effectiveness, and then make appropriate revisions to the implementation process before beginning the PDSA cycle again.
The first stage (Plan) involves identifying the problem, developing an aim statement, and coming up with solutions. In the second stage (Do), the health care team implements its plan and collects data to help evaluate the plan in the third stage. During the third stage (Study), teams use the aim from stage 1 and the data from stage 2 to determine if the plan has resulted in improvement, if the changes were worth the investment, and if there were unintended effects of the plan. The fourth and final stage (Act) depends on the results of the Study stage. If the plan was successful, health care teams work to standardize improvement for regular use. However, if it is determined that a different approach would be better, the team returns to stage 1 to develop a new strategy.
The Institute for Healthcare Improvement Model for Improvement is a tool to help accelerate improvement efforts in health care organizations. The model begins with three fundamental questions and then moves into Plan-Do-Study-Act (PDSA) cycles to test changes. The first question helps set aims by asking “what are we trying to accomplish?” The second question establishes measures for improvement and asks “how will we know that a change is an improvement?” The final question helps select changes to act on by asking “what change can we make that will result in improvement?” Once these questions are answered, the proposed changes are tested using PDSA rapid cycles.
This guide from the Reproductive Health National Training Center is designed to facilitate quality improvement efforts. It outlines clinic efficiency indicators (related to productivity, clinic flow, and patient experience), common challenges, best practices based on the literature and successful strategies used by learning collaborative teams, and resources to improve clinic efficiency.
Process mapping is a technique that involves creating a visual model of the existing process and associated flows, connections, and activities. This map can then be used to find points for improvement for a future state. The technique typically begins by having an improvement team observe the current process before coming together to make the process map. During the creation of the map, the team lays out the steps of the process and notes tasks involved at each point and the amount of time it takes to complete each step. Once the whole process has been laid out, the team can then discuss improvement ideas for each step and locate points of delay.
Co-design is a technique that involves partnership between the individuals working within a system (care team) and the individuals who experience the system (patients) to develop new approaches to products, service delivery, and intervention design. This allows multiple perspectives to be incorporated into the design process and engages the communities who will benefit from the changes.
For an adolescent population, co-design can occur through community engagement and/or a Youth Advisory Council. Youth Advisory Councils provide an opportunity for youth within a program or organization to have a voice in project planning and development. Members are typically recruited through informational meetings, tables at schools, or classroom presentations. This group meets with the project design team regularly or on an as needed basis for ongoing projects.