Module 2
The Model for Improvement is central to healthcare QI, but other frameworks bring valuable perspectives. Teams often blend approaches depending on their goals and context.
Comparing Quality Improvement Frameworks
| Framework | Focus | Strengths | Healthcare Use | Best For |
|---|---|---|---|---|
Model for Improvement (IHI) |
Rapid-cycle testing |
Easy to apply, iterative, flexible, accessible to all skill levels |
ED flow, safety culture, access improvement, screening programs |
PMHCA programs of any size |
Lean |
Eliminate waste |
Efficiency, value-focused, staff-centered, visual management |
Reducing delays, streamlining intake workflows, reducing redundant documentation |
High-volume settings with visible process waste |
Six Sigma |
Reduce variation |
Data discipline, statistical rigor, defect reduction |
Standardizing high-risk processes (medication safety, surgical checklists) |
Error reduction in standardized processes |
Operational Excellence (OpEx) |
Strategy + improvement |
Combines Lean and Six Sigma; system-wide focus; links improvement to strategy |
Culture and system transformation, large-scale redesign |
Large organizations with dedicated QI infrastructure |
Agile / TQM |
Flexible, team-based |
Adaptive, cross-functional collaboration, continuous feedback |
Project-based improvements, rapidly changing environments, and innovation |
Multi-disciplinary teams with complex, evolving challenges |
A pediatric clinic noticed that families were filling out nearly the same information three times: once at check-in, again in the exam room, and a third time during the behavioral health consult. The team looked at each step families went through and realized the repeated paperwork wasn't helping anyone. It was just extra time and hassle. So they combined it into a single form that stayed with the family for the entire visit.
Result: The change saved 12 minutes per visit and reduced frustration for families and staff.
The same clinic wanted to find out whether calling families after a positive depression screening would help more of them actually get connected to behavioral health care. Instead of changing things for the whole clinic right away, they tried it on a small scale first: for two weeks, one provider called families within 48 hours of a positive screen to check in and help set up care. Then they looked at whether more families followed through compared to before.
Result: More families followed through on getting care, which gave the team good reason to try the follow-up call more broadly.
- What each one is trying to fix: Lean is about eliminating steps that waste time without adding value, such as repetitive paperwork. The Model for Improvement is about testing whether a new idea actually works before committing to it.
- How the work happens: Lean looks at the current process and removes what doesn't need to be there. The Model for Improvement tries a change on a small scale first, then checks the results before deciding what to do next.
- What success looks like: For Lean, success means the same visit takes less time and effort. For the Model for Improvement, success means having evidence that a change actually improved things, which justifies doing it more widely.
These are two different tools, but they're not an either-or choice. A clinic could just as easily map out its check-in process to reduce waste while also testing a new follow-up step for behavioral health referrals, using both simultaneously.