The Model for Improvement*, used by the Institute for Healthcare Improvement (IHI), is a simple yet powerful tool for accelerating improvement. This model — and testing changes on a small scale with Plan-Do-Study-Act (PDSA) cycles** — has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes resulting in improved outcomes. The Model for Improvement has been combined with the concept of "Bundles" of changes to simplify the very complex processes of the care of critically ill patients.

To be effective, the critical care change concepts suggested must be adapted and applied at the local level using front-line teams. The Model for Improvement must be applied using methods that include either directly or indirectly all those who are stakeholders in their development and implementation. The methods must also be applicable across multidisciplinary boundaries and even hospital departments.

A variety of tools and tips will aid each institution in adapting the details of change concepts to fit local environments and gain acceptance of local practitioners while maintaining the integrity of the core change concepts.

Understanding the Model for Improvement and Bundles, along with the development of strong improvement teams, is critical to the success of improving care of critically ill patients.

Improvement efforts should be led by a multidisciplinary core team. Forming the Team