Health care around the world is in need of revolutionary change. We are not performing at the level our patients deserve. There are huge gaps between knowledge and practice. Adverse events harm patients far too often. Too many people do not get the care they need. And the system propagates waste: waste of time, resources, and good will. Yet there is also good news: examples of results from around the world demonstrate that breakthrough improvement in health care is possible.
While all changes do not lead to improvement, all improvement requires change. The ability to develop, test, and implement changes is essential for any individual, group, or organization that wants to continuously improve. There are many kinds of changes that will lead to improvement, but these specific changes are developed from a limited number of change concepts.
A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement. Creatively combining these change concepts with knowledge about specific subjects can help generate ideas for tests of change. After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to test a change or group of changes on a small scale to see if they result in improvement. If they do, expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely.
The change concepts included here were developed by Associates in Process Improvement. See The Improvement Guide (Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. San Francisco, California, USA: Jossey-Bass Publishers, Inc.; 1996) for a list of hundreds of change concepts, as well as examples of how they were applied in process improvement, both inside and outside of health care.
Click here for more information and general tips on Setting Aims, Establishing Measures, Forming the Team, Testing Changes, Implementing Changes, or Spreading Changes.
