Using the Model for Improvement to improve physical activity and nutrition outcomes in a school setting

In 2009, the New York State Department of Health applied the "Model for Improvement" to three community health projects. The intent was to learn from the process about what works and how to work through challenges toward health improvement, and details of each step are explained in each step (click on each of the steps e.g. Project Components, Forming Teams etc.). The Project Summary (pdf, 1 page) illustrates the overall process used. Each team's experiences are explained. Please review The Breakthrough Series Collaborative Methodology Glossary for definitions. This initiative was supported by a Healthy People State Action grant from John Snow, Inc. (JSI), through funding from the Office of Disease Prevention and Health Promotion, U. S. Department of Health and Human Services.

Model for Improvement
Project Components
Five components have to be in place in preparation for applying the Model for Improvement: (1) a project that clearly identifies a process or outcome to be improved over a finite time period; (2) people who will test the interventions or changes; (3) measures; (4) menu of interventions or changes instituted that are based on science; and (5) multiple tests done over time, usually between 6 and 16 months. A description of these components is articulated through the aim statement. Developing the team, the charter and aim statement are among the first steps in the Model for Improvement.
Forming Teams and Writing the Charter
The team is made up of program leaders, facilitators, subject experts, front-line staff, and improvement methodology experts. In addition, there may be site project teams, which include a team leader, staff to implement interventions, an opinion leader and an improvement methodology specialist. To communicate the project purpose, the team develops a Collaborative Charter. This document draws a broad roadmap for the work of the teams.
Setting Aims
The Aim is aligned to the Collaborative Charter and identifies team improvement objectives in time-specific, quantitative measurable terms with the context of a specific population.
Establishing Measures
The improvement plan identifies quantitative measures to determine whether a specific change or intervention implemented actually leads to improvement.
Selecting Interventions
Interventions, changes or activities will need to be identified that are likely to positively affect the measures and will result in the desired outcomes. It is assumed that all improvement requires changes, but not all changes will result in improvement. So each Plan-Do-Study-Act (PDSA) cycle includes the Study phase, to assess whether the changes resulted in improvement.
Testing Interventions
Conduct the PDSA cycle to test a change or intervention in the real work setting. It involves planning the intervention, trying it, observing the results, and acting on what is learned. This may involve modifying the activity and running the PDSA cycle again.
Implementing Interventions
After the initial testing and observing the outcomes, the change is applied on a larger scale (i.e. more settings, more people). The team may need to test an intervention multiple times under different circumstances to identify the conditions under which it works and does not.
Spreading Changes
Disseminate or "spread" the changes to other parts of the community. This takes planning and continued PDSA cycles to observe intended and unintended outcomes.