The model for improvement is an approach that helps identify, carry out, and evaluate changes in order to achieve improvement. It consists of three key questions that every project team should ask:

What are we trying to accomplish?

To initiate the improvement process, it is important to establish a specific aim that is SMART (specific, measurable, achievable, realistic, and time-bound). For instance, a patient falls reduction project might aim to ‘reduce patient falls on Ward A by 50% within six months.’ It is also essential to consider the stakeholders and set a deadline for the project. The aim may align with the aim defined in the Driver Diagram.

How will we know that a change is an improvement?

Measuring improvement involves three types of measures: outcome measures, process measures, and balancing measures. In the example above, an outcome measure might be number of patient falls. Process measures examine the reliability of the processes that may impact the aim, for example number of falls risk assessments completed. Balancing measures help identify unintended consequences. For example, for a falls reduction project, staffing levels can be a useful balancing measure. The measures may align with those in the Driver Diagram.

What changes can we make that will result in improvement?

To drive improvement, it is necessary to generate ideas and identify changes that can be implemented. The Driver Diagram can be used to discover potential changes. Remember not all changes will result in improvement, and a single change might not achieve the desired aims.

The video below from our Black Maternity Matters project gives an overview of the Model for Improvement:

Watch Vardeep Deogan as she discusses SMART targets and their importance in the Model for Improvement. She introduces the Model for Improvement and emphasises the significance of having a SMART target. She also provides tips for creating a SMART target with your team. At 14:20, participate in a quiz activity to test your knowledge of SMART targets. This recording is from the West of England Academy AHSN Winter Series 2021. If you’re interested in attending similar training please visit our events page.

Plan Do Study Act (PDSA) cycles

PDSA cycles are a crucial component of the improvement process. They involve four steps:

  1. Plan: Identify the idea or change to be tested and develop a plan for implementation.
  2. Do: Execute the plan on a small scale, carefully documenting the process and any observations.
  3. Study: Analyze the data collected during the test, comparing it to the expected outcomes and goals.
  4. Act: Determine the next steps based on the results of the study phase. Adjust the plan, scale up the test, or implement the change fully.

PDSA cycles provide a means to test ideas, learn from the results, and refine the approach to achieve success. Multiple cycles may be necessary before an idea starts working reliably.


Join Teddy Baker, as he explains an activity that you can do with your teams to practice Plan Do Study Act cycles. He outlines the steps of the activity, which can be done online or face-to-face, and assigns roles and responsibilities for completing the challenge. You will need a T-Shirt and a timer! This recording is from the West of England Academy AHSN Winter Series 2021. If you’re interested in attending similar training please visit our events page.