El Modelo de mejoramiento del IHI
Entre las referencias revisadas una de las más completas es la presentada por el Institute for Healtcare Improvement (IHI). De su página web extrajimos el ejemplo que sigue, como una muestra de un posible abordaje para algunas de las etapas del Proyecto. (Los enlaces que tiene esta página le llevarán a la página original del IHI)
Intensive Care
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
Setting Aims
Commitment to improving critical care delivery is reflected by a strong and well-worded aim statement.Establishing Measures
Measures should provide information-for example, did the introduction of the ventilator bundle decrease length of time on the ventilator?Selecting Changes
Teams must test and implement changes at four levels: patient, care team, leadership and system, and flow in and out of the ICU in order to improve critical care delivery.Testing Changes
The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.Sources:
*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
**The Plan-Do-Study-Act cycle was developed by W. Edwards Deming (Deming WE. The New Economics for Industry, Government, Education.).
