CFHI Quality Improvement Primer Series

CFHI Quality Improvement Primer SeriesA primer is an on demand video that provides a high-level introduction to a topic aligned with CFHI’s quality improvement approach and curriculum.

Each primer includes links to an on demand video and additional resources.


Browse our selection of Quality Improvement Primers and check back frequently for new additions.

Partnering with Patients, Families & Caregivers in Co-designing Care

With the best of intentions, healthcare providers typically design programs based on what we think patients need and want. But how often do we then discover that we’ve missed the mark— and we don’t get the outcomes that we expected? Starting from the premise of expertise by experience, patient engagement involves the active participation of patients, family members or caregivers in decision-making not only in direct care activities, but in the co-design of service improvements, research, and education. This session describes two core design elements for effective partnerships with patients to improve the quality of care and service delivery, and strategies for addressing the three pillars of engagement-capable environments.

Stakeholder Engagement and Mapping: Healthcare Toolkit Essentials

If you want to go fast, go alone. If you want to go far, go together! Involving those who will be affected by your change initiative will lead to a better process, greater community support and buy-in, a better understanding of the local context – and ultimately, a more effective effort. In this Primer, you’ll learn how to identify and understand your stakeholders, and the roles they can play in supporting your initiatives. You’ll learn how to map the interests and influence of each stakeholder group, paying special attention to two key groups: patients and families, and direct care providers. Using our worksheet, you can plan your key messages, expected outcomes and communication strategies to design for success.

Working Together and Team Effectiveness

Working within complex systems often requires two or more individuals coming together to share knowledge, skills and experience. They come together in pursuit of a common goal, often with the expectation that by working together they will achieve more than they would by working separately. Recognizing that healthcare requires both a personal and business focus, it follows that there are varying forms of working together relationships or teams; interprofessional service delivery teams and inter/intra organizational teams that focus on the business of healthcare; including quality, cost, and innovation. Working with people from across organizations and/or sectors within healthcare, requires attention to be paid to the working relationships. While it is thought by many that working together is intuitive, it is hard work. This quality improvement primer on working together and team effectiveness aims to guide teams on that journey.

Driver Diagrams: Improvement Theory

The driver diagram is a tool to facilitate the development, use, refinement and communication of improvement theory. Improvement theory reflects the best available evidence, experience, and analysis of the current system and local organizational context. The driver diagram is similar to other planning, but should not become a composite of a work breakdown structure. Tests of change (Plan-Do-Study-Act, PDSA) follows from ideas formulated based on improvement theory. The driver diagram is a structure for learning and should be continually refined based on new understanding that emerges. Driver diagrams can serve as an effective communication tool, engaging a shared understanding of the reason change is being planned, tested and implemented. Following successful improvement, the driver diagram should be part of a change package to support efforts to spread improvement. If improvement is unsuccessful, theory should be critically reviewed and modified.

Plan – Do – Study – Act (PDSA)

Plan – Do – Study – Act (PDSA) is an approach to developing, testing and implementing change. The use of sequential PDSA cycles facilitates effective improvement by enabling changes to be shaped by practical experience in the context of implementation. PDSA cycles follow a similar pattern that will be familiar to many people; the scientific method, learning, treatment or nursing process. We all tacitly use PDSA every day, the challenge is to methodically apply this approach to improvement work and link PDSA tests of change to an improvement theory and performance data. Sustaining and spreading improvement requires a deep understanding of the kind of practical issues PDSA can illuminate. Using quantitative and qualitative data is a requirement of effective improvement work; the PDSA cycle provides a practical guide to collecting and using these data.

Achieving Successful Improvement

The demand for change in healthcare is increasing. Although quality improvement (QI) is increasingly being used over more traditional top-down approaches to change, achieving success and sustaining the improvement results is hard with many initiatives failing. There is a growing body of literature and tools providing an understanding of what promotes success and sustainability with QI initiatives. However, using these tools is challenging as there are many factors and knowing whom, where and when to address them is difficult. This session will introduce a new consolidated tool to help guide QI teams and organizations to achieving QI success.

Highly Adoptable Improvement

In an effort to improve health care, are we making it harder to deliver care? Many quality improvement (QI) initiatives add workload and are not perceived as valuable by care providers. This can lead to increased burden, workarounds, error, and resistance. This in turn leads to failure of the QI initiative or an inability to sustain the results. A year of research has contributed to the understanding of what makes change initiatives and interventions more adoptable. In this session, participants will understand the impact of workload and perceived value on improvement initiatives and be exposed to a model and toolkit that can help teams and organizations design more adoptable improvement.

Advance practice nurses meet needs of older patients and shift culture in Hamilton emergency departments

Juravinski Hospital has committed to providing elder-friendly care in their ED, and was the first HHS facility to embrace the ACE strategies. Participating in CFHI’s ACE collaborative enabled the hospital to “kick-start” this work.

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