CFHI Core Definitions

The following definitions inform CFHI’s healthcare improvement efforts and were developed together with a broad group of CFHI stakeholders and staff. These definitions will continue to evolve through application and learning.


A practice, policy or program that is novel in that it is proven to be more effective than the status quo – enhancing or outperforming the way care is currently delivered, funded or governed. We often distinguish between improvement and innovation: improvement entails spreading and scaling a known (but not yet evenly distributed) solution, while innovation entails identifying and incubating a solution.

A better practice, policy or program that yields greater benefit for people compared to the status quo


Expanding the reach of a practice, policy or program to benefit more people, with the same or better results. This entails adaptation as much as adoption from one context or setting to another. There is also awareness of the systemic enablers and barriers at play, as the innovation may not yet be the way things are routinely done.

It’s happening elsewhere – better practice is becoming common practice so more people are benefitting


Expanding the reach of a practice, policy or program to as many people who could potentially benefit as possible, with continued results that will often level-out over time. Adaptation and adoption have occurred in a system, or across systems, to integrate the innovation, which has become the way things are routinely done.

It’s happening everywhere – better practice is common practice, with many people benefitting


Holding the improvement gains of a practice, policy or program that is now a core or common service offering within the healthcare system.

It’s still happening – better practice remains common practice and many people continue to benefit

Health Systems Transformation

Also known as a high-performing or learning health system, this is a system, or systems, of health and care designed to learn and adapt to yield results that reach all who could benefit. The system identifies best practices, policies and programs that are spread, scaled and sustained. This is achieved by building improvement capacity and the capability of its people, as well as system infrastructure. Transformation is often the result of changing:

  • the nature of relationships in a system: for example, who delivers care, or who governs it
  • how resources are deployed and to what end: for example, who pays and to what degree is quality achieved

An improvement-oriented system designed to yield results (health, care, value, and provider satisfaction)

Quality Improvement Collaboratives

A shared learning program that brings together inter-professional teams of healthcare professionals, patients, families and others to tackle a common healthcare issue through an improvement approach. Collaboratives support teams in turning evidence-informed best practices into common practices, while also enhancing improvement capacity and capability in their organization or system.

Improvement design, testing, implementation and evaluation are adapted to each team’s context and culture. Learning within a collaborative aims to increase participant knowledge and skills and supports sharing experiences from teams’ learning journeys. Evaluation is central to learning, with teams making measurable improvement and acquiring an in-depth understanding of quality improvement methodology applicable to a broad range of issues. Given the focus on shared problems and solutions over a predetermined time period (typically 1- to 2-years), one of the goals of a collaborative is to leapfrog barriers and time lags which often hamper improvement progress.

A learning network designed to support teams to go further, faster and realize improvements for the people they serve. Together, teams tackle shared challenges using common evidence-based solutions, while also gaining lasting quality improvement skills.

The terms:

  • benefit/gain/result refers to the quadruple aim (health, care, value and provider satisfaction)
  • people refers to patients/families/communities/provider
  • system refers to the site of improvement – a clinic, organization, health region or other
  • practice refers to a model, tool or approach.

In improvement, local context matters and testing occurs at every stage of the improvement cycle (from testing to spreading, scaling and sustaining). The magnitude of risk when testing at scale exceeds early-stage testing because more system resources and people are involved.