Care Quality Improvement Collaborative

Improvement cycles Turn a focused service question into shared learning For care teams and support roles testing a bounded improvement across a care workflow. This fictional example follows Harborview Care Network, where a cross-role team is examining how handoff notes are completed. The collaborative supports improvement experiments; it is not an accreditation evidence collection site. Choose the next cycle step Each page contains a worked example for the same fictional coordination workflow. Define the problem and aim Describe the observable gap, bound the workflow, and state the intended improvement. Plan a small test Specify a limited test, its roles, observation approach, and review point. Define measures Make each number interpretable with a unit, denominator, time period, source, and as-of date. Review learning Separate what was observed from what the team thinks it means. Decide whether to spread Consider context and evidence before repeating, adapting, sharing, or stopping. Section Divider How the collaborative works Keep the experiment useful and bounded A worked coordination example from Harborview Care Network. Keep the question narrower than the whole service A team noticed that handoff notes were sometimes missing a clearly identified next owner. Rather than redesign every handoff, it focused on one weekly coordination meeting and a short note used after that meeting. The facilitator records the agreed next owner in the shared note. A second team member checks whether that field is present in the sampled notes. The team records exceptions without adding patient-identifying details to this example. Bring the right role into the right question The improvement lead coordinates the cycle; the workflow owner explains local practice; a measurement partner checks definitions. Questions involving regulated, safety-critical, or sensitive work go to the relevant trained role and approved local material. Record who owns each cycle decision. Route policy or clinical-practice questions to the accountable local role. Do not treat this example as authorization to change a care procedure. Use the cycle pages as shared references These authored pages are the available resources in this example site. Problem and aim A bounded example and prompts for describing the workflow gap. Plan Open page Small test plan An ordered planning sequence and a contrast between a bounded test and a broad rollout. Measure definitions A sample measure dictionary and clearly labeled illustrative values. Measure Learning review A completed example that separates observations, interpretation, and open questions. Learn Spread decision A comparison of reasonable next steps for a local experiment. Define the problem and aim Describe the gap before proposing a fix A useful aim names the workflow, the observable gap, and the intended direction of change. Problem: what is happening, where it happens, and what observable evidence shows a gap. Aim: what the team intends to improve within a defined scope and period. Keep the two separate so a preferred solution does not get mistaken for the problem. A practical pattern is: “In [defined workflow and setting], improve [observable process measure] from [starting point] toward [intended direction] by [review date], without worsening [relevant balancing consideration].” Use local, approved sources for any operational baseline or deadline. Worked example: make the handoff note easier to use Problem statement In the fictional Harborview Care Network, a sample of notes from one weekly service-coordination meeting showed that the next owner was not clearly named in some handoff entries. The example focuses on documentation of ownership, not on whether a clinical decision was correct. Workflow: notes produced after one weekly service-coordination meeting. Observable gap: next owner is not explicitly recorded in some sampled entries. Scope: one meeting workflow, not every unit or care setting. Aim statement For the next four weekly reviews, increase the share of sampled handoff entries that name a next owner from 12 of 20 (60%) toward at least 16 of 20 (80%), while checking that note completion does not add avoidable work for the meeting team. The values are fictional sample figures, not a live baseline or target. The denominator is 20 reviewed entries per sample in this example. The four-week period is an illustrative cycle window, not a service commitment. Prompts for a clear problem and aim Use these prompts to make the scope and evidence visible before choosing a change. Prompt Harborview example Which workflow is in scope? Notes after one weekly service-coordination meeting What gap can the team observe? Some sampled entries do not name a next owner What is the intended direction? Increase entries with an explicitly recorded next owner What boundary matters? One meeting workflow; no claim about other settings What else should be watched? Whether note completion adds avoidable work Continue the cycle Plan a small test Turn the aim into a limited, reviewable test. Define measures Agree what will be counted and how it will be interpreted. Plan a small test Plan a test that can answer one question A small test limits scope so the team can observe the work and learn before considering a larger change. Write down the question, the setting and period, who coordinates and observes, what evidence will be recorded, and when the team will review it. For any regulated, safety-critical, or sensitive work, use approved local material and involve the appropriate trained roles before proceeding. This page is a coordination aid, not clinical instruction or approval. Planning sequence Complete these coordination decisions before the test begins. State the learning question Example: “When the facilitator uses a named-owner field in the meeting note, is that field present in the sampled entries afterward?” Set the boundary Name one workflow and a short observation window. The fictional example uses one weekly service-coordination meeting for four weeks. Assign roles Name a cycle coordinator, a workflow owner, and a person responsible for checking the measure definition. Responsibilities are roles, not assumed approvals. Agree what will be observed Use the written definition on the Measures page. Record the source, period, denominator, and any missing observations. Check local requirements and set a review point Before any sensitive or regulated work, consult approved local procedures and the relevant trained roles. Set a date for the team to review observations and decide what to do next. Bounded test or broad rollout? The fictional examples concern note coordination, not care delivery. Bounded test Try the named-owner field in notes after one weekly coordination meeting for four weeks, then examine the sampled entries and team observations. One workflow A defined observation window A scheduled learning review Overbroad proposal Introduce a new note format across all services immediately, without a local test, agreed measure, or review point. Multiple contexts at once Unclear evidence for learning No explicit decision checkpoint Connect the plan to evidence and learning Define measures Read the sample definitions before deciding what evidence to collect. Review learning Use the review sequence to examine results and context. Define measures A number needs its definition beside it State the unit, numerator, denominator, period, source, and as-of date before interpreting a result. Without those details, readers cannot tell what was counted or whether two values are comparable. The figures below are fictional, authored examples—not live analytics, a service benchmark, or a claim about any organization. A small sample describes only the reviewed entries in its stated context. Sample measure dictionary Fictional Harborview coordination-note example; no patient-level information is represented. Measure Definition and context Named-owner completeness Numerator: sampled handoff entries with a next owner explicitly recorded. Denominator: all handoff entries reviewed for the period. Unit: percent of entries. Sample period Four weekly reviews, 6–27 April 2026. Example count: 80 entries reviewed across four samples. Source Fictional manual review of the shared meeting-note entries; the example does not represent a connected data source. Balancing consideration Team-reported time needed to complete the note, recorded as minutes per meeting; use a consistent local method if this is measured. Limit This local, illustrative sample does not establish performance in other workflows or settings. Illustrative values—not live metrics Fictional sample only; source: manual review of 80 meeting-note entries over four weekly reviews, 6–27 April 2026; as of 27 April 2026. Baseline: 12 of 20 entries named a next owner in the first sample 60% Final sample: 15 of 20 entries named a next owner in week four 75% Weekly samples reviewed; 20 entries per sample 4 Read the result with its limits Process measure Named-owner completeness describes whether the agreed note field appears in sampled entries. It indicates a documentation process feature, not the quality or outcome of a care decision. Keep the numerator and denominator visible. Use the same inclusion rule each review. Record missing or unavailable entries rather than silently excluding them. Balancing consideration A team may also observe whether completing the note adds time or friction. That observation needs its own defined method and should be interpreted in context. Do not infer causation from a before-and-after comparison alone. Do not generalize a small local sample to another service. Discuss unexpected effects with the relevant workflow owner. Use the definitions in the cycle Plan a small test Set the observation window and roles before collecting evidence. Review learning Discuss what the sample shows and what it cannot establish. Review learning Review the test, not the people Use the review to understand observations, context, and the next decision—not to assign blame or overstate a small sample. Bring the aim, measure definitions, observations, and relevant workflow context into the discussion. Separate what the team directly saw from its interpretation. If a question concerns a regulated, safety-critical, or sensitive practice, route it to the appropriate trained role and approved local material. A practical learning-review sequence Restate the aim and boundary Confirm the workflow, period, and intended change the team actually tested. Read the measure definition aloud Check the unit, numerator, denominator, source, and period before discussing the result. Share observations Report the recorded values and specific workflow observations separately from explanations. Name unexpected effects and missing evidence Record what changed, what did not get observed, and questions that remain open. Choose and record one next decision Repeat, adapt, share for discussion, or stop; note the rationale, decision owner role, and when the team will revisit it. Completed example: week-four review Fictional Harborview sample; 20 entries reviewed in week four. Observed 15 of 20 sampled entries named a next owner, compared with 12 of 20 in the first sample. The facilitator reported that the field was left blank in several notes when the meeting ended without an agreed next owner. Week-four completeness: 15/20 (75%). First sample completeness: 12/20 (60%). Source: fictional manual review of meeting-note entries. Interpreted and still open The team considered the higher final sample a promising local signal, not proof that the field caused the change. It did not yet know whether the pattern would hold in another meeting or whether note completion added time. Decision: adapt and repeat the same bounded test for another review window. Reason: the samples are small and one workflow may not represent other contexts. Open question: does the revised prompt make the next owner easier to identify without adding avoidable meeting work? Move from review to next choice Recheck measure definitions Keep the next review comparable by using a clear definition. Consider a spread decision Compare options without treating a local signal as proof for rollout. Decide whether to spread A promising local result is a reason to examine context It is not automatic proof that a change should spread. Before extending an experiment, consider how the workflow, roles, resources, and constraints differ elsewhere. Make the next decision explicit, identify who owns it, and record what evidence or local review would change the decision. A result from one small sample does not establish that a change is suitable across services. Four reasonable next decisions Use the rationale and evidence needed to choose a proportionate next step. Repeat The question remains useful; repeat the same bounded test to see whether the pattern recurs. Keep the setting and measure definition stable; set another review point and record the new sample. Adapt A specific workflow difference or observation suggests the test needs a small change. Name the difference, involve the workflow owner, and state what the next test will reveal. Share for discussion Another team may learn from the approach, but local fit has not been established. Share the scope, definitions, observed results, and limitations; invite local review rather than recommending automatic adoption. Stop The question is no longer useful, the test is not workable, or the evidence does not justify more testing. Record the reason, unresolved question, and any handoff needed to the accountable local role. Worked decision: adapt and repeat Why the fictional team did not spread immediately Harborview's week-four sample rose from 12 of 20 to 15 of 20 entries with a named next owner. The result came from one meeting workflow and a small sample; the team had not checked how another service records ownership or whether the prompt affects meeting time. Decision: adapt and repeat in the same bounded workflow. Adaptation: revise the meeting prompt so the facilitator asks for the next owner before closing the discussion. Review: use the same measure definition and record team-reported note-completion time as a separate consideration. What sharing would mean The team may share the example as a question and a learning artifact, with its scope and limitations attached. Any other team would need to assess its own workflow and use its approved local processes. Include the numerator, denominator, period, source, and as-of context. Describe what is observed separately from the team's explanation. Route regulated, safety-critical, or sensitive questions to the appropriate trained role. Start another bounded cycle Plan a small test Set the next question, boundary, roles, and review point. Review learning Record observations and the reasoning behind the next decision.