IHI Framework for Improvement
The Institute for Healthcare Improvement (IHI) has developed several foundational frameworks that shape quality improvement practice globally. CPHQ candidates should understand these frameworks and their interconnections.
The Triple Aim (and Quadruple Aim)
IHI's Triple Aim framework identifies three interdependent goals for healthcare system optimization: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare. These three aims must be pursued simultaneously because improving one at the expense of others is not true system improvement. The Quadruple Aim adds a fourth goal: improving the work life of healthcare providers, recognizing that clinician well-being is essential for sustainable quality improvement.
The Model for Improvement
The Model for Improvement combines two components. The first component consists of three fundamental questions: "What are we trying to accomplish?" (aim statement), "How will we know that a change is an improvement?" (measures), and "What change can we make that will result in improvement?" (change concepts). The second component is the PDSA cycle, used to test changes rapidly. Together, these elements provide a practical, straightforward framework for driving improvement.
IHI Breakthrough Series Collaborative
The Breakthrough Series Collaborative model brings together multiple organizations working on a common improvement topic. Participating teams learn from subject matter experts and from each other through a structured process of learning sessions and action periods. Teams implement changes in their own settings, share results, and adapt successful strategies from peer organizations. This model has been used for hundreds of quality improvement topics worldwide.
Whole System Measures
IHI developed a set of whole system measures aligned with the Triple Aim. These measures span clinical outcomes, patient experience, cost, and equity. They provide organizational leaders with a balanced scorecard for assessing overall system performance rather than focusing on individual quality metrics in isolation.
CPHQ Exam Focus
Know the three fundamental questions, the relationship between the Model for Improvement and PDSA cycles, the Triple Aim goals, and how the Breakthrough Series Collaborative model accelerates improvement across organizations.