Quick Quality Healthcare
Journey To Excellence
Using Change Concepts to develop change ideas
A Team Effort
A change concept is a general idea or guiding principle that helps teams move from analyzing a problem toward designing possible solutions. It is not a detailed plan, but a broad guide for innovation — something that sparks ideas for improving workflows, behaviors, or system design in a meaningful way. The Institute for Healthcare Improvement (IHI) describes change concepts as “general notions or approaches to change that have been found to be useful in developing specific ideas for improvement.”
Key features of change concepts
It is general and adaptable — examples include eliminating waste, error‑proofing, standardizing work, improving workflow, or focusing on variation.
It stimulates creative thinking — by combining local context with these broad ideas, teams come up with concrete, useful interventions.
How Change Concepts Help
They help prioritize where to act, especially when a process has many possible improvement points.
They speed up idea generation — giving teams categories or themes to explore rather than starting from nothing.
They link well with other improvement tools (e.g. PDSA cycles, driver diagrams) so that ideas aren’t just creative but testable and measurable.
They help develop change ideas - Change ideas are specific, testable interventions inspired by change concepts. Change ideas translate change concepts into specific, actionable interventions tailored to the local context.
Example change ideas
Simplify Workflow - Reduce unnecessary steps and complexity to make processes easier and faster. (Combine redundant steps in patient discharge; automate routine appointment reminders.)
Standardize Processes - Create uniform methods to reduce variation and errors. (Introduce a surgical checklist; use a standardized handover format like SBAR.)
Eliminate Waste - Remove activities that do not add value for the customer. (Streamline patient admissions by eliminating duplicate form-filling; reduce waiting times by pre-arranging lab appointments.)
Error Proofing (Poka-Yoke) - Design processes to prevent mistakes before they occur. (Use barcoding for medication administration; color-code high-risk medications.)
Optimize Flow - Smooth and balance the movement of people, information, or materials through a system. (Pre-assign post-operative beds before surgery; fast-track low-acuity patients in the emergency department.)
Enhance Communication - Make information exchange clearer, faster, and more reliable. (Implement structured handoffs; use communication boards in clinical units.)
Improve Feedback Loops - Ensure timely and effective feedback between parts of the system. (Immediate notification to prescribers of pharmacy errors; rapid test result reporting.)
Increase Visibility -Make important information easily seen or understood at a glance.(Display infection rate trends in staff areas; visual tracking boards for patient flow.)
Match Capacity to Demand - Align resources with predictable workload patterns. (Schedule more staff during peak patient admission times; allocate pharmacy technicians during ward rounds.)
Reduce Handovers -Minimize the number of transitions between people or departments. (Assign one care coordinator for surgical discharges; implement bedside medication delivery to reduce pharmacy trips.)
Sources of Change Concepts
IHI’s 72 Change Concepts for Improving Quality
Lean Principles (eliminate waste, flow, pull systems)
Six Sigma (error proofing, reduce variation)
Clinical Microsystems Approach (improve relationships, feedback loops)
"You don't apply change concepts blindly — you match them to the specific system weakness you've analyzed."
Designing Interventions for Improvement
In quality improvement, designing effective interventions is not about guessing; It is a disciplined, layered process. Good intervention design links identified problem elements with change concepts and addresses root causes so that failures don’t keep repeating.
Key Steps in Designing Interventions
Diagnose Problem Elements
Use tools like root cause analysis (RCA), Failure Mode and Effects Analysis (FMEA), flow mapping, or variation analysis to find what is going wrong. For example: delays, miscommunications, or defects.Match Problems to Change Concepts
Once you know the issues, choose change concepts that guide where system redesign should go.
Examples:
Delayed medications --> (System Failure = Waste (waiting)) --> ( Change concept = Simplify workflow )
Missed handovers --> (System Failure = Variation, communication failure) --> ( Change concept = Standardize processes )
Documentation errors --> (System Failure = Defects ) --> ( Change concept = Error‑proofing )
“Change concepts” offer direction, not detailed solutions.
3. Apply Human Factors Thinking
Before designing the concrete intervention, think about how people will interact with the new process. Ask:
Will this reduce cognitive load?
Could normal human mistakes interfere?
Is critical information visible, intuitive, consistent?
Use human factors to: simplify tasks; standardize important steps; make visuals, prompts, dashboards; design interfaces/layouts that match human strengths and limitations. Good design helps people succeed and prevents errors.
4. Address Root Causes, Not Only Symptoms
After diagnosing, make sure your intervention addresses underlying causes. For instance:
Technical causes → system or tool redesign (e.g. interactive order sets, better IT workflows)
Process causes → streamline workflows, reduce unnecessary steps, stabilize transitions between roles
Human factors causes → error‑proofing, environment design, simplifying work context
Avoid relying only on adding rules—design the system to prevent issues from arising in the first place.
5. Design Specific, Localized Interventions
Build concrete intervention ideas that fit local context, informed by change concepts and the diagnosis. Interventions should respect Lean / Six Sigma principles (eliminating waste, managing variation) and human factors insights. Examples might include standard handover checklists, color‑coded boards, mandatory order fields, visual prompts, etc.
This method ensures interventions are targeted, practical, and grounded in real understanding of what goes wrong — so they are more likely to meaningfully improve systems.