This play was developed by the Institute for Healthcare Improvement (IHI) based on their work in the Better Health and Lower Costs for People with Complex Needs collaborative, which ran from 2014-2017.
Starting small with care re-design is a tactic from quality improvement methodology. It allows you to learn deeply about the needs of your patients and begin testing new models of care without taking on too much risk. In this play, you’ll begin by working with five patients from the population segment you’ve identified and then scale up in multiples of five (25 patients, then 125, and so on).
The goal of this play is to help you develop and cost your care model.
- Start co-designing a care model by creating an ideal care plan for five patients from your population of focus, taking the population’s assets and needs into account.
- Test methods to engage the patients at each step in the care journey.
- Identify what you learn and iterate on your care model.
- Scale up to the next multiple of five, taking into account the different structural, operational, and financial implications that may arise at each level.
- The important thing is to get started and begin learning. Don’t let the perfect be the enemy of the good.
- When co-creating care plans with the first five patients, strive to do all that is needed to give these patients “perfect care.”
- Try really different things. If you only do office-based care, try home visits.
- Identify staff who are interested in testing with these five patients.
- Be disciplined about studying deeply a small number of patients when it comes to testing aspects of your care model. In other words, “Act for the individual, learn for the population.”
- Think about strategies to overcome structural issues that arise when moving to scale, such as funding, human resources, and information technology.
- Keep in mind that you will need to reach patients on the larger scale to validate your approach and seek funding.
for more information
- View a printable PDF of this play.
- Learn more about IHI's complex care efforts.
- For more information on scaling up through iterative testing, visit the Care Redesign Guide.
- Read more about structural issues with going to scale in Avedis Donabedian’s article, “The Quality of Care: How Can It Be Assessed?”
- Take a look at IHI’s scale-up grid template as well as some examples of completed scale-up grids.
- For ideas on care designs, the Better Care Playbook has a Quick Reference Guide to Promising Care Models.