IHI Breakthrough Series (6 to 18 Months Time Frame) Select Topic (Develop Mission) Planning Group Develop Framework & Changes Participants ( Teams) Prework LS 1 P S AD P S AD LS 3 LS 2 Supports Phone Conferences Extranet Visits Assessments Sponsors Monthly Team Reports Dissemination Publications, Congress, etc. AD P S Expert Meeting AP1AP2 AP3* LS – Learning Session AP – Action Period *AP3 – continue reporting data as needed to document success Holding the Gains

Degree of belief that the changes will result in improvement High Getting Ideas Idealized Design or other methods Testing: Prototype (in simulated environment) or Pilot (in work setting) Spread Adapt to new locations or populations Successful changes Unsuccessful proposed changes Low Moder- ate When Are We Ready To Run a BTS Collaborative? Start a Collaborative when degree of belief is moderate to high Adapted from IG Pg 145 Implement: Make the change a permanent part of the system in location where testing

Relationship Between Factor Ratings and % 4’s in BTS Seven Factors Rated 1-5 (Score of 21 = Middle ratings of factor) Great Change Package Measures that Work Focused topic Results focused chair, faculty Individualized support Leverage Early Adopters Teams are motivated Worst 9 performing BTS’s Best 9 performing BTS’s = 3 Collaboratives 4 = Significant improvement on BTS assessment scale