The Experts:

Ian Hutchby

Ian Hutchby is an improvement advisor at Ko Awatea and has been instrumental in the success of three high profile Ko Awatea campaigns: 20,000 Days, Beyond 20,000 Days and Safety in Practice. He is also involved in the National Orthopaedic Enhanced Recovery After Surgery (ERAS) Collaborative and is faculty for Ko Awatea’s improvement programmes and workshops.

Brandon Bennett

Brandon Bennett is principal advisor at Improvement Science Consulting, Washington, DC. Since 2012, he has worked with Ko Awatea as a senior improvement advisor on many of our successful improvement projects and programmes. Brandon also serves as an improvement advisor on IHI’s global initiatives and remains faculty for IHI’s Improvement Advisor Professional Development Program.

Their View:

Quality improvement in healthcare has evolved from focusing on quality assurance to understanding that transformational improvements are the only way health systems will continue to be sustained. Improvement science enables healthcare professionals to lead improvement from the frontline.

A framework for improvement involves understanding the core elements of improvement thinking and acquiring the tools to apply improvement thinking in practice.

The core elements of improvement science are:

  • understanding variation – having a window through data into the performance of systems
  • systems thinking – the ability to see the interconnected parts of the systems and how they affect each other
  • psychology of change – understanding motivation
  • mechanism for learning in the system – articulating theories and learning whether they work in practice.

In improvement science, learning is predicated on theories of change based on research and frontline practice.

Drawing theories of change from the people on the frontline creates ownership of the improvement project, which is critical for engagement and motivation. Motivation also comes from the hands-on, practical nature of using plan, do, study, act (PDSA) cycles, and from giving permission to fail – not every change will be successful.

Key tools for applying improvement science in practice are the Model for Improvement, run charts and data over time, and driver diagrams.[1],[2],[3]

  • The Model for Improvement asks three questions that help improvement teams to develop focus on their aims, understand the changes that can be made to result in improvement, and measure the success of those changes. Under the Model for Improvement, PDSA cycles act as the methodological engine that drives change forward by enabling improvement teams to learn what works and sustain improvements.
  • Run charts and data over time enable teams to understand whether a change is an improvement.
  • Driver diagrams help teams to focus on the changes they can make to create improvement.

This article is adapted from Brandon Bennett and Ian Hutchby’s intensive workshop at Ko Awatea’s APAC Forum 2015.

The APAC Forum 2016 will be held in Sydney, Australia, 12-14 September. To see the programme and register, please visit


[1] Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance (2nd ed.). San Francisco: Jossey-Bass; 2009.

[2] Perla, R, Provost, L, Murray, S. The Run Chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Qual Saf 2011. 20: 46-51.

[3] Bennett B, Provost L. What’s your theory? Driver diagram serves as a tool for building and testing theories for improvement. Quality Progress. July 2015: 36-43.

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