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Improvement Matters and Tools to Use

At Mid Cheshire we follow a 6-step process to making improvements, called our Improvement Matters 6Ds.  

The 6Ds provide a structured framework to understand the problem without jumping to a solution, to explore the root causes and ideas for improvement, to test and track these on a small scale and to sustain and celebrate our successes. 

We use the A3 tool for all of our improvement work to encourage problem solving and scientific thinking.

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Starting your Improvement Project and using the A3:

Please log your Improvement Project on the Improvement Tracker before you start and then work through the 6D steps within the A3.

The A3 is the key tool used at MCHFT for improvement projects. It includes the 6D steps and provides a structured framework for thinking through a problem that helps you to fully understand a problem and the root causes before jumping to a solution.  It is a live document which you update as you progress your improvement work and is a great visual, communication tool that allows you to tell the whole story on one page and invite contributions from others. 

Once you have completed your improvement A3, please upload it the Improvement Tracker to share and celebrate learnings.

The A3 template can be found in the 'Describe' step in our toolbox below and we recommend that you work through this throughout your project from start to finish. 

Improvement Resources:

A toolbox of tried and tested tools, techniques and templates underpins each the 6Ds to support staff in problem-solving and making improvements.

These resources are all provided below under each of the 6D steps for you to select from.  The idea is that you choose which tools best suit your improvement work - you aren't expected to use them all!

Describe.JPGDescribe the problem you are trying to solve and engage with others to build the will and case for change!

The Describe step focuses on the problem or issue that you are trying to solve.  It is really important to engage others in describing the actual problem and aligning it to our Strategic Improvement Aims and priorities.  

Remember to start working through the A3 from the beginning of your improvement work. 

  •  A3 - A problem-solving tool to guide you through your improvement project and capture progress and learnings at each step. ​​​​​​​

Some useful tools to use at the Describe step:

Diagnose.JPGDiagnose the problem and use observation and data to understand the current state and root cause!

The Diagnose phase focuses on understanding the current ‘as is’ state and the root causes of the problem or issues through direct observation, collection of data and insight, such as staff and patient feedback, and tools such as 5 Whys and Fishbone Diagrams. This Diagnose phase helps to develop a deep understanding of the processes, barriers and wastes in the system and avoid jumping to solutions without truly understanding the problem and root causes.

Some useful tools to use at the Diagnose step:

Design.JPGDesign your project by agreeing your aim and the change ideas to achieve your aim!

The Design step builds on your knowledge of how the system is currently performing in order to plan the improvement. Here you will design your project by setting a SMART aim of what you are trying to achieve and identifying change ideas that will help you achieve your aim and make your improvements.  

Some useful tools to use at the Design step:

Data.JPGData to set your improvement measures and monitor data over time to measure any improvements!

The Data step focuses on setting your improvement measures (outcome, process and balancing measures) and planning how you will collect and monitor data over time to track whether your changes are making improvements.  

Some useful tools to use at the Data step:

Do.JPGDo your tests of change using PDSA cycles - test changes at pace in iterative cycles and monitor impact!

The Do step focuses on testing change ideas using Plan, Do, Study, Act (PDSA) cycles to find out if they are starting to make an improvement or whether you need to adapt, abandon or adopt.  The emphasis is on small scale tests of change, at pace and in rapid iterative cycles, using data and insight to monitor impact.

Some useful tools to use at the Do step:

Develop.JPGDevelop your project by scaling up, sustaining, spreading and sharing your improvements!

The Develop step is vital in helping to ensure that your improvements stick and become the new ways of working. Without this focus, things may easily resort back to the previous way of doing things. It is also important that we share learnings with others so we can celebrate the improvement work happening across the Trust.

Some useful tools to use at the Develop step:

  • Sustainability Tool - Diagnostic tool to identify strengths, weaknesses and likelihood of your improvements sustaining
  • Embed and Sustain Plan - Plan how you will embed and sustain your improvements so they become part of the day to day work
  • Complete A3 - Share your improvement journey by capturing your learnings and progress throughout (Once you have completed your A3, remember to upload it to the Improvement Tracker)
  • QI Poster - Share the learnings and outcomes of your improvement work so your improvement efforts can be celebrated across the Trust
  • Standard Work - Helps you to reduce variability in a process by using the current best known way of carrying it out.

The Continuous Improvement Team love to hear about all your fantastic improvement work so please do share your completed projects with us: improvementmatters@mcht.nhs.uk 

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