title: Developing the Capacity for Rapid-Cycle Improvement at a Large Freestanding Children's Hospital.
abstract: BACKGROUND
  To develop the capacity for rapid-cycle improvement at the unit level, a large freestanding children's hospital designated 2 inpatient units with normal patient loads and workforce as pilot "Innovation Units" where frontline staff was trained to lead rigorous improvement portfolios.
  
  
  METHODS
  Frontline staff received improvement training, and interdisciplinary teams brainstormed ideas for tests of change. Ideas were prioritized using an impact-effort evaluation and an assessment of how they aligned with high-level goals. A template for each test summarized the following: the opportunity for improvement, the test being conducted, dates for the tests, driver diagrams, metrics to measure effects, baseline data, results, findings, and next steps. Successful interventions were implemented and disseminated to other units.
  
  
  RESULTS
  Multidisciplinary staff generated 150 improvement ideas and Innovation Units collectively ran >40 plan-do-study-act cycles. Of the 10 distinct improvement projects, elements of all 10 were deemed "successful" and fully implemented on the unit, and elements from 8 were spread to other units. More than 3 years later, elements of all of the successful improvements are still in practice in some form on the units, and each unit has tested >20 additional improvement ideas, using multiple plan-do-study-act cycles to refine them.
  
  
  CONCLUSIONS
  The Innovation Unit model successfully engaged frontline staff in improvement work and established a sustainable system and framework for managing rigorous improvement portfolios at the unit level. Other hospitals and health care delivery settings may find our quality improvement approach helpful, especially because it is rooted in the microsystem of care delivery.
authors.affiliation: Division of General Pediatrics, Departments of Pediatrics and fieldston@email.chop.edu.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.affiliation: Division of General Pediatrics.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Jonas
authors.affiliation: Office of Safety and Medical Operations, and.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Lederman
authors.affiliation: Departments of Anesthesiology and Critical Care Medicine, and.
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Zahm
authors.affiliation: Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Rui
authors.initials: R
authors.lastname: Xiao
authors.affiliation: Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Christina M
authors.initials: CM
authors.lastname: DiMichele
authors.affiliation: Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Ellen
authors.initials: E
authors.lastname: Tracy
authors.affiliation: Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Katherine
authors.initials: K
authors.lastname: Kurbjun
authors.affiliation: Division of General Pediatrics, Departments of Pediatrics and.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tenney-Soeiro
authors.affiliation: Office of Safety and Medical Operations, and.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Geiger
authors.affiliation: Division of General Pediatrics, Departments of Pediatrics and.
authors.forename: Annique
authors.initials: A
authors.lastname: Hogan
authors.affiliation: Hospital for Sick Children, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Apkon
mesh_terms: D002648:Child; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D009936:Organizational Innovation; D009937:Organizational Objectives; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000379:methods; D058996:Quality Improvement; D013192:Staff Development / Q000379:methods*