The definition of a term is a statement expressing the essential nature of something that enables a common understanding of key terms within an improvement team.
Contents
Introduction
Definitions are important in exploring common understanding within improvement teams. They play a key role in ensuring people understand the same thing about key terms or issues. However, their role is not to standardise or set a common language, rather to enable communication through better understanding or translation.
For example, design is a word that often invokes passion and misunderstanding amongst its users. Is it a verb or a noun? Does it refer to the artefact or the process? There is no right or wrong answer here, rather it is important that the originator and recipient of a message hold a common understanding of what is said. This will require knowledge of the background and context of each individual by the other and ideally the ability to translate the meaning of the word simultaneously or, if necessary, to agree a common use. The former model of communication is always preferable as it is likely to be accompanied by a greater empathy between individuals, but the later may be essential to avoid ambiguity.
This section provides definitions for a number of terms relevant to improvement, ordered by their likely use within the strands of the Improvement Model that they relate to. They are here for reference and not intended to define a common language. Indeed, alternative and related terms are provided, along with some indication as to how they might be related or used together. Nonetheless, some care has been taken to try to ensure that when these terms are used within the toolkit, it is the meaning defined here that has been adopted. Hence the terms are presented in groups, aligned with the key strands.
Definitions may be mapped to definitions to assist in understanding their adjacency, distinction and overlap. More than one term may be used for any particular purpose and this is often encouraged when there is good reason for doing so. The mapping provides indication as to how definitions might be linked, but is not expected to exhaustively show where these terms are related in practice.
Text list of definitions
Problem
Solution
Evidence
Case
Plan
Pictorial list of definitions
You can click on any of the images below to find out more about that definition.
Cards for each of the definitions are available in the boxed version of this toolkit. If you would like further information on how to get hold of these cards, please contact edc-toolkit@eng.cam.ac.uk
Context
Stakeholder
stakeholder — a person with an interest or concern in something
A stakeholder is a person with an interest in the project because they have something to gain or lose
Use:
- Stakeholders may be service providers or users
- Identify as many stakeholders and their needs as possible
- Carefully prioritise the needs of all the stakeholders
see also user
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User
user — a person who uses or operates something
The patient is the core user of a system, but other stakeholders are also users in the delivery of services
Use:
- Users are a special category of system stakeholders
- Identify as many users and their particular needs as possible
- Carefully balance the needs of the users and other stakeholders
see also stakeholder
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Trigger
trigger — the thing that caused someone to do something
The trigger is the reason why there is an improvement programme and defines the initial scope of the programme
Use:
- The trigger describes the event or action that initiated change
- Triggers may be in response to adverse events or near misses
- Triggers may be preemptive to improve a system or avoid error
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Context
context — the circumstances that surround something
The context includes all aspects that affect the problem and the implementation of a solution
Use:
- The context describes all factors that may influence change
- May be used to describe enablers for improvement
- May be used to capture barriers to improvement
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Scope
scope — the extent of the area that something deals with
The scope is the boundary between aspects considered as part of the problem and others that affect the problem
Use:
- A consensus view of the scope is vitally important
- Should bound the area of interest for subsequent improvement
- Often used in conjunction with system and aim
see also trigger, context, system and aim
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System
system — a set of things working together to do something
A system is a set of elements that, when combined, have qualities that are not present in the elements themselves
Use:
- A system may comprise people, rules and other things
- A system may be part of or made up of other systems
- Often used in conjunction with scope and aim
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Aim
aim — the intention or ambition or achieving something
The project aim represents a clear statement of intent that helps everyone align with the project objectives
Use:
- A consensus view of the aim is very helpful
- Should provide broad focus for all subsequent development
- Often used in conjunction with scope and purpose
see also scope, system, purpose and need
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Purpose
purpose — the thing that something is supposed to achieve
The purpose defines the things that the particular health and care system is supposed to deliver and achieve
Use:
- A consensus view of the purpose is important
- Should provide focus for identifying potential improvements
- Often used in conjunction with aim and theme
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Need
need — a strong feeling that you must have something
A need is an essential condition that a particular stakeholder believes has to be satisfied from their perspective
Use:
- Needs may relate to fundamental issues and specific desires
- All stakeholders in a system are likely to have specific needs
- Often used in conjunction with aim, purpose and theme
see also aim, purpose and theme
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Theme
theme — the core idea that is apparent in something
The themes are high-level targets for improvement and capture the essence of the things the improved system must do
Use:
- A consensus view of the theme(s) is particularly important
- Should provide particular focus for all subsequent development
- Often used in conjunction with need and requirement
see also need and requirement
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Problem
Requirement
requirement — a description of something you must have
A condition that has to be satisfied for the improvement to be successful, derived from an agreed set of themes
Use:
- Requirements relate to a balanced set of stakeholders’ needs
- Requirements should be reflected in subsequent evaluation
- Often used in conjunction with need and specification
see also theme and specification
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Specification
specification — a detailed description of how something should be
A specification is a structured set of requirements providing a holistic view of the need for improvement
Use:
- A specification describes an agreed collection of requirements
- The specification should be reflected in subsequent verification
- Often used in conjunction with need and requirement
see also requirement
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Challenge
challenge — a difficult or demanding task or situation
The challenge represents what is known or perceived to be wrong with the current system
Use:
- A consensus view of the challenge is particularly important
- Often used synonymously with the description of a problem
- Focus on a challenge may encourage a more enthusiastic response
see also problem
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Problem
problem — a detailed description of a particular challenge
The problem statement represents the consensus view on the challenge that is going to be solved
Use:
- A consensus view of the problem is particularly important
- Often used synonymously with the description of a challenge
- Focus on a problem may encourage a more muted response
see also challenge
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Journey
journey — an act of travelling from one place to another
A patient journey captures the things that happen to an individual as they interact with health and care services
Use:
- A description from the point of view of the person making the journey
- The journey may be described for a typical person or an individual
- Multiple journeys may be used to describe a single intervention
see also pathway
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Pathway
pathway — a course of action to achieve a specified result
The clinical pathway is a description of the things that are expected to happen in provision of a health or care service
Use:
- A description from the point of view of the person defining the pathway
- The pathway may be defined for a typical person or an individual
- Multiple pathways may be used to describe a single intervention
see also journey
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Persona
persona — a caricature designed to display certain attributes
A persona is a description of a person with a blend of real attributes, to assist the design of an improved system
Use:
- Personas represent notable attributes of system stakeholders
- Personas typically describe caricatures of system users
- Personas are often used in conjunction with scenarios
see also scenario
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Scenario
scenario — a typical sequence or development of events
A scenario describes an instance of a particular system as a starting point for discussing targets for improvement
Use:
- Scenarios represent notable sequences of events
- Scenarios typically describe journeys of system users
- Scenarios are often used in conjunction with personas
see also persona
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Solution
Idea
idea — a suggestion or plan for doing something
A suggestion for how an aspect of the system could be improved which has not yet been worked into a viable concept
Use:
- A suggestion or plan that may form part of a concept
- A good idea is likely to be realisable and meet the requirements
- Often used in conjunction with the description of a concept
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Concept
concept — an idea that is connected with something
A concept is a description of something that does not yet exist, but has the potential to improve the service
Use:
- An idea or combination of ideas that may solve a problem
- A viable concept is very likely to meet the requirements
- Often used in conjunction with the description of an idea or solution
see also idea, model and solution
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Model
model — a simplified representation of something
A model is a simplified physical or virtual embodiment of a concept which communicates particular aspects of it
Use:
- A simple model is often adequate early in the programme
- Models may used to describe form and/of function
- Multiple models may be better than a single integrated model
see also idea, concept and solution
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Solution
solution — a way of solving a particular problem
A solution is chosen from one of the many concepts considered when exploring ways to solve the problem
Use:
- A combination of elements which together solve a problem
- A viable solution demonstrably meets the requirements
- Often used in conjunction with the description of a concept
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Hazard
hazard — the possibility of harm or an adverse outcome
A hazard is something that leads to the possibility of harm or events that result in an adverse outcome
Use:
- Hazards represent possible threats present within a system
- Barriers may be used to limit potential exposure to hazards
- Often used in conjunction with the description of an risk
see also risk
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Risk
risk — the probability of harm or an adverse outcome
A risk is exposure to hazards and the probability of harm or events that result in an adverse outcome
Use:
- Risks represent probable threats present within a system
- Barriers may be used to limit the potential consequence of risks
- Often used in conjunction with the description of a hazard
see also hazard
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Robustness
robustness — the ability to deliver under change
A robust system is capable of performing when subjected to variation, shock or change
Use:
- Robustness is measured with respect to target performance
- Robustness may relate to particular elements of the system
- Robustness may relate to parts of the delivery process
see also adaptability
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Adaptability
adaptability — the ability to adapt to change
An adaptable system is capable of performing by adapting to variation, shock or change
Use:
- Adaptability is measured with respect to target performance
- Adaptability may relate to particular elements of the system
- Adaptability may relate to parts of the delivery process
see also robustness
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Flexibility
flexibility — the ability to be changed easily
A flexible system is capable of being adapted in response to variation, shock or change
Use:
- Flexibility is measured with respect to target performance
- Flexibility may relate to particular elements of the system
- Flexibility may relate to parts of the delivery process
see also agility
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Agility
agility — the ability to be changed rapidly
An agile system is capable of being adapted rapidly in response to variation, shock or change
Use:
- Agility combination of elements which together solve a problem
- Agility may relate to particular elements of the system
- Agility may relate to parts of the delivery process
see also flexibility
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Evidence
Resilience
resilience — the ability to recover from change
A resilient system is capable of recovering when subjected to variation, shock or change
Use:
- Resilience is a continuous process rather than a property
- Resilience may be delivered in a variety of forms
- Resilience is enabled by effective forecasting
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Quality
quality — the degree of excellence possessed by a thing
The quality targets are specific objectives for clinical and cost effectiveness, patient safety and patient experience
Use:
- Quality is not solely a focus on clinical and cost effectiveness
- Quality should be identifiable, measurable and targeted
- Quality should be continuously monitored
see also resilience, target
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Target
target — the identity of something to be aimed at
A target is an objective for a given stage of the improvement process related to service or programme performance
Use:
- Targets should be realistically attainable and measurable
- Targets should reflect desirable levels of quality
- Targets may vary through the improvement process
see also resilience, quality
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Evaluation
evaluation — showing a solution satisfies its requirements
The evaluation of the elements of a system tests whether they are likely to achieve their intended performance
Use:
- Evaluation checks performance against individual requirements
- Approaches to evaluation should reflect the requirements
- Often used in conjunction with verification and validation
see also verification and validation
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Verification
verification — showing a solution meets its requirements
The verification of a system tests whether it achieves its intended performance under specified conditions
Use:
- Verification checks performance against the requirements
- Approaches to verification should reflect the requirements
- Often used in conjunction with evaluation and validation
see also evaluation and validation
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Validation
validation — showing a solution is fit for its intended purpose
The validation of a system checks whether it works with real users and other stakeholders in real contexts
Use:
- Validation begins with checking requirements against the needs
- Approaches to validation should reflect prioritised needs
- Often used in conjunction with evaluation and verification
see also evaluation and verification
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Case
Rationale
rationale — the reasons or a logical basis for something
The rational for an improvement concept reasons why it has the form and function that it has
Use:
- Rationale relates to the reasoning behind key decisions
- Typically expressed with relation to the change facilitator
- Often used in conjunction with definition of the case
see also case
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Case
case — a set of arguments to support doing something
The case for improving a system balances the benefits against the costs of delivering the improvement
Use:
- A clear case is essential to gather the necessary support for a plan
- The case should clearly define expected outcomes and costs
- The case should be sufficient, accurate and realistic
see also rationale
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Plan
Process
process — a series of actions to achieve something
An improvement process comprises activities which are chosen in response to targets to design an improved system
Use:
- A consensus view of the process is particularly important
- The process should clearly define expected actions and outcomes
- The process outcomes should be achievable using available resource
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Plan
plan — a detailed proposal for doing something
An improvement plan provides a description of the activities and resources required to deliver an improvement
Use:
- A consensus view of the plan is particularly important
- The plan should clearly define expected actions and timing
- The plan should be achievable using available resource
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Resource
resource — the thing that enables something to happen
The resource required to deliver improvement is likely to include people, things, tools and funding
Use:
- Resource relates to the people and things that enable change
- Typically expressed within the context of the change
- Often used in conjunction with definition of the plan
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Ethos
ethos — the characteristic spirit of a system
The ethos of a community or system guides its attitudes and aspirations for improvement
Use:
- The prevailing characteristic of an organisation or system
- The character of an individual seen as values and beliefs
- The moral or practical code guiding behaviour
see also culture and behaviour
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Culture
culture — the distinctive customs and behaviour of a system
The culture of a community or system informs its philosophy and practice for improvement
Use:
- The way of life of a particular group, organisation or system
- The philosophy, practices and attitudes of an organisation
- The social practices associated with a particular field
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Behaviour
behaviour — the general practice and conduct of a system
The behaviour of a community or system reflects the manner in which it delivers improvement
Use:
- The way in which one conducts oneself or behaves
- The course of action towards or treatment of others
- The way in which something functions or operates
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