Keeping it Simple: The NIATx Process Improvement Model Revisited

October 4, 2016

Scott Gatzke
NIATx Coach
Director, ElderTree Dissemination

The late Peter Drucker, an influential business thought leader and educator, once stated:

Almost all quality improvement comes via simplification of design and processes

Recently, I was reminded of the simple elegance of NIATx model.
A friend came to me and asked what I would do if faced with the following problem:

His organization struggled to make timely improvements to their operations.
When a change was finally implemented, it often reverted back to the old process after a few months.

Having guided change teams for years in organizations both large and small, I was all too familiar with the challenge he presented. 

Continuous improvement is better than delayed perfection

Improvement efforts that seem to drag on forever with minimal results are often towing what I call the anchor of perfection.

A change team will plan and design their improvement for months - hoping to develop the perfect process - and only after it is "just right" will they test it. This quest for perfection is ineffective for quality improvement, because all processes will fail you in ways you cannot anticipate.

You’re better off to plan a small pilot test, test it, study the results, and decide to adapt, adopt, or abandon the change. Then, do another test until you reach your improvement goal. This is the Plan-Do-Study-Act or PDSA cycle, the core of the NIATx model. 

A wise quality improvement mentor of mine likes to say: "Continuous improvement is better than delayed perfection." Rapid-cycle testing is the way to avoid overplanning and learn what really works and does not work in the process.

Top three reasons change projects fizzle out 

The issue of not sustaining a change, once it's been implemented, is another all-too-common problem. In my experience, I have found one or more of the following three things as the culprit for derailing a successful change:

1. The customer was not consulted or sufficiently considered when designing the change.
2. Front-line staff who carry out the process were not part of the change team, had no input, and did not buy in to the change.
3. No sustain leader was assigned to monitor the process and bring the change team back together if things started to backslide. 

All of these issues are covered and accounted for in the NIATx Model.

I shared the NIATx Model Quick Reference below with my friend. 

How to Steps for the NIATx Change Model

Planning Phase
1. Identify one important process to improve and a problem to focus on. Define your aim and measure (data).
2. Conduct a walk-thru or talk-thru of the process. What’s working and not working?
3. Assemble a Change Team (5-7 people). Include staff who work in the process.

Improvement Phase
4. Review your project aim and walk-through experience with Change Team; discuss strengths & improvement opportunities in the process. 
5. Flowchart the current process; list problem areas or steps in the process.
6. Identify Solutions:
Conduct a Nominal Group Technique exercise to brainstorm solutions and vote on which change to test first (other ideas go to the “parking lot” for future PDSA cycles).
7. Assign roles/tasks among the Change Team and document your Change Project.
8. Do PDSA rapid-cycle tests until you achieve your aim. Rely on data in deciding to adopt, adapt, or abandon a change.
9. Develop a sustainability plan for your change project to sustain the gains.

Sustain Phase

10. Celebrate with your team! Change project is completed.
11. Tell Your StoryShare your change project results. 

After completing his first change project using the model, my friend commented: 
The NIATx Model is a clear, simple approach to process improvement that all our staff can use. Whenever we need to improve something, we don’t waste time wondering where to start. The NIATx Model walks us through the steps.” 
His experience with the NIATx Model had me believing Peter Drucker was right. Simplification really is the path toward quality improvement. 

Have you used the NIATx model to make changes in your organization?

Share your story in the comments section below!

Visit for detailed descriptions of the steps and tools along with many other resources to help you complete a change project and sustain your improvements. 

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