Action Period
The time between learning sessions when teams work on improvement in their home organizations. They are supported by the Collaborative leadership team and faculty, and they are connected to other Collaborative team members.

Aim or Aim Statement
A written, measurable, and time-sensitive statement of the accomplishments a team expects to make from its improvement effort. The aim statement contains a general description of the work, the population of focus, the numerical goals, and a statement on spreading the changes to another population.

Annotated Run Chart or Annotated Time Series
A line graph showing results of improvement efforts plotted over time. The changes or annotations made are also noted on the chart at the time they occur, allowing the viewer to connect changes made with specific results.

Assessment Scale
A numerical scale used to assess the progress of participating teams toward reaching their aim. 1 = forming team, and 5 = outstanding, sustainable improvement. In each Collaborative, Collaborative faculty assesses teams and may also ask them to evaluate their own progress using this scale. The expected level of attainment by the end of the Collaborative is a 4 (significant progress).

BTS Collaborative
Breakthrough Series Collaborative (see "Collaborative")

Collaborative Chair
The leader of the Collaborative, usually an expert in the topic.

Clinical Champion
An individual in the organization who believes strongly in the improvements and is willing to try them and work with others to learn them. Teams need at least one nurse champion on their team. Champions in other disciplines who work on the process are important as well.

Change Concept
A general idea for changing a process. Change concepts are usually at a high level of abstraction, but evoke multiple specific ideas for how to change processes. “Simplify,” “reduce handoffs,” “consider all parties as part of the same system,” are all examples of change concepts.

Change Package
A collection of change concepts and key changes.

CQIO
Coordinating quality improvement organization. Qualis Health is the CQIO for the National Nursing Home Improvement Collaborative.

Collaborative
A time-limited initiative (usually 6–13 months) made by multiple organizations that come together with faculty to learn about and create improved processes on a specific topic. After the initiative's end, teams continue to monitor their progress and are expected to help disseminate the new improvements and knowledge broadly across their institution. In addition, the teams are expected to help spread the innovations to other organizations in their system.

Collaborative Framework
The Collaborative framework consists of the charter, change package, and measurement strategy. The framework provides constant direction to the teams regarding why they are doing this work, what changes they can make, and how they can use measurement to determine if they are making changes that result in improvements.

Collaborative Team
All individuals from the nursing homes and the nursing home’s QIO or QIOP that drive and participate in the improvement process. A core team of three individuals attends the learning sessions, but a larger team of six to eight people, often from various disciplines, participates in the improvement process in the organization.

Community of Practice
Groups of people who share a concern, set of problems, mandate, or sense of purpose. Communities of practice complement existing structures by promoting collaboration, information exchange, and sharing of best practices across boundaries of time, distance, and organizational hierarchies. A great deal of knowledge creation happens in these less visible but increasingly recognized and supported groups.

Collaborative Coordinator
Qualis Health staff person responsible for the day-to-day activities of the Collaborative, including meetings, materials, phone calls, website, reports, and information management.

Cycle
See "PDSA cycle."

Day-to-Day Leader
The person on the nursing home’s team who is responsible for driving the improvement process every day. This person manages the team, arranges meetings, and assures that tests are being completed and that data are collected.

Director
The manager of a Collaborative who works with the faculty, teaches and coaches teams, and plans and executes learning session and action period activities.

Early Adopter
In the improvement process, the opinion leader within the organization who brings in new ideas from the outside, tries them, and uses positive results to persuade others in the organization to adopt the successful changes.

Early Majority/Late Majority
The individuals in the organization who will adopt a change only after it is tested by an early adopter (early majority) or after the majority of the organization is already using the change (late majority).

Electronic Mailing List or E-Mail List
A communication system that allows teams to stay connected with the leadership team and each other during the action periods. Sharing information, getting questions answered, and solving problems are all part of e-mail list activity.

Handbook
Pages containing a complete description of the Collaborative, along with expectations and activities to complete before the first meeting of the Collaborative.

IHI
Institute for Healthcare Improvement

Implementation
Taking a change and making it a permanent part of the system. A change may be tested first and then implemented throughout the organization.

Improvement Advisor
The expert in process improvement and measurement who assists the co-chairs and director in guiding the Collaborative’s work and coaching teams.

Improvement Cycle
See "PDSA cycle."

Key Changes
The list of essential process changes that will help lead to breakthrough improvement, usually developed by the leadership team and chair based on literature and their experiences.

Key Contact
The individual on the organization team who takes responsibility for communication between the team and Qualis Health, including monthly reporting and disseminating information to team members. The key contact is often the day-to-day leader on the team.

Key Messenger
The individual in the organization who can be relied on for spreading ideas to others within the organization.

Knowledge Management
A method for gathering information and making it available to others.

Leadership Team
The small group of experts on the topic who assist the chair and director in teaching and coaching participating teams. Usually the leadership team contains representatives from all the disciplines who are involved in the change process.

Learning Session
A two-day meeting during which team members meet with faculty and collaborate to learn key changes in the topic area, including how to implement changes, accelerate improvement, and overcome obstacles. Teams leave these meetings with new knowledge, skills, and materials that prepare them to make immediate changes.

Measurement Strategy
A collection of measure, required and optional, that describe in detail how to calculate statistics and provide direction on appropriate goals.

Measure
A focused, reportable unit that will help a team monitor its progress toward achieving its aim.

Model for Improvement
An approach to process improvement, developed by Associates in Process Improvement, which helps teams accelerate the adoption of proven and effective changes.

NNHIC
National Nursing Home Improvement Collaborative

Outcome Measure
Measures of change (or lack of change) in the well-being of a defined population. Improvement in an outcome measure reflects the health status of the resident, whereas a process measure reflects the care delivery to the resident. Improvement in an outcome measure has a direct effect on mortality and morbidity.

Outcomes Congress
A large public meeting at the end of the Collaborative during which the best practices in the topic area are presented to others interested in making improvements in the area.

PDSA Cycle
A structured trial of a process change (Plan, Do, Study, Act). Drawn from the Shewhart cycle, this effort includes the following steps:

• plan—a specific planning phase;
• do—a time to try the change and observe what happens;
• study—sometimes called “check,” an analysis of the results of the trial; and
• act—devising next steps based on the analysis.

This PDSA cycle will naturally lead to the “plan” component of a subsequent cycle. PDSA cycles are also called “rapid cycles” or “improvement cycles.”

Pilot Population
See "population of focus."

Pilot Site
The clinic location where changes are tested. After implementation and refinement, the changes will be spread to additional locations.

Population of Focus
A designated set of residents who will be tracked to determine whether changes have resulted in improvements. For this Collaborative, a pilot population might be defined as residents having a specific stage of pressure ulcer or residents at high risk who will be tested and the team will implement changes as part of the Collaborative.

Pre-Work Period
The time before the first learning session when teams prepare for their work in the Collaborative. Pre-work activities include selecting team members, registering for the first learning session, scheduling initial meetings, preparing an aim statement, defining a pilot population, selecting measures, and initiating data collection.

Process Change
A specific change in a process in an organization. More focused and detailed than a change concept, a process change describes what specific changes should occur. “Instituting a pain management protocol for patients with moderate to severe pain” is an example of a process change.

QIO
Quality Improvement Organizations (QIOs) across the country, including Qualis Health, are charged with ensuring that Medicare beneficiaries get appropriate, high-quality healthcare under a program mandated by federal law. This program is administered by the Centers for Medicare & Medicaid Services (CMS) on the national level, but is implemented statewide by QIOs—private companies that until recently were known as Peer Review Organizations (PROs).

QIOP
Quality improvement organization peer. For the purposes of the NNHIC, a QIOP is a multi-building entity nursing home organization with facilities of 30 buildings or greater in at least 5 states. QIOPs will act in the same capacity as a QIO and will attend and support their nursing home in all Collaborative activities.

Rapid Cycle
See "PDSA cycle."

Run Chart
See "annotated time series."

Sampling Plan
A specific description of the data to be collected, the interval of data collection, and the subjects from whom the data will be collected. The sampling plan is included on all senior leader reports. It emphasizes the importance of gathering samples of data to obtain “just enough” information.

Senior Leader
The executive in the organization who supports the team and controls the resources employed in the processes to be changed. This person is usually at the administrator level or higher. The senior leader works to connect the team’s aim to the organization’s mission, provides resources for the team, and promotes the spread of the team’s work to others.

Senior Leader Report
The standard reporting format for monthly progress updates in a Collaborative. This concise, two-page report includes an aim statement, measures to be used, a sampling plan, a listing of the changes made, and the results displayed graphically on run charts. The nursing home pilot team prepares the report and sends it to the senior leader at the nursing home, along with posting it to the electronic mailing list. Qualis Health staff review and summarize monthly reports.

Spread
The intentional and methodical expansion of the number and type of people, units, or organizations using the improvements. The theory and application of spread comes from the literature on diffusion of innovation.

Staging Plan
A plan of what populations/units will be spread to and in what order.

System Leader
The team member who has direct authority to allocate the time and resources to achieve the team’s aim, has direct authority over the particular systems affecting the change, and will champion the spread of successful changes to other resident populations. In the present Collaborative, this person may be the administrator or the director of nursing services.

Technical Expert
The team member in the organization who has a strong understanding of the process to be improved and changes to be made. A technical expert may also provide expertise in process improvement, data collection and analysis, and team function.

Test
A small-scale trial of a new approach or a new process. A test is designed to learn if the change results in improvement and to fine-tune the change to fit the organization and patients. Tests are carried out using one or more PDSA cycles.

Tipping Point
In epidemiology, the concept that small changes will have little or no effect on a system until a critical mass is reached. Then a further small change “tips” the system and a large effect is observed