Testing begins with a design step that involves choosing one of the candidate drivers and hypothesizing how it could be addressed. For example,
"If medical personnel wash their hands for no less than 30 seconds with provided antibacterial soap and refrain from direct physical contact with other people and surfaces between patient visits, then measured nosocomial infection rates will decrease by 40%."
This hypothesis defines the intervention and communicates an expected impact on infection rates. The intervention is simple to implement, scalable, and minimally designed. We want to keep it simple. Once this is established, we can develop the study protocols, time frame, and data needed to assess the impact of the intervention. These protocols should be easy to implement, and the study time frame should be < 90 days. Collected data should require minimal effort to collect, be easy to analyze and should facilitate objective interpretation.
The next two steps involve implementing the intervention, collecting our data, and then analyzing and interpreting the data. The final step is to evaluate the efficacy of the intervention and determine how to proceed. If we determine the intervention to be successful, it can be integrated into regular practice or policy. If we determine it to be unsuccessful or partially successful, it can be abandoned or revised for further study. Lessons learned from the testing cycle can now feed back into our understanding of the problem, priors can be updated, and a new round of study can be started with another driver or a revised version of the current driver. Through this recursive process, we begin to peel away layers of the problem, individually addressing each while developing a deeper understanding of it.
Final Thoughts
The short-cycle improvement study works most effectively for applied research in scenarios that require contextually sensitive responses to complex problems. It can be used for: (a) initial development and testing of interventions, (b) testing proven interventions to assess their effectiveness in a different context, or (c) to address problems with a minimal investment of resources.
Developing a rapid yet sustainable tempo for operational improvement is a key function of high performing organizations. The
short in short-cycle cannot be overemphasized. The power of this approach is its parsimony. Large scale longitudinal studies have their place, but short-cycle studies provide a method for analyzing and addressing problems that cannot wait for the the findings of long term studies. Two institutions - the
Carnegie Foundation for the Advancement of Teaching and the
Institute for Healthcare Improvement - have pioneered the development and application of these methods. Each deserves recognition for those efforts.
Key Ideas
- Let the phase of the study inform your epistemic orientation. Exploration phase: inductive. Testing phase: deductive.
- Context is critical. Solutions to most things within the social sciences are contextually contingent.
- Understanding deepens with engagement. Working within the medium of the problem leads to a more robust understanding of it.
- Make sure you are addressing the causal drivers of the problem rather than just the symptoms.
- Address one causal driver at a time rather than attempting to fix the entire problem (see Idea #2).