Collaborative Improvement Design (CID)
HBOM’s signature human-centered design framework for accelerating healthcare improvement
What is CID?
Collaborative Improvement Design (CID) is a hybrid framework that integrates principles from traditional quality improvement (QI) and project management processes with Human-Centered Design (HCD). It was developed over 3 years of practical application in healthcare systems across the state of Michigan to help teams co-design, test, and implement low-cost, high-impact solutions to complex healthcare challenges.
QUICK LINKS
CID Handout
Download
Design Project Charter
Download
Journey Mapping Template
Download
CID provides a structured-yet-flexible process that promotes:
- Deep learning from human experiences
- Co-development across collaborator groups
- Creativity and innovation grounded in evidence
- Rapid testing, reflection, and refinement
Rather than focusing on a problem or hypothesis, CID centers around a driving question:
“How might we…?”
This guiding inquiry reframes challenges as opportunities and encourages innovation and collaboration within quality improvement.
The CID process:
CID follows a cyclical process that moves through four main phases:
Plan & Share → Learn → Co-Develop → Implement
This process includes stages for teams to engage in divergent and convergent thinking. Divergent stages are opportunities for creativity and exploring possibilities without considering limitations. Convergent stages are times to prioritize, analyze, and refine ideas and options.
In early cycles of the CID process, teams are encouraged to focus on “low-hanging fruit” or straightforward, low-cost opportunities that can be addressed quickly to build trust, demonstrate success, and strengthen relationships with collaborators.
Later CID cycles can build upon previous relationships and solutions, allowing teams to take on increasingly complex challenges that require more coordination, resources, and longer implementation. Over time, this iterative approach transforms small, practical improvements into sustained, large-scale impact.
Phase 1: Plan & Share
Goal: Align and inform collaborators
Key Activities:
- Establish project scope, timeline, and goals
- Identify collaborators, roles, and resources
- Define metrics of success
Onboard all collaborators to the project
Example Outputs:
- Design project charter
- How Might We question
- Table of collaboration
Phase 2: Learn
Goal: Understand the current context, needs, and barriers from multiple perspectives.
Key Activities:
- Use design research methods like interviews, focus groups, or surveys
- Review existing data and literature
- Observe workflows or patient journeys
- Identify barriers and opportunity areas
Example Outputs:
- Journey maps and affinity maps
- Coded interview insights
- User stories
Phase 3: Co-Develop
Goal: Generate, prototype, and refine solutions collaboratively.
Key Activities:
- Host brainstorming and design sessions
- Create low-fidelity prototypes
- Test with users and other collaborators
- Refine ideas based on input
Example Outputs:
- Prototypes
- Pilot protocols
Phase 4: Implement
Goal: Pilot, measure, and scale sustainable solutions.
Key Activities:
- Launch pilot(s) with defined metrics
- Track outcomes and collect user feedback
- Iterate based on results
Example Outputs:
- Measurement dashboard
- Case studies
- Implementation documentation
GUIDING PRINCIPLES:
- Center People: Let actual lived experiences drive solutions.
- Collaborate Broadly: Involve multidisciplinary voices early and often.
- Gather Information & Inspiration: Look beyond traditional data analysis to find sparks of inspiration that drive innovation.
- Prototype Early: Test small, actively search for ways to improve, iterate frequently.
- Measure What Matters: Use data to learn and encourage improvement, not to punish.
- Document & Share: Disseminate learnings openly and often to accelerate improvement.
CID in Action
NewBeat: Increasing Enrollment in Cardiac Rehab
The Challenge: Cardiac rehabilitation is the gold standard of care after major cardiac events. However, while referral rates have increased, enrollment and utilization rates remain low.
Our Guiding Question: How might we increase enrollment in cardiac rehab by addressing both patient and provider barriers?
HBOM partnered with the Michigan Cardiac Rehab Network (MiCR) to tackle this challenge.
Plan & Share
HBOM presented at MiCR’s annual Fall meeting in 2022 to announce the partnership and start conversations with members.
A core project team was formed and general delivery timelines established.
Learn
Why are patients who recieve a referral to cardiac rehab not enrolling?
Patient Perspectives
Design Research Method: Semi-structured Interviews
Key Finding: Patients often didn’t realize they had recieved a referral.
Provider Perspectives
Design Research Method: Jounrey Mapping & Affinity Mapping
Key Finding: Providers identified four major barriers to cardiac rehab enrollment and utilization (provider knowledge, transport, copays, and limited staff)
Co-develop
Start by designing simple, low-cost solutions that address barriers identified in the learn phase. The team chose to tackle provider knowledge gaps first.
Patient Perspectives
Design Research Method: Semi-structured Interviews
Key Finding: Patients often didn’t realize they had recieved a referral.
Provider Perspectives
Design Research Method: Jounrey Mapping & Affinity Mapping
Key Finding: Providers identified four major barriers to cardiac rehab enrollment and utilization (provider knowledge, transport, copays, and limited staff)
