A bundle is described as a structured way of improving the processes of care and patient outcomes: a set of evidence-based practices — generally three to five — that, when performed collectively and reliably, have been demonstrated to improve patient outcomes (Institute for Healthcare Improvement, 2010). It is not simply a list of desirable changes.

  • All of the elements are necessary and must be performed together.
  • The changes are all based on randomized controlled trials, what we call Level 1 evidence.
  • A bundle focuses of how to provide the care, not what care to provide.
  • Bundle changes must occur at a specific time and place; every patient, every time, with complete consistency.
  • A bundle belongs to a person or team, so there is a strong elenment of accountability.


In a bundle, the measures are all-or-none (Nolan & Berwick, 2006). All practices must be applied all the time; three out of four practices would not capture the spirit of the concept.

For an example of a bundle, see Central Line Bundle. This is a set of five ideas to help prevent “catheter-related blood stream infections,” deadly bacterial infections that can be introduced through an IV.

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