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How Do I Do? PDSA Cycles Accelerating Change Dannie Currie, RN, MN, DHSA Safety Improvement Advisor Atlantic Node Safer Healthcare Now!
How Do I Do?
PDSA CyclesAccelerating Change
Dannie Currie, RN, MN, DHSASafety Improvement Advisor
Atlantic Node Safer Healthcare Now!
Overview
• Change Concepts
• PDSA
• Example
• Exercise and Commitment
Change
• Control
• Over
• Personal
• Experiences
Change Concept• A general notion or approach to change that has been found to be
useful in developing specific ideas for changes that lead to improvement.
• Creatively combing these change concepts with knowledge about the specific work can help generate ideas for tests of change. PDSAs are used to test the specific ideas.
• Change concepts are usually at a high level of abstraction, but evoke multiple ideas for a specific process.– Examples:
• Reduce handoffs• Consider all parties as part of the same system• Improve work flow• Eliminate waste
• Berwick, Boushon,& Roessner, 2007
Change Concepts
Aim: Assure customers do not leave bank cards
behind
Change Concepts
Aim: Assure customers do not leave bank cards
behindIdea: Beeping sound
Idea: Beeping sound
Concept:
Use reminder
s
Change Concepts
Aim: Assure customers do not leave bank cards
behindIdea: Beeping sound
Concept:
Use reminder
s
Electric shock
Voice reminders
Siren
Based on Edward DeBono’s Concept Fan
ChangesWhile all changes do not lead to improvement,
all improvement requires change.
Key Change-The list of essential process changes that will lead to breakthrough improvement.
Berwick, Boushon,& Roessner, 2007
Rapid Cycle Change
• Cycle– A structured trial of a process change. Drawn from
the Shewhart cycle, this effort includes:• Plan- a specific planning phase• Do- a time to try the change and observe what happens• Study- an analysis of the results of the trial• Act- devising next steps based on analysis
This PDSA cycle will naturally lead to the Plan of a subsequent cycle.
Berwick, Boushon,& Roessner, 2007
PDSAs Moving From Testing to Implementing
A PS D
A PS D
AP
SD
APSD
Change Ideas
Learning From Data
Very Small test
Follow up tests
Wide Scale tests of change
Implementation of Change
Changes Result in Improvement
Huddles
• The idea of using huddles, as opposed to the standard one-hour meeting, arose from a need to speed up the work of improvement teams. Huddles enable teams to have frequent but short briefings so that they can stay informed, review work, make plans, and move ahead rapidly.
• Berwick, Boushon,& Roessner, 2007
Rapid Cycle TestingAIM: State your overall goal you would like to reach
Example: By October 31, 2007 we will have reduced undocumented and unintentional discrepancies by 75% of baseline on Medical Unit #1.
Describe your first (next) test of change Person Responsible
When to be done
Where to be done
Test a BPMH process and data collection form on the one person within 24 hours of admission
John RN
June 22/07
Med Unit #1
Plan:List the tasks needed to set up this test of change
Person Responsible
When to be done
Where to be done
1. Understand components of a BPMH
2. Write a rough draft steps in a BPMH and select a current form for use
3. Select a Patient and time
4. Conduct a BPMH and use the information to compare with AMO
5. Arrange a huddle with 2 other team members
6. Complete the “testing” worksheet
Mary RN
Jane Team Lead
Susan Unit Manager
Mary RN
Susan Unit Manager
John RN
Today
June 21
June 22
June 22 before 12 noon
June 22 @ 1430
June 22 before 1500h
Here
Med Unit #1
Med Unit #1
Med Unit #1
Conference Rm Med Unit #1
Conference Rm Med Unit #1
Plan (Continued)
Predict what will happen when the test is carried out
Measures to determine if prediction succeeds
1. Guideline and form will be used
2. Guideline and form will need refinements
3. There will be at least 1 medication discrepancy
4. The huddle will identify new change ideas for testing
1. Self Report Y/N
2. Discussed and recorded in huddle
3. Recorded on form
4. Yes/No
Plan
• Planning should provide the following:– Clear description of your next test of change
– List of tasks with who, when and where
– Predictions for what will happen
– Simple measures for the predictions
Completing Test of Change
• Do: Describe what actually happened when you ran the test– The protocol failed to account for poor historians so more collateral
information was required.
• Study: Describe the measured results and how they compared to the predictions– Guideline and form need revisions based on RNs feedback, there were
2 undocumented intentional and 2 unintentional discrepancies. The team leader suggested improvements for the BPMH form
• Act: Describe what modifications to the plan will be made for next time.– The guideline and form will be modified, and another test planned for
June 25th involving 2 RNs and 2 patients on Med Unit #1
Ramping Up Your Cycles• As you move thru cycles increase size of the test
– 1Patient, 1 RN, 1Pharmacist, 1 Physician
– 2 Patients, 2 RNs, 1Pharmacist, 1 Physician
– 5 Patients, 2 RNs, 1Pharmacist, 1 Physician
– 15 Patients, 5 RNs ,1Pharmacist, 2 Physician
– 25 Patients, 10 RNs, 2Pharmacist, 3 Physician
Rapid Cycle Change• Initiation of Rapid Cycle tests is dependent on getting the
first test of change started
• Do Not try to Perfect the change then implement…consider your work a masterpiece in progress
• Failure is a great Opportunity to plan to do better next time…
• Frequency of Testing determines the speed of the process improvement ie daily testing = improvement in weeks; weekly = improvement in 3-4 months
Spread
• The intentional and methodical expansion of the number and type of people, units, or organizations using the improvements. The Theory comes from the literature on Diffusion of Innovation (Everrett Rogers 1995)
• Berwick, Boushon,& Roessner, 2007
Exercise and Commitment
• Commitment to Group
• Groups of 2-3
• Plan for testing a change idea
• Do, Study, Act by next Tuesday….
Exercise and Commitment• Plan 2 tests of change to be completed by Tuesday #2
• Post your results on the QIM community of Practice by Wednesday https://communities.saferhealthcarenow.ca/qim
• Read each other’s PDSA postings and provide feedback.
• Repeat Steps for week #3, Plan 3 tests of change by Tuesday #3
Exercise and Commitment
• If in 3 weeks time you have not successfully run 6 small tests of change what would have prevented this from happening?
Exercise and Commitment
• Monthly Call x 3:– Dec 03/07, January 10/08 and Feb7/08
• 6 month call, May 2008
• I year call December 2008
Acknowledgements• Berwick, D.,Boushon, B., & Roessner, J.(2007). “The Improvement Model,: A
Powerful Engine for Change” IHI Web Based Training at: http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/GausModelforImprovement.htm?TabId=2
• Harris, B. (2007). Change Concepts.
• Murray, M (2006). “Small Steps, Big Changes” workshop.
• Reasear, R. (2007). Institute for Healthcare Improvement “Designing Reliability Into Healthcare Processes: Based on the work of the Institute for Healthcare Improvement Innovation”
