The Improvement Model and PDSAs

Aims of this session

• To understand the Model for Improvement and the PDSA Cycle • To understand the purpose and application of The Model to Improve Healthcare Systems and Processes

Changing systems

• Change is difficult and can be threatening • Change can be time-consuming • Change involves understanding people, systems and processes • Healthcare systems are often complex and fragmented

Why change?

Because: ‘If you always do what you have always done, you will always get what you have always got!’

How it has been done so far…

What is the best way to approach change that results in improvement?

Trial & Error? Detailed prior study Chaos Paralysis Too much action, not enough thinking Too much thinking, not enough action ‘Something must be done, this is something, therefore we must do it…’ ‘We can’t do anything until we know exactly what to do…’ ‘Trial and Learning’ Approach

‘Trial and Learning’

• • • • •

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Setting challenging aims

is it worth doing? Not ‘change for change sake’

Identifying principles/change ideas

- what has worked for someone? What might work for us?

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Measuring progress

knowing what’s happening

Testing changes

- starting small; reducing risk

Implementing and sustaining change

- change in systems and routines; developing skills and abilities

Defining the problem

Always speak to someone different Didn’t specify what I wanted properly Getting Information Set impossible timescales Am I dealing with really urgent work?

Other deadlines Didn’t check often enough Not got an accurate brief Haven’t planned time available well Not sharing workload Didn’t give manager enough time Waiting for line Manager’s approval

The fundamental improvement questions

• What are we trying to achieve?

– Know exactly what you are trying to do – have clear aims and objectives • How will we know that change is an improvement?

– Measuring processes and outcomes • What changes can we make that will result in an improvement?

– What have others done? What hunches do we have? What can we learn as we go along?

What is a PDSA?

• A simple tool for staff to use test out ideas that will improve healthcare systems and processes • A structured approach for making small incremental changes to systems • A full cycle for planning, implementing, testing and identifying further changes

Plan, Do, Study, Act

What changes are we going to make based on our findings?

Act Plan

What exactly are we going to do?

What were the results?

Study Do

When and how did we do it?

Why use PDSAs?

• The PDSA Cycle was developed for use in healthcare systems by the Institute for Healthcare Improvement based in the USA. It has been widely used to deliver improvements in healthcare systems throughout Europe and the USA • It is small in scope and builds incrementally – small rapid cycles lead to improvement • It is highly effective, changes are quick and immediately evident • It is a powerful tool for learning. As much is learned from ideas that don't work as from those that do

The PDSA Cycle

• You need to take time to consider the following prior to undertaking your first PDSA: • What are you trying to accomplish?

• How will you know that a change is an improvement?

The PDSA Cycle

• What changes can you make that will result in improvement?

• Remember, not all changes will result in an improvement. It is essential that learning from what did work as well as what didn’t work is captured before undertaking your next PDSA.

Plan

• This stage involves • Identify the changes • Set objectives • Make predictions • Plan how to measure outcomes • Define roles and responsibilities

Do

• •

This is the stage where the plan is put into action. Remember to keep it small and manageable, i.e. one patient, one doctor, one nurse, one day.

Study

• • • •

Review the cycle Reflect with all relevant stakeholders Analyse data collected Generate ideas for improvements prior to re-testing

Act

• •

The cycle should be tested again unchanged under different conditions Alternatively, you may decide to amend your plan to reflect learning from first cycle and re-test

The principles of PDSAs

• Breaks down change into manageable, bite sized time-limited chunks • A PDSA cannot be too small!!!!!!

• Small changes can be tested without causing upheaval to the whole system • If it doesn’t work, try something different based on your learning

Repeated use of the PDSA cycle

Implementing new procedures & systems - sustaining change Testing and refining ideas Bright idea!

Your turn!

Develop your own PDSA cycle in relation to a small part of your working life you would like to change

Summary

• PDSAs are an efficient, user-friendly way to approach changes to systems • PDSAs ensure that you are measuring the effects of small changes • PDSAs break change down into a series of bite-sized manageable chunks • PDSAs offer confidence to those who are afraid of change

Questions?