Transcript Slide 1

The PDSA Cycle or
How Can We Accelerate Improvements in
HIV Care?
The Quality Academy
Tutorial 13
Learning Objectives: You will learn about…
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Learning Objectives
The importance of
accelerating change
The Plan-Do-Study-Act
(PDSA) Cycle
Concrete examples and
tips how to best apply
the PDSA Cycle
Where to find references
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History Question
In 1601, it was known that
lemon juice prevented the
disease scurvy, a Vitamin C
deficiency. Select the year that
the British Navy adopted this
proven treatment.
A) 1602
B) 1689
C) 1757
D) 1796
Submit
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Why Accelerate Change?
History Question
In 1601, James Lancaster successfully conducted an
experiment to illustrate the effectiveness of lemon
juice to prevent scurvy. When did the British Navy
adopt this treatment?
a)
b)
c)
d)
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1602
1689
1757
1796
Why Accelerate Change?
(195 years later)
Treatment of Scurvy
• Stephen J. Bown - Scurvy: How a
Surgeon, a Mariner, and a
Gentleman Solved the Greatest
Medical Mystery of the Age of
Sail; St. Martin's Press, 2004
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In 1601 lemon juice, as a protective against scurvy, is
recorded by James Lancaster
In 1612, Woodall recommended citrus fruit for protection
against scurvy on sea voyages
In 1753 James Lind published A Treatise on the Scurvy
which portrays his experiment on-board the ship Salisbury
in 1747
From 1772 to 1775 sailors on historic voyages with Captain
James Cook remained free from scurvy
In 1796 lemon juice was officially introduced in the British
Navy as a prophylactic against scurvy
In 1865 British Board of Trade adopted the policy for the
merchant marine
Why Accelerate Change?
History Question
How long did the NIH take
to recommend the treatment
of ulcers as suggested by
Marshall in his 1984 Lancet
Article?
A) 2 years
B) 5 years
C) 10 years
D) 20 years
Submit
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Why Accelerate Change?
History Question
How long did the NIH take to recommend the
treatment of ulcer as suggested by Dr. Marshall in his
1984 Lancet Article?
a)
b)
c)
d)
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Why Accelerate Change?
2 years
5 years
10 years
20 years
Treatment of Ulcer – Dr. Marshall
Timetable:
1979: Dr. Robin Warren, pathologist at Royal
Perth Hospital, Australia found bacteria in
stomach of patients
1981: Dr. Barry Marshall starts residency
1982: Marshall cultivates bacteria: Helicobacter
pylori, 100% in Duodenal Ulcer and 77% in
Gastric Ulcer
1984: first publication in Lancet; presents
treatment of ulcer with common antibioticum
1994: National Institute of Health recommends
treatment of ulcer as suggested by Dr. Marshall
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Why Accelerate Change?
History Question
In an article in the Journal of
Quality Improvement 92
quality improvement projects
were compared. What was
the timeframe from problem
identification to completion
of first pilot?
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Why Accelerate Change?
A) 23 days
B) 50 days
C) 397 days
D) 504 days
Submit
History Question
In a recent article in the Journal of Quality Improvement
92 quality improvement projects were compared. What
was the timeframe from problem identification to
completion of first pilot?
a)
b)
c)
d)
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Why Accelerate Change?
23 days
60 days
397 days
504 days
Survey of 92 Quality Improvement Projects in
Journal of Quality Improvement
• Alemi F, Safaie F, Neuhauser D. “A
Survey of 92 Quality Improvement
Projects.” Journal of Quality Improvement
2001, 27(11): 619-632
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Why Accelerate Change?
504 days from problem identification to
completion of first pilot
397 days from first team meeting to the end of
first cycle
75 days to describe current situation in flowchart
62 days for data collection if change was
improvement
Key Question:
How can we accelerate change and
improvements in HIV programs?
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Why Accelerate Change?
Why Test?
• Increase your confidence that the change will result
in improvement in your organization
• Learn how to adapt the change to conditions in the
local environment
• Minimize resistance when you move to
implementation
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The PDSA Cycle
Model for Improvement
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The PDSA Cycle
The PDSA Cycle
for Learning and Improvement
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The PDSA Cycle
Plan
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2.
Clarify your Objective
Make a prediction
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3.
What is to be done
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The PDSA Cycle
Formulate theory
Objective + specificity
Who
What
Where
When
How
Plan: a New Adherence Screening Tool
• Objective: how can we screen HIV patients for issues that
might affect their ability to adhere to their medication
regimen, in a way that won’t disrupt patient flow?
• Prediction: adding a screening tool will add time to the patient
visit, but we can keep this to a minimum
• Steps: Joanne and Sally researched and identified possible
tools that were reviewed by Sally and Dr. Smith. They
selected one tool for Dr. Smith to use with at least three
patients in the clinic on Thursday
• Necessary tasks: 1. Identify tool. 2. Copy tool and place in
patients' charts. 3. Dr. Smith reviews instructions for using
tool. 4. Explain tool to patient. 5. Use tool
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The PDSA Cycle
Do
1. Carry out the plan
2. Document your
observations
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Expected
Unexpected
3. Begin analysis
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The PDSA Cycle
Do: What Happened?
• Tool was used on one
patient
• Administration took 5 pages
• Added 35 minutes to
documentation
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The PDSA Cycle
Study
Complete
Compare
Summarize
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The PDSA Cycle
Study: Our Results (vs. Our Prediction)
• Theory still holds
• Need to test more tools
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The PDSA Cycle
Act
1.
Adjustments
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2.
New cycles
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The PDSA Cycle
Changes to previous test?
What adjustments?
Expand last cycle?
What are you planning?
What are you going to test?
Act: What Will We Do (Based on What We Learned)?
We will test two different
tools, each with three
patients, by next Wednesday.
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The PDSA Cycle
The PDSA Cycle
for Learning and Improvement
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The PDSA Cycle
Method for Change
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The PDSA Cycle
How Do Tests Lead to Improvements?
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Applying PDSA
Start Small and Do More
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Applying PDSA
At the Beginning, Test on a Small Scale
• “What change could you
implement by next
Tuesday?”
• Use the “Rule of 1”:
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Applying PDSA
1 facility
1 office
1 provider
1 patient
Scale Down the Time Frame
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Years
Quarters
Months
Weeks
Days
Hours
Minutes
Applying PDSA
Drop down two
levels! (years to
months, weeks
to hours)
Keep the First Tests Simple
• Volunteers at first
• Useful, not perfect, data
• Use “huddles” to report
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Applying PDSA
Build Each Cycle on Its Predecessor
“The shorter the timeframes between test cycles,
the more tests can be conducted and therefore,
more opportunities for learning will emerge.”
HIVQUAL Workbook
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Applying PDSA
Key Points
The PDSA Cycle:
• Helps “test your hunches”
• Adapt these changes to your own
environment.
• Start small
• Lead to more complex cycles
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Key Points
Resources
• http://www.IHI.org/IHI/Improvement/ ImprovementMethods
provides information on improvement methods, strategies, and changes.
• Moen, Ronald, Thomas Nolan; “Process Improvement” Quality Progress,
1987, p62.
• Langley, Gerald, Kevin Nolan and Thomas Nolan; “The Foundation of
Improvement,” Quality Progress, June 1994, p. 81.
• Langley, Gerald, Kevin Nolan, Thomas Nolan, Cliff Norman, and Lloyd
Provost; The Improvement Guide. San Francisco, CA; Jossey-Bass, 1996.
• Nolan, Kevin; “ASQs Accelerating Change Collaborative Series: A
Challenge for Industry,” Quality Progress, Jan 1999, p55.
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Resources
Test Question
Which of these would be a good first PDSA Cycle?
A) Test a new appointment system in the HIV
clinic for two weeks.
B) Test a new method for reading PPDs with all
the patients who show up for readings from 10-11
am on Wednesday.
C) Ask all providers to spend more time
counseling patients on adherence, and check in at
the next staff meeting on how it went.
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Test Question
Test Question
What data should you collect on your test of a new way of
reading PPDs?
A) How long the client had to wait
B) Whether the client complained about waiting
C) Whether the staff felt the new method worked
well
D) All of the above
E) It depends on your hypothesis
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Test Question
Test Question
Your group found that changing the PPD reading method cut
wait time in half. What would be a good “second cycle” PDSA?
A) Implement it fully
B) Try it for a full week
C) Try the method with other follow-up services
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Test Question
Please Rate This Tutorial By Indicating How Your
Response To The Following Statements.
Was this Tutorial helpful to you?
Did this Tutorial meet your expectations and
goals?
Was the Tutorial clearly organized and easy to
use?
Would you recommend this Tutorial to
colleagues of yours?
Submit
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Evaluation
Related Tutorials
• To learn more about
the Model for
Improvement, study
Tutorial 12
• To learn more about
how to set up quality
team for success, study
Tutorial 11
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Related Tutorials
The Quality Academy
For further information, contact:
National Quality Center
New York State Dept. of Health
90 Church Street, 13th floor
New York, NY 10007-2919
Work: 212.417.4730
Fax: 212.417.4684
Email: [email protected]
Or visit us online at
NationalQualityCenter.org
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In Closing