August 21 st track one virtual meeting
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August 21 st Track One Virtual Meeting. Sue Gullo, Director Jane Taylor, Improvement Advisor. Prepared and Presented by Institute for Healthcare Improvement Faculty. Session Objectives. Objectives: Describe in-depth the Lens of Profound Knowledge Identify change concepts

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August 21 st Track One Virtual Meeting

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August 21 st track one virtual meeting

August 21st Track One Virtual Meeting

Sue Gullo, Director

Jane Taylor, Improvement Advisor

Prepared and Presented by

Institute for Healthcare Improvement Faculty


Session objectives

Session Objectives

Objectives:

  • Describe in-depth the Lens of Profound Knowledge

  • Identify change concepts

  • Develop a plan for testing changes

  • Discuss change concepts and testing in the context of Falls and HAPU’s

  • Use the Lens of Profound Knowledge to identify what is working and what needs improvement from a system perspective

  • Work with faculty to develop organizational PDSA’s

2


For real change to be designed

For real change to be designed..

  • Complete Pre-work- Open School Modules and Video “Building Skills in Data Collection and Understanding Variation”

    • QI 102 Lesson 4:Developing Changes

    • QI 102 Lesson 5: Testing Changes

  • Print plenary session slides- we will refer to them during our track.

  • Have data on hand that relates to Immobility- HAPU and Falls specifically.

  • Improvement Fellows-bring a Clinical Buddy to the sessions. This would be a person who you can partner with from a clinical unit to test, collect and post data, and drive change.

  • Have handouts printed and ready to use

  • Be ready to change your world!

  • Homework will be described at the end of the session and it will be in collaboration with a clinical buddy you have identified.


A model for learning and change

A Model for Learning and Change

Source: Langley, J. et al, The Improvement Guide, Jossey-Bass Publishers, 2nd edition, 2009


Change concepts

Change Concepts

The Improvement Guide contains an Appendix (Appendix A: A Resource Guide to Change Concepts) that describes in detail how 72 change concepts can be used to create ideas for testing.


Useful ways to develop changes os

Useful Ways to Develop Changes- OS

Critical thinking about the current system1 Sometimes, simply reflecting on problems within a system can generate some good ideas for change. If you make a flow chart of your current process, it may be possible to identify parts of the system that aren’t working or are needlessly complex. Another way to go about critical thinking is to gather and analyze data on the way your system currently works—for example, how you are communicating with people about the meeting—which can then help you identify problems and develop changes to address them. Benchmarking Comparing your own process to “best practice” can help you identify where your own system falls short.

Take the patient’s perspectiveWhen you see the care system from a patient’s perspective, you’ll see opportunities for improvement that might not be apparent as a caregiver. Is it too loud when you’re trying to sleep? Do bright lights give you a headache? Do you have to wait too long to get your test results? Patient shadowing and interviewing are useful techniques when coming up with good ideas to change.


Useful ways to develop changes os1

Useful Ways to Develop Changes- OS

Creative thinking1Where do new ideas come from? You can spark creative thinking in various ways, including simply taking the time to do this sort of thinking; exposing yourself to situations (such as taking the role of a patient) that can spark new ideas; identifying the boundaries that limit the changes you can make and then finding ways to dismantle those boundaries; and temporarily considering unrealistic goals that can prompt you to break out of your old way of thinking.

Using Change Concepts


Using change concepts to come up with ideas os

Using Change Concepts to Come Up with Ideas-OS

  • A change concept is 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 combining these change concepts with knowledge about specific subjects can help generate ideas for tests of change.

  • After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to test a change or group of changes on a small scale to see if they result in improvement. If they do, expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely.


Guidance for testing a change concept

Guidance for Testing a Change Concept

  • A test of change should answer a specific question!

  • A test of change requires a theoryand aprediction!

  • Test on a small scale and collect data over time.

  • Build knowledge sequentiallywith multiple PDSA

    cycles for each change idea.

  • Include a wide range of conditions in the sequence of tests.

  • Don’t confuse a taskwith atest!


To be considered a real test

To Be Considered a Real Test

Test was planned, including a plan for collecting data

Plan was carried out and data were collected

Time was set aside to analyze data and study the results

Action was based on what was learned


The pdsa cycle for learning and improvement

What will happen if we try something different?

What’s next?

The PDSA Cycle For Learning And Improvement

Did it work?

Let’s try it!


Linking pdsa cycles tips for doing it right

Linking PDSA Cycles - Tips for Doing It Right

  • Linking small tests of change helps ensure buy-in from all the people involved. Think AheadYou already know you’ll want to do multiple tests. So make your life easier by planning for it. Think a couple of cycles ahead, testing over a wide range of conditions and collecting useful data from each test to guide the next one. Start Small Keep it simple at the beginning. Scale down the size of the test (for instance, start with just a few patients in one location). Test with volunteers and don’t try to get consensus from everyone in the organization before starting. Get StartedDon’t wait around! Ask, “What change can we test by next Tuesday?”


Repeated use of the pdsa cycle for testing

Model for Improvement

What are we trying to

accomplish?

How will we know thata

change is an improvement?

What change can we make that

will result in improvement?

Repeated Use of the PDSA Cycle for Testing

Changes That Result in Improvement

Spreading

DATA

Sustaining the gains

Implementation of Change

Wide-Scale Tests of Change

Hunches Theories Ideas

Follow-up Tests

Sequential building of knowledge under a wide range of conditions

Very Small Scale Test


Pdsa tests falls

PDSA Tests- Falls


Appropriate scope for next pdsa cycle

Appropriate Scope for next PDSA Cycle


Repeated use of the pdsa cycle for testing falls

Model for Improvement

What are we trying to

accomplish?

How will we know thata

change is an improvement?

What change can we make that

will result in improvement?

Repeated Use of the PDSA Cycle for Testing- Falls

Changes That Result in Improvement

Spreading

DATA

Sustaining the gains

Implementation of Change

Wide-Scale Tests of Change

Hunches Theories Ideas

Follow-up Tests

Sequential building of knowledge under a wide range of conditions

Very Small Scale Test


Pdsa tests hapu

PDSA Tests- HAPU


Appropriate scope for next pdsa cycle1

Appropriate Scope for next PDSA Cycle


Repeated use of the pdsa cycle for testing hapu

Model for Improvement

What are we trying to

accomplish?

How will we know thata

change is an improvement?

What change can we make that

will result in improvement?

Repeated Use of the PDSA Cycle for Testing- HAPU

Changes That Result in Improvement

Spreading

DATA

Sustaining the gains

Implementation of Change

Wide-Scale Tests of Change

Hunches Theories Ideas

Follow-up Tests

Sequential building of knowledge under a wide range of conditions

Very Small Scale Test


Failed test now what

Failed Test…Now What?

  • Be sure to distinguish the reason:

    • Change was not executed

    • Change was executed, but not effective

  • If the prediction was wrong – not a failure!

    • Change was executed but did not result in improvement

    • Local improvement did not impact the secondary driver or outcome

    • In either case, we’ve improved our understanding of the system!


Worksheet aim statement

Worksheet- AIM Statement


Exercise aim statement

Exercise: Aim Statement

  • Our focus will be on Pressure Ulcers and Falls.

  • So, take a few minutes and evaluate your current Aim Statements. Review them for clarity, performance expectations, and completion date.

  • If you have started work on a new HAC or are revising your work plan, take this opportunity to create new Aim Statements or modify existing ones.

  • Use the Aim Statement Worksheet to create or revisit your an Aim Statement.


Aim statement worksheet

Aim Statement Worksheet

HAC name:

Aim statement

(What’s the problem? Why is it important? What are we going to do about it?)

How good?

By when?


Exercise plan your first next pdsa

ExercisePlan Your First (next) PDSA

  • Use your Aim Statement, Driver Diagram, Measurement Plan Worksheet and your Developing Ideas for Change Worksheet as reference materials for this exercise.

  • Select one idea from your Developing Ideas for Change Worksheet as an initial test of change.

  • Complete the Plan section of the PDSA Worksheet

  • Get feedback on your work from others at your table and be prepared to report your plan to the class.


Pdsa worksheet

PDSA Worksheet

  • Use this to document individual tests.

  • Remember: It’s not a test if you don’t actually change some aspect of the process!


The lens of profound knowledge

The Lens of Profound Knowledge

Appreciation

of a system

“The system of profound knowledge provides a lens. It provides a new map of theory by which to understand and optimize our organizations.”

(Deming, Out of the Crisis)

It provides an opportunity for dialogue and learning!

Theory

of

Knowledge

QI

Human Behavior

Understanding

Variation

Aim or Values


August 21 st track one virtual meeting

What insights might be obtained by looking through the Lens of Profound Knowledge?

  • Appreciation for a System

  • Interdependence, dynamism

  • World is not deterministic

  • Optimization, interactions

  • System must have an aim

  • Whole is greater than sum of the parts

  • Human Behavior

  • Interaction between people

  • Intrinsic motivation, movement

  • Beliefs, assumptions

  • Will to change

  • Theory of Knowledge

  • Prediction

  • Learning from theory, experience

  • Operational definitions

  • PDSA for learning and improvement

  • Understanding Variation

  • Variation is to be expected

  • Common or special causes

  • Ranking, tampering

  • Potential mistakes


Profound knowledge worksheet

Profound Knowledge Worksheet


Prep for september 11th

Prep for September 11th

  • What process measures tell you where you need to go?


August 21 st track one virtual meeting

Implementation Checklist

(Source: Langley, J. et. al. The Improvement Guide, page 136)


Collect daily process measures on a run chart

Collect daily process measures on a run chart

  • Quality Buddy and Clinical Buddy meet daily to plot and discuss the data.

  • Process measures

    • Percentage of patients assessed on admission (locally defined)

      • Your choice- falls or pressure ulcers

    • Percentage of patients at risk re-assessed daily

      • Continue on your pressure ulcer or fall choice above


For september 11th

For September 11th

  • Participants are expected to complete the following IHI Open School Modules prior to the September 11th session:

  • QI 103 Lesson 1: Measurement Fundamentals

  • QI 103 Lesson 2: Displaying Data


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