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Accelerating Improvement PDSA Cycles to Test, Adapt, and Implement Innovations Donna M. Daniel, PhD Learning Session 1, October 21, 2003 Prepared with assistance from Lloyd Provost, Associates in Process Improvement and the Institute for Healthcare Improvement. Act Plan Study Do

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Accelerating ImprovementPDSA Cycles to Test, Adapt,

and Implement Innovations

Donna M. Daniel, PhD

Learning Session 1, October 21, 2003

Prepared with assistance from Lloyd Provost, Associates in Process Improvement and the Institute for Healthcare Improvement.


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Act

Plan

Study

Do

Model for Improvement

What are we trying to

accomplish?

How will we know that a

change is an improvement?

What change can we make that

will result in improvement?


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The PDSA Cycle for Learning and Improvement

Act

Plan

  • Objective

  • Questions and

  • predictions (why)

  • Plan to carry out

  • the cycle (who, what, where, when)

  • What changes are to be made?

  • Next cycle?

Study

Do

  • Complete the

  • analysis of the data

    • Compare data to

  • predictions

    • Summarize what

    • was learned

  • Carry out the plan

  • Document problems

  • and unexpected

  • observations

  • Begin analysis

  • of the data


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Purpose:

Increase protein in residents’ diet

Plan:

Add protein powder to all dessert recipes

To Do:

Collect data

Educate staff

Experiment with recipes

Purchase protein powder

Small-Scale, Rapid PDSA Cycle


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Small-Scale, Rapid PDSA cycle continued

Do:

Study:

Act:

  • Adopt?

  • Adapt?

  • Abandon?


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A

P

S

D

D

S

P

A

A

P

S

D

A

P

S

D

Repeated Use of the Cycle

Changes That Result in Improvement

DATA

Spread

Implementation of Change

Wide Scale Tests of Change

Hunches Theories Ideas

Follow-up Tests

Very Small Scale Test


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Cycles for Testing ChangesPurpose:

Cycle 1 -

Cycle 2 -

Cycle 3 -

Cycle 4 -

Cycle 4 -

Cycle 5 -


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Q: What changes can we make that will result in an improvement?

A: Improvement Strategies


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Why Test?

  • To answer questions…

    • Will change result in improvement?

    • How much improvement?

    • Need to adapt the change?

    • Any costs and/or side-effects?

  • Other reasons…

    • Opportunity for “failures”

    • Minimizes resistanceupon implementation


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Why not start with implementation?

  • The change is permanent - need to develop all support processes to maintain change.

  • High expectation to see improvement (no failures).

  • Increased scope will lead to increased resistance.

  • Generally takes more time than tests.


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Successful Cycles to Test and Adapt Changes

  • Scale down size of test (# of residents, location)

  • Conduct multiple cycles to test & adapt change

  • Test with volunteers

  • Do not try to get buy-in, consensus, etc.

  • Be innovative to make test feasible

  • Collect useful data during each test

  • Test over a wide range of conditions


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Decrease the Time Frame for a PDSA Test Cycle

  • Years

  • Quarters

  • Months

  • Weeks

  • Days

  • Hours

  • Minutes

Drop down two levels to plan test cycle!


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P

P

P

P

P

P

A

A

A

A

A

A

D

D

D

D

D

D

S

S

S

S

S

S

S

S

S

S

S

S

D

D

D

D

D

D

A

A

A

A

A

A

P

P

P

P

P

P

A

A

A

A

A

A

P

P

P

P

P

P

S

S

S

S

S

S

D

D

D

D

D

D

P

P

P

P

P

P

A

A

A

A

A

A

D

D

D

D

D

D

S

S

S

S

S

S

Overall Aim: Implement the Prevention & Treatment Model at Your Nursing Home

Assessment & Monitoring

Organizational Commitment

Prevention Strategies

Treatment Interventions

Community

Develop Strategies for Each Component of the Model


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  • AIM- Improve Prevention & Treatment of Pressure Ulcers

Concept D

Concept C

Concept B

Concept A

Change Concepts, Theories, Ideas


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Act

Plan

Study

Do

Improving by NEXT Tuesday!

Willing to compromise on

  • scope,

  • size,

  • rigor, and

  • sophistication, but the cycle should include one resident and must be completed by Tuesday.

Report cycle on e-mail list by October 28th, 2003.


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The Power of One…


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References

  • The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. G. Langley, K. Nolan, T. Nolan, C. Norman, L. Provost. Jossey-Bass Publishers., San Francisco, 1996, Chapter 6.

  • Quality Improvement Through Planned Experimentation. 2nd edition R. Moen, T. Nolan, L. Provost, McGraw-Hill, NY, 1998.

  • “Accelerating the Pace of Improvement - An Interview with Thomas Nolan,” Journal of Quality Improvement, Volume 23, No. 4, The Joint Commission, April, 1997.

  • “Understanding Variation”, Quality Progress, Vol. 13, No. 5, T. W. Nolan and L. P. Provost, May, 1990.


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