How Do I Do?

1. How Do I Do? PDSA Cycles Accelerating Change Dannie Currie, RN, MN, DHSA Safety Improvement Advisor Atlantic Node Safer Healthcare Now!

2. Overview • Change Concepts • PDSA • Example • Exercise and Commitment

3. Change • Control • Over • Personal • Experiences

4. 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

5. Change Concepts Aim: Assure customers do not leave bank cards behind

6. Change Concepts Idea: Beeping sound Concept: Use reminders Aim: Assure customers do not leave bank cards behind Idea: Beeping sound

7. Voice reminders Siren Electric shock Concept: Use reminders Idea: Beeping sound Aim: Assure customers do not leave bank cards behind Based on Edward DeBono’s Concept Fan Change Concepts

8. Changes While 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

9. 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

10. A A A A P P P P S S S S D D D D PDSAs Moving From Testing to Implementing Changes Result in Improvement Learning From Data Implementation of Change Wide Scale tests of change Follow up tests Change Ideas Very Small test

11. 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

12. Rapid Cycle Testing AIM: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.

13. Plan:

14. Plan (Continued)

15. 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

16. 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

17. 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

18. 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

19. 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

20. Exercise and Commitment • Commitment to Group • Groups of 2-3 • Plan for testing a change idea • Do, Study, Act by next Tuesday….

21. 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

22. 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?

23. 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

24. 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”

25. Contacts Dannie.Currie@cdha.nshealth.ca 1- 902- 577- 1485 Theresa.Fillatre@cdha.nshealth.ca 1-902-221-4719 Karin.Walsh@cdha.nshealth.ca 1-902-473-7995