How to Manage PDSAs

1. How to Manage PDSAs Prem Kumar Improvement Advisor-20,000 Days Campaign

2. What VHIU need are more PDSA Cycles Yeah right.

3. Model for Improvement What are we trying to Aim accomplish? How will we know that a Measurement change is an improvement? What change can we make that Develop Change/ Driver Diagram will result in improvement? Act Plan Study Do Improvement Guide, Chapter 1, p.24 Appendix C, p. 454

4. All Improvement requires change, but not all changes result in improvement

7. 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? Act Plan Testing Study Do Improvement Guide, Chapter 1, p.24 Appendix C, p. 454

8. The Plan-Do-Study-Act Cycle Most Important Part of a PDSA cycle Because with out it we don’t have a comparison for the purpose of learning - Improvement Guide, Chapter 5, p. 97

9. Repeated Use of the PDSA Cycle A P S D D S P A A P S D A P S D Changes That Result in Improvement DATA Implementation of Change Wide-Scale Tests of Change Follow-up Tests Hunches Theories Ideas Very Small Scale Test Improvement Guide, Chapter 7, p. 146

10. Primary Driver 1 Change Idea 1 Change Idea 3 Change Idea 2 Primary Driver 3 Change Idea 1 Change Idea 3 Change Idea 2 The work of improvement Primary Driver 2 Change Idea 1 Change Idea 3 Change Idea 2

11. Challenges with Multiple PDSA • A Visual track of each PDSA • Alignment of PDSA to drivers • Timeliness of PDSA • Who is doing the PDSA • How to manage the knowledge generated

12. PDSA Tree Adopt Abandon Adapt PDSA 3 PDSA 1 PDSA 2 Change Idea PDSA 4 PDSA 5

13. Transition of Care PDSA Tree Date: 27/11/2012 Reviewed 27/02/2013 Staff to set a GDD based on the top 10 DRGs-Michele 5/12 Nurse setting the GDD Pt awareness on GDD GDD match with actual Dx date Reason of GDD not met-Ruth& Michele 12/12 Who, How, When? Staff awareness on GDD GDD in MDT meeting Establish GDD & Daily Review Doc to use care plan to review GDD-Ruth/Michele 5/12 Pt awareness on GDD-Surgical To have a standardised process to provide each patient with a GDD How and what is the best way to establish a GDD? # of clinical directors believe in establishing GDD GDD by Doc post acute ward round – Brian 17/12 Check consultant aware of GDD in mind Process Map Janene/Michele 23/1 GDD in ward 33 Janene & Michele 23/1 Is the GDD documented on care plan? GDD mentioned in notes GDD given to surgical pt and any plans documented CAT tool to indentify why Pt waiting CAT tool usefulness Reasons of Pt waiting on Bed Add time of Dx Surgical-17/4 Post ward round delay in services for Pt > 7 days Visual Display of GDD-Surgical Pt less than 48 hour Cultural Support to inform – Maika/Ian 23/12 Patient & Family Nurse to inform Pt- Ruth Sharing GDD DOC to use care plan for updated GDD info Doc reviewing /confirming GDD-Ajay 5/12 Drs To have a standardised process to share GDD Best way to communicate the GDD to patient and interested parties? Update GDD on white board Staff Update GDD on WiMS Other Services E-referral – Erin 5/12 Ascertain ref process in ward 6 PDSA box Timely task referral Dx Checklist Clivena/Helen 10/4 Repeat PDSA Active PDSA Adopt Adapt Abandon What's Happening What ref system are available in service dir. Achieving the GDD Identifying Pt need @ admission in EC 4 pts (Ajay Kumar/ Fionna W) 13/1 Repeat with interventions 10/5 Identifying Pt need @ admission in EC (Ajay Kumar/ Fionna W) Checklist/Process map in notes 17/4 Fionna GDD orientation to HO rotation 17/4 To have the processes in place to achieve the GDD How can we achieve the GDD as a team GDD assigned in EC-Fionna 17/4 Early Dx if Pr referred to NASC earlier Delay in x-fer to AT&R Dx Summary ?? To attend CN meeting Referral system assessment & documentation from acute to AT&R Test the checklist for ref to DN 27/3 Surgical HHC to receive Dx list twice daily Discharge to HHC Known patient dx communication to HHC Owner: Prem Kumar Focus Timeliness Responsibility Direction Meeting Minutes Focused learning Visual display PDSA Feedback Goal Discharge Date Aim: To improve the number of inpatients having GDD from 0% to 100% also To increase the number of inpatients achieving the GDD for from 0% to 100% by July 2013. Prediction: GDD will improve the patient experience and efficiency. Also this will reduce the LoS

16. Failure- a learning opportunity “I missed more that 9,000 shots in my career. I’ve lost almost 300 games. 26 times I’ve been trusted to take the game-winning shot….and missed. I've failed over and over and over again in my life. And that is why... I succeed." Michael Jordon

19. Finding the right socks at right time problem solving Every morning find the right colour socks with in 5 seconds * Right Colour Right Socks * Time to find the socks * The mess created * My satisfaction* * After wash placement time Idea that worked

20. PDSA Simulation

21. Please decide at your table • Who will be: • Time Keeper • Quality Assurance Officer • Data Analyst

22. PDSA Measures Accuracy Time 3 – All pieces on Mr. P & positioned correctly 2 – All pieces on Mr. P, but one or more is out of place 1 – One or more pieces are not on Mr. P. Start: When time keeper says go. Stop: When Assembly indicates last piece is in place AND removes hand.

27. 3 – All pieces on Mr P & positioned correctly 2 – All pieces on Mr P, but one or more is out of place 1 – One or more pieces are not on Mr P.

28. PDSA Tree PDSA 3 PDSA 4 PDSA 5 PDSA 1 PDSA 2 Aim Time Adopt Abandon Adapt

29. We need a volunteer

30. Accuracy • 3 – All pieces on Mr. P & positioned correctly • 2 – All pieces on Mr. P, but one or more is out of place • 1 – One or more pieces are not on Mr. P. • Time • Start: When time keeper says go. • Stop: When Assembly indicates last piece is in place AND removes hand