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.
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?
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
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
Small-Scale, Rapid PDSA cycle continued Do: Study: Act: • Adopt? • Adapt? • Abandon?
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
Cycles for Testing ChangesPurpose: Cycle 1 - Cycle 2 - Cycle 3 - Cycle 4 - Cycle 4 - Cycle 5 -
Q: What changes can we make that will result in an improvement? A: Improvement Strategies
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
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.
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
Decrease the Time Frame for a PDSA Test Cycle • Years • Quarters • Months • Weeks • Days • Hours • Minutes Drop down two levels to plan test cycle!
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
AIM- Improve Prevention & Treatment of Pressure Ulcers Concept D Concept C Concept B Concept A Change Concepts, Theories, Ideas
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.
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.