Plan, Do, Study Act! Using PDSAs to Move Step by Step to Baby-Friendly

How We Change “If everyone was well-trained” “If we had more funding” “If they had an incentive” “If they had better attitudes” “Let’s develop a perfect strategic plan” “This is what’s happening, and they’ll just have to deal with it.” “Let’s give it time” “We’ll get to that after…” “Some things will never change” “No one’s complaining, so it must be fine”

Structured approach for making incremental change in a system Full cycle for planning, testing and identifying further changes Common-sense tool for bringing about rapid improvement Method to reduce resistance to change Approach to minimizing risk and maximizing learning

Plan Answer the MfI Questions What are we trying to accomplish? (Aim) How will we know that a change is an improvement? (Measures) What change can we make that will result in an improvement? (Change Idea) Plan a PDSA to test your change idea (PDSA Worksheet) What can be done by next Tuesday? Scale Roles

Tips for Identifying Change Ideas Test hunches Test ideas that work elsewhere Analyze current process (i.e. Pre-Work!) The Improvement Guide, pages 361-363 Address customer complaints Use reminders Use affordances Develop contingency plans Smooth workflow

Plan – A Note on “Scale” No Commitment Some Commitment   No Commitment Some Commitment Strong Commitment Low degree of belief that change idea will lead to improvement Cost of failure large Very small-scale test Cost of failure small Small-scale test High degree of belief that change will lead to improvement Large-scale test Implement

Scale DATA Accumulating information, data and knowledge Changes That Result in Improvement A P S D Accumulating information, data and knowledge DATA Implement Change Wide-Scale Tests of Change: All babies delivered by scheduled cesarean the week of March 10 – 14. (1) My first test was informative. I figured out that I could walk some days, but not all and that I needed to adjust my initial plan if I wanted to be successful. This “PDSA RAMP” demonstrates how we need to do a series of tests to get to the change that will result in improvement. (2) Based on the results of my first test I decided to test adjusting my schedule on Wednesdays so that I’m not late to my meeting. That worked well, (3) So I decided to try it for another two weeks and see if I could keep it up for the long term and under different conditions, e.g. – in different weather (4) So I decided to go ahead and implement my plan. I hardwired it by putting in my calendar. Follow-up Tests: All babies delivered by scheduled cesarean on Tuesday, by Doctor A. Hunches Theories Ideas Very Small Scale Test: One health baby born by scheduled cesarean on Monday, with Doctor A.

Do and Study Do: Carry out your test according to plan Study: Reflect on test, asking: Did the change result in improvement? Were there negative consequences? Did we learn anything new? Were our hypothesis confirmed?

Act If yes to “should we revise this change and try again?,” complete another cycle (go back to plan). If yes to “should we keep this same change and scale up?,” complete another cycle (go back to plan). If yes to “should we try a different idea altogether?,” complete another cycle (go back to plan). If yes to “should we implement?,” report results to appropriate personnel and plan implementation.

Create Multiple PDSA Ramps Skin-to-Skin Rooming-In No Routine Supplements

Example: Dr. Ong’s Rounding

Remember: Some Principles of PDSAs Reduce change to manageable, bite-sized, time-limited chunks Not audits – snap shots in time A PDSA cannot be too small!!!!!! It can be too big Small changes can be tested without causing upheaval to the whole system Tell others what you are doing If it doesn’t work, try something different based on your learning Document what did / didn’t work It is important to emphasise that PDSAs cannot be too small but that they can be too large. If looking at a number of records, ensure that this is a manageable amount and that the entire cycle, including the study and the act can be completed over a short period, no longer than a week. A PDSA can be done in a few hours.

Practice

Practice Use a PDSA worksheet Work through the Model for Improvement’s 3 Questions Design a real PDSA that you will use this month

Want to Learn More? The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd ed., by Langley et al. Quality Improvement Through Planned Experimentation, by Moen at al. www.IHI.org Open School On Demand Courses and Presentations

Questions?