Experiencing the Model for Improvement Learning Loops Experiencing the Model for Improvement

What did you learn? What did you learn? What surprised you most? What did you learn about measurement? How would you explain a PDSA cycle to a colleague? What have you learnt about yourself? Debriefing What will you do differently next time someone suggests a change?

The Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Nolan’s model--three questions and PDSA, b but not just one PDSA. Difference between this and Juran is the emphasis on repeated PDSA cycles Act Plan Study Do 3

The Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Nolan’s model--three questions and PDSA, b but not just one PDSA. Difference between this and Juran is the emphasis on repeated PDSA cycles Act Plan Study Do 4

The Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Nolan’s model--three questions and PDSA, b but not just one PDSA. Difference between this and Juran is the emphasis on repeated PDSA cycles Act Plan Study Do 5

The PDSA Cycle for Learning & Improvement What will happen if we try something different? What’s next? Four parts of the cycle: Plan: Decide what change you will make, who will do it, and when it will be done. Formulate an hypothesis about what you think will happen when you try the change. What do you expect will happen? Identify data that you can collect (either quantitative or qualitative) that will allow you to evaluate the result of the test. Do: Carry out the change. Study: Make sure that you leave time for reflection about your test. Use the data and the experience of those carrying out the test to discuss what happened. Did you get the results you expected? If not, why not? Did anything unexpected happen during the test? Act: Given what you learned during the test, what will your next test be? Will you make refinements to the change? Abandon it? Keep the change and try it on a larger scale? Did it work? Do It !!! 6

Guidance for Testing a Change Concept A test of change should answer a specific question! A test of change requires a theory and a prediction! Test on a small scale and collect data over time. Build knowledge sequentially with multiple PDSA cycles for each change idea. Include a wide range of conditions in the sequence of tests. Don’t confuse a task with a test! 29 7

Move Quickly to Testing Changes Year Quarter Month Week Day Hour “What tests can we completed by next Tuesday?” “If you think we can test the change in a month, what can you test a day from now?” Assumptions about Time: 2 Orders of Magnitude LESS teams are most effective when they move quickly to testing changes (& maintain momentum) best to first test innovative changes on a small scale okay to test multiple changes at once test under a variety of conditions importance of linking tests of change don’t try to get buy-in or consensus for tests (but will be necessary for implementation) 8

Testing v. Implementation Testing – Trying and adapting existing knowledge on small scale. Learning what works in your system. Implementation – Making this change a part of the day-to-day operation of the system Would the change persist even if its champion were to leave the organization?

Implementation The change is permanent - need to develop all support infrastructure to maintain change High expectation to see improvement (no failures) Increased scope will lead to increased resistance (Value of evidence from successful tests) 19 10

Key Points to Remember! PDSA’s cannot be too small One PDSA will almost always lead to another You can achieve rapid results They help you to be thorough & systematic They help you learn from your work Anyone can use them in any area

The Value of “Failed” Tests “I did not fail one thousand times; I found one thousand ways how not to make a light bulb.” Thomas Edison When asked by a critical journalist how it felt to have failed 1000 times, Edison is said to have replied… The learning point here is that the concept of learning through failure is something of a forgotten concept for people who are educated to such a high standard? 12