PI Model Mike Davies, MD FACP

“Improving our work IS our work, not a distraction from work!” “All teach all learn” “Healthcare is a team sport”

Discussion Think of a “big change” that was not implemented very well…. What Went Wrong?

Why change strategies often don’t work Lots of planning then lots of implementing Analysis paralysis Lack of consensus on problem and solution Risky change process

Why change strategies often don’t work Pushing one solution/idea One person’s perspective How do we know it works? Lack of agreement Ignores all of the context/circumstances

Improvement Involves “Experimentation” Setting aims/goals Generating ideas Testing Measuring progress Reflection

Lots of activity doesn’t necessarily mean lots of improvement! Focus changes on aims and goals Are the changes we’re making really an improvement (according to the aims and goals)? Avoid the “my idea” trap Take the emotion out – Measure! -“It is not enough to be busy, so are the ants. The question is, what are you so busy about?” Thoreau

3 Questions 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

A Model for Improvement What is our aim? How will we know a change is an improvement? What changes can we make to make an improvement? Plan the test: the experiment Act differently the next time ACT PLAN STUDY DO Execute it Assess the results Langley, Nolan, et.al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass. San Francisco, CA. 1996

The ‘unofficial version’! Hunch What could be happening here? Test Let’s try something different Reflect How did it work? Change Should we keep doing it? From Sarah Frasier

Review

“Kinds” of Data Judgment Improvement Research Performance appraisal “do something TO you” Improvement Process improvement efforts “do something WITH you”

Repeated Use of the PDSA Cycle Changes That Result in Improvement Repeated Use of the PDSA Cycle A P S D 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? Model for Improvement DATA D S P A Implementation of Change A P S D Wide-Scale Tests of Change A P S D Review Follow-up Tests Hunches Theories Ideas Very Small Scale Test

PDSA Cycles Are Not Plans! Are small in scale Thinking months – think weeks; thinking weeks – think days; thinking days – think hours Thinking facility – think unit; thinking unit – think teams; thinking teams, think ONE team Thinking all patients – think a type of patient; thinking a type of patient, think a sample; thinking sample then 3-5 may be enough

Exercise AIM- find the rule underlying a series of numbers Measure - feedback from the instructor Changes - are new ideas suggested by the team

PDSA Test Results

Repeat PDSA Changes Hunch Theory Idea DATA Implementation Wider Tests Follow-up Tests S A Small Scale Test

How to Implement a Change High Successful Change Belief that change will result in improvement Still Needs Further Testing Unsuccessful Change Low Developing Testing Implementing From Lloyd Provost

P A D S P A P D A S P A D P S A P D A S D S D P S A A P P A D S S A D P S A P D A S S A A P Balance Demand And Supply S A Decrease Appt. Types Decrease Demand

Readiness for Change From Lloyd Provost

Review

Successful PDSA Think multiple tests over wide range of conditions Think a couple of PDSA’s ahead Scale down the size Learn from the last experience

3 Questions 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

Change Thinking It is NECESSARY to be successful So….. get started! It may not be SUFFICIENT to be successful only a few times So……keep going! Build up data, experience and evidence over time! This is true learning!

Summary Keep focused on Aim – Measure – Change Changes are “small experiments” Experiment wisely – PSDA Learn from small changes over wide conditions before implementing widely Get started and keep going