Model for Improvement Heidi Johns, Quality Leader BCPSQC April, 2013

Session Objectives Apply the framework for the Model for Improvement. Apply the PDSA cycles to your improvement project. Understand how to link PDSA cycles.

Model for Improvement It is a framework that takes a philosophy and helps you to get organized.

Brief History William Edward Deming The components of the theory work together as a guide. If you do not pay attention to the interaction of the components or the effectiveness of the improvement could be compromised.

Deming’s Theory of Profound Knowledge QI Understanding Systems Thinking Understanding Variation Understanding Theory Understanding Human Behaviour (Psychology) The Improvement Guide, 2 nd ed.

Out of the Theory came Model for Improvement - Associates for Process Improvements – Improvement Guide. The model is designed to accelerate improvement.

Knowledge for Improvement Improvement Knowledge Subject Matter or Content Knowledge Improvement The Improvement Guide 2 nd ed. Improvement: Learn to combine subject matter knowledge and improvement knowledge in creative ways to develop effective changes for improvement.

Know your system – map it out Collect data Leadership Form a multidisciplinary team – people in the process Improvement Basics

SMALL TESTS of CHANGE Communicate Spread proven changes/change principles to other areas Never stop learning and improving Improvement Basics cont’d

A structured approach to improvement Scientific Method Sequential Learn by doing Testing Theory, evidence, and action Model for Improvement What it is

A recipe Grand design Unspoken theories, rhetoric, power structures, public opinion or actions isolated from learning Used to perform tasks Model for Improvement What it is not

Three Questions What are you trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?

Three Questions cont’d The questions provide: Direction Focus Context for Continuous Improvement Activities

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 improvement? Act Plan Study Do Thinking Doing The Improvement Guide, 2 nd ed.

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 improvement? Act Plan Study Do AIM

What problem are we trying to solve? What aspect of the status quo is unacceptable? Improvement should be developed with intention.

AIM tips and tricks “Marginal aims can be achieved with marginal change but bold aims require bold change….setting a challenging goal as the aim, the team immediately recognizes that business as usual is not an option.” based on The Improvement Guide What would be a caution about this statement?

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 improvement? Act Plan Study Do AIM Measures The Improvement Guide, 2 nd ed.

Measures What you are expected to accomplish is explicitly stated before you begin anything Provides common base for communication How well does performance match goals

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 improvement? Act Plan StudyDo AIM Measures Test Ideas The Improvement Guide, 2 nd ed.

Testing Developing of ideas Testing of the ideas - Failure is an option Implementation of successful ideas

Change Concepts Build the ideas for the change. A change concept is a general notion or approach found to be useful in developing specific ideas for change that results in an improvement. The Improvement Guide, p 131

Change Concept Change concepts provides the ideas to test Change Concept USE REMINDERS Screen Savers on every computer Signs above sinks in all facilities Hand sanitizers at department entrance Next idea ???

Change Concepts – Activity At your table pick a change concept then create a list of change ideas that you could test? “Using Change concepts will provoke new ways of thinking about how to improve the situation at hand” The Improvement Guide, p 131

P lan D o S tudy A ct Theory that you need to apply Planning is often omitted OR We get stuck in planning Feedback

Improvement Model - PDSA The Improvement Guide, 2 nd ed.

Plan Prediction What to test Data collection

DO Answer a specific question! Theory and a prediction Collect data over time Build knowledge sequentially Include a wide range of conditions in the sequence

Small Scale Test – Do Simulate the change Have subject matter experts review the change Test the idea with volunteers Use 1:1:1 rule use manual “pencil and paper” data collection Use sampling

“Failed” tests expected and important Execution of change Inadequate support processes Theory not useful for conditions No local improvements Data collection

How big of a Cycle?

If you don’t test vQ vQ

Study Ask Questions??????? Evaluate Build knowledge.

Team: ___________PDSA Cycle Worksheet Cycle: ___________ Plan Objective for this cycle: Question(s) we want to answer: Predictions: (What do we expect to happen?) Plan for change or test: (Who, what, when, where) Plan for data collection: (Who, what, when, where) Do How was the test or change carried out? Was there any difference from what was planned? Study Complete analysis of data collected and summarize what was learned. Act Are we ready to continue with this change? Plan for the next cycle.

PDSA Ramp repeated use of the cycle Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Increasing --- complexity number of people different situations Time

Repeated Use of the Cycle Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide Scale Tests of Change Implementation of Change Spread

Multiple Ramps When to use Multiple process change Multiple interventions REMEMBER, this is about improvement not controlled experimentation

PDSA Review All Washed Up

AIM - Results Change Ideas A P S D Evidence & Data AP SD AP SD AP SD

Sources Donald M. Berwick, BMJ, Vol. 312, pdf Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide, A Practical Approach to Enhancing Organizational Performance, San Francisco, CA. Jossey-Bass Publishers. 2009, 2 nd ed.