1. Improvement Advisor-20,000 Days Campaign
How to Manage PDSAs
Prem Kumar
Improvement Advisor-20,000 Days Campaign

2. What VHIU need are more PDSA Cycles
Yeah right.

3. Act Plan Study Do Model for Improvement What are we trying to
Aim
accomplish?
How will we know that a
Measurement
change is an improvement?
What change can we make that
Develop Change/
Driver Diagram
will result in improvement?
Act
Plan
Study Do
Improvement Guide, Chapter 1, p.24
Appendix C, p. 454

4. All Improvement requires change, but not all changes
result in improvement

7. 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?
Act
Plan
Testing
Study Do
Improvement Guide, Chapter 1, p.24
Appendix C, p. 454

8. The Plan-Do-Study-Act Cycle
Most Important Part of a PDSA cycle
Because with out it we don’t have a comparison for the purpose of learning -
Improvement Guide, Chapter 5, p. 97 8

9. Repeated Use of the PDSA Cycle
Changes That Result in Improvement A P S D
DATA D S P A
Implementation of Change A P S D
Wide-Scale Tests of Change A P S D
Follow-up Tests
Hunches Theories Ideas
Very Small Scale Test
Improvement Guide, Chapter 7, p. 146 9

10. The work of improvement
Primary Driver 2
Change Idea 1
Change Idea 2
Change Idea 3
Primary Driver 1
Change Idea 1
Change Idea 2
Change Idea 3
Primary Driver 3
Change Idea 1
Change Idea 2
Change Idea 3

11. Challenges with Multiple PDSA
A Visual track of each PDSA
Alignment of PDSA to drivers
Timeliness of PDSA
Who is doing the PDSA
How to manage the knowledge generated

12. PDSA Tree Adopt Abandon Adapt PDSA 1 PDSA 2 PDSA 3 PDSA 4 PDSA 5
Change
Idea
PDSA 4
PDSA 5

13. Establish GDD & Daily Review
Transition of Care
PDSA Tree
Date: 27/11/2012
Reviewed 27/02/2013
Pt awareness on GDD
Staff awareness on GDD
Check consultant aware of GDD in mind
Doc to use care plan to review GDD-Ruth/Michele 5/12
Is the GDD documented on care plan?
GDD mentioned in notes
# of clinical directors believe in establishing GDD
GDD given to surgical pt and any plans documented
Pt awareness on GDD-Surgical
Patient & Family
Drs
Staff
Other
Services
Update GDD on white board
Update GDD on WiMS
DOC to use care plan for updated GDD info
Nurse to inform Pt-
Ruth
Ascertain ref process in ward 6
Delay in x-fer to AT&R
Referral system assessment & documentation from acute to AT&R
Early Dx if Pr referred to NASC earlier
E-referral – Erin 5/12
Timely task referral
GDD in MDT meeting
Nurse setting the GDD
GDD match with actual Dx date
Reasons of Pt waiting on Bed
CAT tool to indentify why Pt waiting
CAT tool usefulness
Post ward round delay in services for Pt > 7 days
Pt less than 48 hour
Repeat PDSA
Active PDSA
Adopt
Adapt
Abandon
What's
Happening
PDSA box
Identifying Pt admission in EC
(Ajay Kumar/ Fionna W)
Staff to set a GDD based on the top 10 DRGs-Michele 5/12
GDD by Doc post acute ward round – Brian 17/12
Reason of GDD not met-Ruth& Michele 12/12
Cultural Support to inform – Maika/Ian 23/12
Doc reviewing /confirming GDD-Ajay 5/12
What ref system are available in service dir.
Identifying Pt admission in EC 4 pts
(Ajay Kumar/ Fionna W) 13/1
GDD in ward 33
Janene & Michele 23/1
Discharge to HHC
Process Map
Janene/Michele 23/1
Known patient dx communication to HHC
Owner: Prem Kumar
HHC to receive Dx list twice daily
Repeat with interventions
10/5
Dx Checklist
Clivena/Helen
10/4
Visual Display of GDD-Surgical
Test the checklist for ref to DN 27/3 Surgical
Add time of Dx
Surgical-17/4
To attend CN meeting
Dx Summary ??
GDD orientation to HO rotation
17/4
Checklist/Process map in notes 17/4
Fionna
GDD assigned in EC-Fionna
Establish GDD & Daily Review
To have a standardised
process to provide each
patient with a GDD
How and what is the best
way to establish a GDD?
process to share GDD
Best way to communicate the GDD to patient and interested parties?
Achieving the GDD
To have the processes in place to achieve the GDD
How can we achieve the GDD as a team
Sharing GDD
Who, How, When?
Focus
Timeliness
Responsibility
Direction
Meeting Minutes
Focused learning
Visual display
PDSA Feedback
Goal
Discharge
Date
Aim: To improve the number of inpatients having GDD from 0% to 100% also
To increase the number of inpatients achieving the GDD for from 0% to 100% by July 2013.
Prediction: GDD will improve the patient experience and efficiency. Also this will reduce the LoS

16. Michael Jordon Failure- a learning opportunity
“I missed more that 9,000 shots in my career. I’ve lost almost 300 games.
26 times I’ve been trusted to take the game-winning shot….and missed.
I've failed over and over and over again in my life. And that is why... I succeed."
Michael Jordon

19. Finding the right socks at right time problem solving
Every morning find the right colour socks with in 5 seconds
* Right Colour Right Socks * Time to find the socks
* The mess created * My satisfaction*
* After wash placement time
Idea that
worked

20. PDSA Simulation

21. Please decide at your table
Who will be:
Time Keeper
Quality Assurance Officer
Data Analyst

22. PDSA Measures Accuracy Time Start: When time keeper says go.
Stop: When Assembly indicates last piece is in place AND removes hand.
3 – All pieces on Mr. P & positioned correctly
2 – All pieces on Mr. P, but one or more is out of place
1 – One or more pieces are not on Mr. P.

23. Plan Do
Study
Act
PDSA Cycle #
Level
Test Cycle Aim
Test Cycle Measures/Learning Questions
Predicted Cycle Outcomes
Capture Relevant Data
Observations expected/unexpected
Results
Test Cycle Learning
Test Cycle successful Yes/No
Action Taken
Alternate Pathways Uncovered
Test Cycle completed Yes/No
If No, reason 1  2
 Start with feet and work to top
 Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy
 Time = 120sec
Accuracy = 3 2

24. Plan Do
Study
Act
PDSA Cycle #
Level
Test Cycle Aim
Test Cycle Measures/Learning Questions
Predicted Cycle Outcomes
Capture Relevant Data
Observations expected/unexpected
Results
Test Cycle Learning
Test Cycle successful Yes/No
Action Taken
Alternate Pathways Uncovered
Test Cycle completed Yes/No
If No, reason 1  2
 Start with feet and work to top
 Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy
 Time = 120sec
Accuracy = 3
 Time = 2.37
 Struggled to get pieces organized in order. 2

25. Plan Do
Study
Act
PDSA Cycle #
Level
Test Cycle Aim
Test Cycle Measures/Learning Questions
Predicted Cycle Outcomes
Capture Relevant Data
Observations expected/unexpected
Results
Test Cycle Learning
Test Cycle successful Yes/No
Action Taken
Alternate Pathways Uncovered
Test Cycle completed Yes/No
If No, reason 1  2
 Start with feet and work to top
 Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy
 Time = 120sec
Accuracy = 3
 Time = 2.37
 Struggled to get pieces organized in order.
 Time improved by 20 sec. Accuracy improved from 2 to 3
 Organization of parts helps time & accuracy.
 Yes 2

26. Test Cycle Measures/Learning Questions Predicted Cycle Outcomes
Plan Do
Study
Act
PDSA Cycle #
Level
Test Cycle Aim
Test Cycle Measures/Learning Questions
Predicted Cycle Outcomes
Capture Relevant Data
Observations expected/unexpected
Results
Test Cycle Learning
Test Cycle successful Yes/No
Action Taken
Alternate Pathways Uncovered
Test Cycle completed Yes/No
If No, reason 1  2
 Start with feet and work to top
 Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy
 Time = 120sec
Accuracy = 3
 Time = 2.37
 Struggled to get pieces organized in order.
 Time improved by 20 sec. Accuracy improved from 2 to 3
 Organization of parts helps time & accuracy.
 Yes
 Next test to include ordering pieces. Need to set order before test.
 None
 N/A

27. 3 – All pieces on Mr P & positioned correctly
Time
140 X
120
100
Seconds 80 60 40 20 10 1 2 3 4 5 6
PDSA
3 – All pieces on Mr P & positioned correctly
2 – All pieces on Mr P, but one or more is out of place
1 – One or more pieces are not on Mr P.
Accuracy 3 2 1 X 4 5 6
PDSA

28. PDSA Tree PDSA 1 PDSA 2 PDSA 3 PDSA 4 PDSA 5 Time Adopt Abandon Adapt
Aim
Time
Adopt
Abandon
Adapt

29. We need a volunteer

30. Accuracy
3 – All pieces on Mr. P & positioned correctly
2 – All pieces on Mr. P, but one or more is out of place
1 – One or more pieces are not on Mr. P.
Time
Start: When time keeper says go.
Stop: When Assembly indicates last piece is in place AND removes hand