1. QI Session 3 Plan, Do, Study, Act
2.45pm: Paul to give overview of PDSA
20 minutes

2. Plan, Do, Study, Act
Use process mapping, 5 whys and other techniques to identify what you want to change.
Use PDSA to implement and evaluate change.

3. PDSA Cycle Adapt? Adopt? Abandon? State the objective of the test.
Make predictions about what will happen and why.
Develop a plan to test the change. (Who? What? When? Where? What data?).
Try out the test on a small scale.
Document problems and unexpected observations.
Begin analysis of the data.
Set aside time to analyse the data and study the results.
Compare the data to your predictions.
Summarize and reflect on what was learned.
Determine what modifications should be made.
Prepare a plan for the next test.
Adapt?
Adopt?
Abandon?

5. “In God we trust…all others bring data….”
W. E. Demming

6. Measurement for Improvement
“All improvement requires change, but not all change is an improvement”
Make your measurement simple allowing rapid repeated cycles.
Don’t collect unnecessary data.
Consider a balancing measure…what could go wrong?
Run charts vs SPC charts…

7. Run Charts vs SPC Charts

8. PDSA Cycle Example
We have a low rate of chemotherapy treatment in our SCLC patients.
We have noticed that these patients sometimes deteriorate rapidly following referral/diagnosis.
There is often a delay between diagnosis and assessment for chemotherapy and then to the delivery of chemotherapy.
Can we speed up the patient pathway for these patients to have the best chance of being able to deliver chemotherapy?
Big Aim: to improve chemotherapy usage in SCLC patients.
Small Aim: to reduce the time between diagnosis and chemotherapy.

9. PDSA Cycle Example PLAN:
We will ask the oncologists to commit to a maximum 7 days between decision to treat and start of treatment.
We will assess our baseline performance by measuring the time taken by consecutive patients in the pathway through November/December 2015.
Time from referral to diagnosis (histology report)
Time from referral to oncology OPA
Oncology OPA to receipt of chemotherapy
We will implement the new policy from 1st Jan 2016, and continue to measure through Jan-Feb.
We predict that the new system will reduce the time to chemo by an average of 5 days.
We anticipate this will lead to more chemotherapy and better survival but it will not be a measurement of this PDSA cycle.

10. PDSA Cycle Example DO: Initials baseline measurement completed.
There was some concerns about workload but agreement was reached with the oncologists to implement the new policy.
Further measurements have been taken to demonstrate the changes.

11. PDSA Cycle Example
38 days

12. PDSA Cycle Example
38 days
28 days

13. PDSA Cycle Example STUDY:
There has been an improvement in the length of the pathway of approx. 10 days.
The oncologists have realised that in some cases they can see the patients in the clinic on Tuesday, and start the chemo on Friday – giving a wait of only 3 days. They have been excited by this improvement and are keen to reduce the time to the OPA.
One of the patients commented that the process was very quick and she barely had time to think - we need to be careful that patients do not feel rushed into treatment.

14. PDSA Cycle Example ACT:
We will try another PDSA cycle where we ask the pathologists to alert the LCNS to a probable SCLC case at the earliest opportunity.
This may bring the date of diagnosis forward, but will allow quicker booking of OPAs.
We will carry out a targeted patient experience survey to check that our patients are happy with a faster pathway.
We will audit the proportion of patients receiving chemotherapy in 6 months time to evaluate whether this has improved.

15. PDSA Cycle Example
38 days
28 days
22 days

16. QI Session 3: PDSA Get into groups of 2 or 3
Use a topic that you explored in the “5 Whys”, or consider:
Streamlining a pathway
Better access to LCNS for in-patients
Increased radical treatment in older patients
Use the worksheet provided to develop complete an initial PDSA cycle.
Your facilitator will help to ensure your aims are SMART.
Your facilitator will give you some dummy results that you can use to develop your STUDY and ACT sections.
Facilitators:
20 minute exercise
There is a handout explaining the PDSA cycle and a template for the teams to fill out. The most important aspect is making sure that cycles are small- often they want to plan a large objective e.g. changing the way they run their MDT, when this needs to be broken down into several small cycles.
Get the teams to look at their 5 ‘whys’ exercise and pick one issue to set as an aim. Remind them setting an aim may take some time and must be succinct and Specific, Measurable, Achievable, Realistic and Time bound (SMART)
Once they have considered their overall aim, they need to plan one aspect of how this aim might be delivered.
If a group completes their PDSA quickly, the facilitator can suggest what actually happened in the small scale test, and the team can move onto a second phase etc etc. They might suggest some successes but also a barrier/hurdle that needs to be addressed in the next phase.