1. Run charts Science of improvement
Developing changes that are new, by definition, requires a creative effort = the art of improvement
Studying the changes and their resulting impact (beneficial or not beneficial) forces us to consider the science of improvement
Today I’m presenting a short primer on PDSA Cycles because many people are familiar with the term but it is widely misunderstood and misused. To me, it is probably the most vital part we glass over or rush through with any QI effort. So I encourage you to refine this skill within your own team and throughout your organization. Though the PDSA cycle is meant to promote rapid cycle testing, sometimes the cycle takes longer than we anticipated.
Diane Liu, MD
Director, UPIQ
Utah Pediatric Partnership to Improve healthcare quality

2. Principles of improvement
Knowing why you need to improve
Having a feedback mechanism to tell you if the improvement is happening
Developing an effective change that will result in improvement
Testing a change before implementation
Knowing when and how to implement change
From The Improvement Guide Langley and Provost page 25 “Key Points from Chapter One)

3. Learning and Improvement Theories, hunches, and best practices
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
Breakthrough Results A P S D
Evidence & Data D S P A
Wide-scale implementation of change A P S D
This is how we use PDSAs in practice. We start with some hunch or theory (our predictions; the change ideas) and we test on a very small scale. We evaluate the data from that test and plan the next test; and so on. We don’t implement any change until we have done the sequential building of knowledge we get from running PDSA cycles.
Learning and Improvement
Test new conditions A P S D
Sequential Building of Knowledge with multiple PDSA Test Cycles
Figure 7.2 ‘The Improvement Guide’ Langley, et al. 2009
Follow-up tests
Theories, hunches, and best practices
Small Scale Testing

4. RUN Chart (a.k.a. time series or trend chart)
Display key measures over time
Determine if changes result in improvement
Determine if gains are held
Graphical display of data
Plotted in order
Simple to interpret
Makes progress visible

5. Interpret run charts – “rules” of significance
Shift – 6 or more consecutive points all above or all below the median
Trend – 5 or more consecutive points all going up or all going down
Number of Runs – nonrandom points; series of points in a row on either side of median

6. Sample run chart
SHIFT
ALMOST a TREND!

7. HPV RUN CHART – MISSED OPPORTUNITIES
No median line but we were pretty much hugging the 40% - so if we believe the median is near there, there really aren’t any shifts or trends going on. Need more months of data to help us know if any of our changes are resulting in improvements for reducing missed opportunities.

8. Knowledge is gained sequentially
REMEMBER
Improvement is an outcome of the application of (appropriate) knowledge
Knowledge is gained sequentially
All improvement occur due to changes but not all changes lead to an improvement

9. QUESTIONS? Diane.Liu@hsc.utah.edu
THANK YOU!
QUESTIONS?
Diane Liu, MD
Director of The Utah Pediatric Partnership to Improve Healthcare Quality