1. Tell us about your PDSAs!

2. Model for Improvement Act Plan Study Do 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
The BTS Model for Improvement was first developed by Tom Nolan and colleagues, and is described in detail in The Improvement Guide (Langley, Nolan, Nolan, Norman, and Provost, Jossey-Bass, 1996).
The Model for Improvement is based on the idea that every system is designed to give you exactly the results that you get from it. To get different results, you have to change the system. The three questions and the Plan, Do, Study, Act Cycle give you a method to learn how to make the changes that will result in improvement.
Yesterday, we talked about the three fundamental questions for improvement. Today we will be focusing on the action part of the Model.

3. The PDSA Cycle Objective What changes Complete the Carry out the plan
Act
Plan
Objective
Questions and
predictions (why)
Measure of success
Plan for the cycle (who,
what, where, when)
What changes
are to be made?
Next cycle?
Study Do
Complete the
analysis of the data
Compare data to
predictions
Summarize what
was learned
Carry out the plan
Document problems
and unexpected
observations
Begin analysis
of the data
Four parts of the cycle:
Plan:
Decide what change you will make, who will do it, and when it will be done. Formulate an hypothesis about what you think will happen when you try the change. What do you expect will happen?
Identify data that you can collect (either quantitative or qualitative) that will allow you to evaluate the result of the test.
Do:
Carry out the change.
Study:
Make sure that you leave time for reflection about your test. Use the data and the experience of those carrying out the test to discuss what happened. Did you get the results you expected? If not, why not? Did anything unexpected happen during the test?
Act:
Given what you learned during the test, what will your next test be? Will you make refinements to the change? Abandon it? Keep the change and try it on a larger scale?

4. Repeated Use of the Cycle
Changes that result in improvement A P S D
DATA D S P A A P S D
This diagram shows the relationship between multiple cycles. The process is iterative with the learning building from one to the other. The slope of the ramp indicates that the cycles are also building in size and scope to increase one’s confidence that the changes will result in the desired improvement. A P S D
Hunches and Theories

5. Testing on a Small Scale
Conduct the test with one provider in the office, or with one patient
Conduct the test over a short time period
Test the change with the members of the team that helped develop the plan
Test the change on a small group of volunteers
Minimize confusion, frustration until bugs are worked out, then spread
Additional ideas for planning small scale tests.

7. PDSA Reminders Please fill out your entire PDSA worksheet.
We are looking forward to seeing what you learn from your PDSA, and how you are using that experience to plan the next one.
Talk with your practice facilitator about your PDSAs – they are there to help you!

8. General Reminders
If you have submitted baseline data – we have sent you back a form removing that baseline data, in order to make the form more user friendly in the coming months.
Is your quality improvement team meeting on a regular basis?
We hope so! This will become very beneficial in creating change.
Frequently touch base with your practice facilitator.
South Central – Sharon Adams ( ,
North West – Patty Stubber ( ,