1. Supporting NHS Wales to Deliver World Class Healthcare All Wales Stroke Services Improvement Collaborative All Nations Centre, Cardiff 4 th November 2008

2. Slide 2 All Wales Stroke Services Improvement Collaborative The Model for Improvement Part Two Dr Alan Willson Director of Research and Development NLIAH Director 1000 Lives Campaign Director AWSSIC

3. Slide 3 All Wales Stroke Services Improvement Collaborative Learning Objectives – the theory The 3 questions of the Model for Improvement (MFI) PDSA cycles Run charts – the practice Team aim for Stroke Services The ‘How’ of measurement The PDSA Cycle related to a Stroke service change

4. Slide 4 All Wales Stroke Services Improvement Collaborative Model for Improvement

5. Slide 5 All Wales Stroke Services Improvement Collaborative Act Adapt? Adopt ? Abandon? Next cycle? Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) Study Complete the analysis of the data Compare data to predictions Summarize what was learned Do Carry out the plan (on a small scale) Document problems and unexpected observations Begin analysis The PDSA Cycle:

6. Slide 6 All Wales Stroke Services Improvement Collaborative Test of change have been going on for years “Negative results on the fish… Let’s try rubbing two sticks together.”

7. Slide 7 All Wales Stroke Services Improvement Collaborative This is different! 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

8. Slide 8 All Wales Stroke Services Improvement Collaborative Why test? Learn Design Confidence Resistance

9. Slide 9 All Wales Stroke Services Improvement Collaborative 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 AIM

10. Slide 10 All Wales Stroke Services Improvement Collaborative Aims Overall collaborative aim Specific aim Your local aim? To improve the outcome following stroke To increase the reliability of delivering 4 care bundles for acute stroke

11. Slide 11 All Wales Stroke Services Improvement Collaborative Aim Exercise

12. Slide 12 All Wales Stroke Services Improvement Collaborative 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 AIM Goals & Measurement

13. Slide 13 All Wales Stroke Services Improvement Collaborative What are we trying to accomplish? How will we know that a change is an improvement? What change(s) can we make that will result in improvement? AIM Goals & Measurement Change(s)

14. Slide 14 All Wales Stroke Services Improvement Collaborative Share your changes…

15. Slide 15 All Wales Stroke Services Improvement Collaborative Act Adapt? Adopt ? Abandon? Next cycle? Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) Study Complete the analysis of the data Compare data to predictions Summarize what was learned Do Carry out the plan (on a small scale) Document problems and unexpected observations Begin analysis The PDSA Cycle:

16. Slide 16 All Wales Stroke Services Improvement Collaborative How small is small ?

17. Slide 17 All Wales Stroke Services Improvement Collaborative Tips for PDSA Cycles “What change could you test by next Tuesday?” Start Small “Rule of 1”: 1 facility 1 office 1 provider 1 patient Volunteers at first Useful (not perfect) data Use “huddles” to report Learning first …

18. Slide 18 All Wales Stroke Services Improvement Collaborative MODEL FOR IMPROVEMENT Objective for this PDSA Cycle DO : CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS. DATE :____ CYCLE :____ PLAN: QUESTIONS : PREDICTIONS : PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE P DS A STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED. ACT: ARE WE READY TO MAKE A CHANGE? PLAN FOR THE NEXT CYCLE.

19. Slide 19 All Wales Stroke Services Improvement Collaborative Learning Objectives – the theory The 3 questions of the Model for Improvement (MFI) PDSA cycles Run charts – the practice Team aim for Stroke Services The ‘How’ of measurement The PDSA Cycle related to a Stroke service change