2. By the end of this session Deeper understanding of how methodology can be applied to practice Appreciate how to minimise the risk of making a change Understand how to accelerate learning as we test the change

3. Structure of the session 1. Refresh on methodology 2. Share practical experiences 3. Hints and tips to maximise success

5. Plan Reiterate overarching aim State the objective of the test/cycle

6. Plan What questions do you want answered Make PREDICTIONS Who will schedule and conduct the test What changes will be made Where will the test be conducted When will the test be done What will be measured to confirm/evaluate your predictions

7. Do Carry out the test Describe what actually happened Document any unexpected outcomes or problems encountered Gather the data to be reviewed and begin analysis of it

8. Study Complete analysis of data Compare data to the prediction Reflect on what happened Set out what learning was gained from the test Remember - No failures only enhanced learning

9. Act Decision time: Abandon Adapt Adopt Make modifications State what the next cycle is Back to planning

10. Based on slide © IHI 2009 Sequence for improvement Develop a change Test a change Implement a change Sustain & spread a change to other locations Support with data and consideration of people Theory & prediction Test under a variety of conditions Make part of routine operations Study ActPlan Do

12. HINTS and TIPS

13. Plan Think a couple of cycles ahead – is it feasible for implementation? Recruit volunteers rather than get buy-in or consensus for a test Be innovative to make a test feasible Planning one large PDSA cycle to get all the answers should be avoided….! ….Planning the perfect test takes time

14. Think About Size Current Situation ResistantIndifferentReady Low Confidence that current change idea will lead to Improvement Cost of failure large Very Small Scale Test Cost of failure small Very Small Scale Test Small Scale Test High Confidence that current change idea will lead to Improvement Cost of failure large Very Small Scale Test Small Scale Test Large Scale Test Cost of failure small Small Scale Test Large Scale Test Implement

15. Do Reasons for unsuccessful tests: The change was not executed properly - planning and communication not adequate Support processes to make the change successful were not adequate Apply your subject matter knowledge to unsuccessful tests

16. Study It doesn’t happen Take time as a team to reflect on learning Reflect on what actually happened – knowledge of how system works enhanced Assess to see if your degree of belief in the change has increased

17. Act Objective for next test not specifically defined Pace is crucial for momentum Differences between cycles to develop, test, implement and spread a change

18. Cycle attributes Developing a change Start small, 1 child, 1 worker, 1 family Testing a change Once change is developed, vary the conditions Implement a change Permanent support structures, degree of belief high Spread a change Foundation of spread is communication, share data

19. Reducing level of risk Simulate the change Have members of the project team test first Pass it by knowledgeable staff Test in parallel with existing process Small scale, short timeframe Test with volunteers

20. The Value of “Failed” Tests “I did not fail one thousand times; I found one thousand ways how not to make a light bulb.” Thomas Edison 11