1. Testing Changes Quality Academy Cohort 6 Residency 1 April 2013 Melanie Rathgeber, MERGE Consulting

2. QI is not just about making changes. Not all changes result in improvement. The use of formal improvement methods help organizations make effective and sustainable change.

3. Why can’t we just implement change without formal methods?  Implementing without testing tends to lead to:  More resistance  Consequences in other parts of system that weren’t predicted  Changes that don’t work in our environment  Wasted efforts – slow change 3

4. Ideas for changes come from: 1. In depth understanding of processes and systems (mapping, data) 2. Creative thinking 3. Adapting best practices for your setting: - literature - ideas from top performers - existing models (e.g. bundles, change package, guidelines, accreditation standards) 4

5. To increase the usual pace of change in your organization… Move two steps down: If your Aim will take 6 months to achieve, what can you do in 6 days to get started? Source: Paul Plsek Years Months Weeks Days Hours Minutes

6. A Series of PDSA Cycles 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 6

7. Example AIM: to reduce re-admission rates following COPD exacerbations. Our team has an idea to do follow up phone calls with COPD patient PDSA: to learn how long it will take to do the follow up calls. Questions and predictions: How long will it take to complete a follow- up call? Prediction 10 minutes. Do 5 calls and record time Calculate median time = 14 minutes

8. For each PDSA cycleWrite down …. PlanTo learn if …… We predict that …. Do StudyWhat is the result? Is your prediction accurate? ActOur next step is to learn if …… Your turn to fly: make the best damn paper airplane you can. Minimum 15 PDSA cycles recorded on paper