1. 1 Using PDSA Cycles for Quality Management Brazos Valley Council of Governments July 2010

2. The PDSA Cycle   Using information from the Data Review Activity, or an example from your own agency, identify a quality issue needing improvement.   What improvement should be made?   How will you implement these changes?   How will you know the changes were effective/brought about the change you wanted? 2

3. 3 The PDSA Cycle

4. 4 Plan 1.Clarify your Objective 2.Make a prediction Formulate theory Objective + specificity 3.What is to be done Who What Where When How

5. 5 Plan: a New Adherence Screening Tool  Objective: Determine how we can screen HIV patients for issues that might affect their ability to adhere to their medication regimen, in a way that won’t disrupt patient flow  Prediction: Adding a screening tool will allow us to document % adherence rate for all patients, while adding only 5 minutes to the average patient visit.  Steps: Joanne and Sally researched and identified possible tools that were reviewed by Sally and Dr. Smith. They selected one tool for Dr. Smith to use with at least three patients in the clinic on Thursday  Necessary tasks: 1. Identify tool. 2. Copy tool and place in patients' charts. 3. Dr. Smith will review instructions for using tool. 4. Explain tool to patient. 5. Use tool The PDSA Cycle

6. 6 Do 1.Carry out the plan 2.Document your observations ExpectedExpected UnexpectedUnexpected 3.Begin analysis

7. 7 Do: What Happened?  Tool was used on one patient  Administration took 5 pages  Added 35 minutes to documentation The PDSA Cycle

8. 8 Study Complete Analysis Compare to Predictions Summarize Results

9. 9 Study: Our Results (vs. Our Prediction)  Theory still holds  Need to test more tools to identify one that will work in our clinic  Therefore… The PDSA Cycle

10. 10 Act The PDSA Cycle 1.Adjustments Changes to previous test?Changes to previous test? What adjustments?What adjustments? Expand last cycle?Expand last cycle? 2.New cycles What are you planning?What are you planning? What are you going to test?What are you going to test?

11. 11 Act: What Will We Do (Based on What We Learned)? We will test two different tools, each with three patients, by next Wednesday. The PDSA Cycle

12. 12 Key Points The PDSA cycle:  Helps “test your hunches”  Adapt these changes to your own environment.  Start small  Lead to more complex cycles Key Points

13. 13 References and Resources  National Quality Center, Quality Academy http://www.nationalqualitycenter.org/QualityAcademy/ http://www.nationalqualitycenter.org/QualityAcademy/  Texas Department of State Health Services, AA Review Tool http://www.dshs.state.tx.us/hivstd/fieldops/EvalTools.shtm http://www.dshs.state.tx.us/hivstd/fieldops/EvalTools.shtm  Institute of Medicine, Crossing the Quality Chasm: The IOM Health Care Quality Initiative, http://www.iom.edu/CMS/8089.aspx http://www.iom.edu/CMS/8089.aspx