View
216
Download
0
Category
Tags:
Preview:
Citation preview
Session Objectives
• Apply the framework for the Model for Improvement.
• Apply the PDSA cycles to your improvement project.
• Understand how to link PDSA cycles.
Brief History
• William Edward Deming
• The components of the theory work together as a guide.
• If you do not pay attention to the interaction of the components or the effectiveness of the improvement could be compromised.
Deming’s Theory of Profound Knowledge
QI
Understanding Systems Thinking
Understanding Variation
Understanding Theory
Understanding Human Behaviour
(Psychology)
The Improvement Guide, 2nd ed.
Out of the Theory came
• Model for Improvement - Associates for Process Improvements – Improvement Guide.
• The model is designed to accelerate improvement.
Knowledge for Improvement
Improvement Knowledge
Subject Matteror Content Knowledge
Improvement The Improvement Guide 2nd ed.
Improvement: Learn to combine subject matter knowledge and improvement knowledge in creative ways to develop effective changes for improvement.
• Know your system – map it out
• Collect data
• Leadership
• Form a multidisciplinary team – people in the process
Improvement Basics
• SMALL TESTS of CHANGE
• Communicate
• Spread proven changes/change principles to other areas
• Never stop learning and improving
Improvement Basics cont’d
• A structured approach to improvement• Scientific Method• Sequential • Learn by doing• Testing• Theory, evidence, and action
Model for ImprovementWhat it is
• A recipe
• Grand design
• Unspoken theories, rhetoric, power structures, public opinion or actions isolated from learning
• Used to perform tasks
Model for ImprovementWhat it is not
Three Questions
•What are you trying to accomplish?•How will we know that a change is an improvement?•What changes can we make that will result in improvement?
Three Questions cont’d
•The questions provide:DirectionFocusContext for Continuous Improvement Activities
Model for Improvement
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
Thinking
Doing
The Improvement Guide, 2nd ed.
Model for Improvement
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
AIM
AIM• What problem are we trying to solve?
• What aspect of the status quo is unacceptable?
• Improvement should be developed with intention.
AIM tips and tricks “Marginal aims can be achieved with marginal change but bold aims require bold change….setting a challenging goal as the aim, the team immediately recognizes that business as usual is not an option.” based on The Improvement Guide
What would be a caution about this statement?
Model for Improvement
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
AIM
Measures
The Improvement Guide, 2nd ed.
Measures
• What you are expected to accomplish is explicitly stated before you begin anything
• Provides common base for communication
• How well does performance match goals
Model for Improvement
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
AIM
Measures
Test Ideas
The Improvement Guide, 2nd ed.
Testing• Developing of ideas
• Testing of the ideas - Failure is an option
• Implementation of successful ideas
Change Concepts
Build the ideas for the change.
A change concept is a general notion or approach found to be useful in developing specific ideas for change that results in an improvement. The Improvement Guide, p 131
Change Concept
Change concepts provides the ideas to test
Change Concept
USE REMINDERS
Screen Savers on
every computer
Signs above
sinks in all
facilities
Hand sanitizers at department
entrance
Next idea ???
Change Concepts – Activity
At your table pick a change concept then create a list of change ideas that you could test?
“Using Change concepts will provoke new ways of thinking about how to improve the situation at hand” The Improvement Guide, p 131
Plan Do Study Act • Theory that you need to apply
• Planning is often omitted OR
• We get stuck in planning
• Feedback
DO
• Answer a specific question! • Theory and a prediction• Collect data over time• Build knowledge sequentially • Include a wide range of conditions in the sequence
Small Scale Test – Do • Simulate the change• Have subject matter experts review the change• Test the idea with volunteers• Use 1:1:1 rule use manual “pencil and paper” data
collection• Use sampling
“Failed” tests expected and important
• Execution of change• Inadequate support processes • Theory not useful for conditions• No local improvements• Data collection
If you don’t test
• http://www.youtube.com/watch?v=lCrsebfDkvQ
Team: ___________ PDSA Cycle WorksheetCycle: ___________
• Plan• Objective for this cycle:• Question(s) we want to answer:• Predictions: (What do we expect to happen?) • Plan for change or test: (Who, what, when, where)• Plan for data collection: (Who, what, when, where)
• Do• How was the test or change carried out? Was there any difference from what was planned?
• Study• Complete analysis of data collected and summarize what was learned.
• Act• Are we ready to continue with this change? Plan for the next cycle.
PDSA Ramp repeated use of the cycle
Hunches Theories
Ideas
Changes That Result in
Improvement
A P
S D
APS
D
A P
S DD SP A
DATA
Increasing ---complexitynumber of peopledifferent situations
Time
Repeated Use of the Cycle
Hunches Theories
Ideas
Changes That Result in
Improvement
A P
S D
APS
D
A P
S DD S
P ADATA
Very Small Scale Test
Follow-up Tests
Wide Scale Tests of Change
Implementation of Change
Spread
Multiple RampsWhen to use
• Multiple process change
• Multiple interventions
• REMEMBER, this is about improvement not controlled experimentation
Sourceshttp://www.apiweb.org/associates.htm
Donald M. Berwick, BMJ, Vol. 312, 619-22http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350403/pdf/bmj00532-0035.pdfLangley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide, A Practical Approach to Enhancing Organizational Performance, San Francisco, CA. Jossey-Bass Publishers. 2009, 2nd ed.www.improvementassociates.com
Recommended