Model for Improvement Heidi Johns, Quality Leader BCPSQC April, 2013

Model for Improvement

Heidi Johns, Quality LeaderBCPSQCApril, 2013

Session Objectives

• Apply the framework for the Model for Improvement.

• Apply the PDSA cycles to your improvement project.

• Understand how to link PDSA cycles.


•It is a framework that takes a philosophy and helps you to get organized.

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


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






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?





Act Plan

Study Do

AIM

Measures


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





Act Plan

Study Do

AIM

Measures

Test Ideas


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

Improvement Model - PDSA


Plan

Prediction What to test

Data collection

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

How big of a Cycle?

If you don’t test

• http://www.youtube.com/watch?v=lCrsebfDkvQ

http://www.youtube.com/watch?v=lCrsebfDkvQ

http://www.youtube.com/watch?v=lCrsebfDkvQ

Study

Ask Questions???????Evaluate

Build knowledge.

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

PDSA Review

All Washed Up

AIM -

Results

Change IdeasA P

S D

Evidence & Data

A P

S D

A P

S D

A P

S D

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

Documents

Model for Improvement Heidi Johns, Quality Leader BCPSQC April, 2013