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Rapid Cycle, Small Scale Testing David M. Williams, Ph.D. Institute for healthcare Improvement. P D S A. lease o omething nything !. Building Knowledge & Making Improvement. Building Knowledge & Making Improvement. Aim Statement: Improve what? By how much? By when?. - PowerPoint PPT Presentation
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Rapid Cycle, Small Scale Testing
David M. Williams, Ph.D.Institute for healthcare Improvement
leaseoomethingnything!
PDSA
Building Knowledge &
Making Improvement
Aim Statement: Improve what? By how much? By when?
Building Knowledge &
Making Improvement
Measure(s)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
weeks
Percent
Building Knowledge &
Making Improvement
Change Ideas
Building Knowledge &
Making Improvement
AP D
S
AP
D S
APD
S
A P
DS
Now, let’s focus on the PDSA part of the MFI and tests of change
Building Knowledge &
Making Improvement
… the PDSA cycle!
Act Plan
Study Do
Plan, Do, Study, Act Cycle
1939
1. Design the product (with appropriate tests).2. Make it; test it in the production line and in the laboratory.3. Put it on the market.4. Test it in service, through market research, find out what the user thinks of it, and why the non-user has not bought it.5. Re-design the product, in the light of consumer reactions to quality and price. Continue around and around the cycle.
1951
1986
Development of the Shewhart Cycle
Materials courtesy of Ron Moen and Cliff Norman
Deming’s Sketch of the Shewhart Cycle - 1985
Walter Shewhart(1891 – 1967)
Act Plan
Study Do
Plan, Do, Study, Act Cycle
AIM
Act
PlanObjectiveQuestions and predictions (why)Plan to carry out the cycle (who, what, where, when)
Study Do
Plan, Do, Study, Act Cycle
Plan
Act Plan
Study
DoCarry out the planDocument problemsand unexpectedobservationsBegin analysis of the data
Plan, Do, Study, Act Cycle
Do
Do
Do
Do
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Act Plan
Study Complete the
analysis of the dataCompare data to
predictionsSummarise what
was learned
Do
Plan, Do, Study, Act Cycle
Study
Act
Adopt? Adapt? (New Plan)?
Abandon?
Plan
Study Do
Plan, Do, Study, Act Cycle
Act - Adapt
Repeated Use of the PDSA Cycle
Hunches Theories
Ideas
Changes That Result in Improvement
A P
S D
APS
D
A P
S D
D SP ADATA
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
1) What are we trying to accomplish?
2) How will we know that a change is an improvement?
3) What change can we make that will result in improvement?
Sequential building of knowledge under a wide
range of conditions
Results PDSA 2
Results of PDSA 3
Results of PDSA 4
Repeated Use of the PDSA Cycle
Hunches Theories
Ideas
Changes That Result in Improvement
A P
S D
APS
D
A P
S D
D SP ADATA
The PDSA Cycle for Learning and Improvement
Click icon to add picturePlan• Objective• Questions &
predictions• Plan to carry out:
Who?When?How? Where?
Do• Carry out plan• Document
problems• Begin data
analysis
Act• Ready to
implement?• Try something
else?• Next cycle
Study• Complete data
analysis• Compare to
predictions• Summarize
What will happen if we try something
different?
Let’s try it!Did it work?
What’s next?
PDSA Guidance
Test changes at the smallest level that is possible and reasonable.
One patient – one day – one admit - one doctor.
Test under various conditions before expanding.
What can you do by next Tuesday?
Fail often to succeed sooner.
38
Activity ≠ Change
Is a change:
Establish a prompt to redose
Create a standing order
Provide staff with protocol compliance feedback
Test placement of alcohol rub dispensers
Is NOT a change:(but may be a necessary preliminary task)
Planning
Having a meeting
Educating staff
Creating a protocol
Assigning responsibilityFor each change idea, you should have an explicit
prediction of how it will impact the outcome.
Tips for Testing
Use a form to document your test.
Scale down – think “Drop Two”
Oneness
Make changes in parallel
Know the situation in your organization
• Year• Quarter• Month• Week• Day• Hour
• 1 patient• 1 day• 1 admit• 1 physician
“What tests can we complete by next Tuesday?”
Failed Test…Now What?
Be sure to distinguish the reason:
Change was not executed
Change was executed, but not effective
If the prediction was wrong – not a failure!
Change was executed but did not result in improvement
Local improvement did not impact the secondary driver or outcome
In either case, we’ve improved our understanding of the system!
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
42
A P
S D
AP
SD
A P
S D
D S
P A
A P
S D
AP
SD
A P
S D
D S
P A
A P
S D
AP
SD
A P
S D
D S
P A
A P
S D
AP
SD
A P
S D
D S
P A
Early Intervention in Maternity Services Project(s)
Attachment and Child Development beyond maternity services Project(s)
Developing parents' skills Project(s)
Continuity of care in transitions between services Project(s)
A P
S D
AP
SD
A P
S D
D S
P A
27 - 30 month Child Health review Project(s)
AIM: BIG DOT EARLY YEARS
Change Concepts, Theories, Ideas
Attachment and Child Development beyond maternity services
27 - 30 month Child Health review
Early Intervention in Maternity Services
Continuity of care in transitions between services
MULTIPLE KEY CHANGES FOR A SINGLE AIM
Breakout Sessions Key changes – PDSAs
In the next session…
• Learn from examples of small tests (PDSAs) from Pioneer Sites.
• Think of ideas for small tests of change in your work.
• Develop a plan for a small test you can do by next Tuesday.
45