Testing Changes

Quality AcademyCohort 6

Residency 1 April 2013

Melanie Rathgeber, MERGE Consulting

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.

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

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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)

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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

A Series of PDSA Cycles

Hunches Theories

Ideas

Changes That Result in

Improvement

A P

S D

APS

D

A P

S D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

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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.

Questions and predictions: How long will it take to complete a follow-up call? Prediction 10 minutes.

Do 5 calls and record time Do 5 calls and record time

Calculate median time = 14 minutesCalculate median time = 14 minutes

For each PDSA cycle Write down ….

Plan To learn if ……

We predict that ….

Do

Study What is the result? Is your prediction accurate?

Act Our 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