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The Model for Improvement and PDSA Cycles

The Model for Improvement and PDSA Cycles
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Maggie Dunham

on 28 January 2014

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Transcript of The Model for Improvement and PDSA Cycles

The Model for Improvement and Plan-Do-Study-Act Cycles
This material was prepared by CFMC (the Medicare Quality Improvement Organization for Colorado), the Integrating Care for Populations & Communities National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.  The contents presented do not necessarily reflect CMS policy. [PM-4060-168 CO 2013]

Course Objectives:
Describe and execute a Plan-Do-Study-Act (PDSA) Cycle
Understand the Model for Improvement
Identify how to construct a strong aim statement

Recognize the importance of measurement for improvement
Developed by Associates in Process Improvement
The Model for Improvement
Framework to accelerate improvement work
Act
Model for Improvement
Set Aim
Select measure
Identify changes to make
PDSA cycles
Plan
Do
Study
PDSA
CyclE
Form an aim statement for your work
Ensure team has same goals and expectations of improvement efforts going forward
Set a challenging goal for your work
Step 1
Defines what you expect to improve
What is an Aim Statement?
Many physicians are prescribing antipsychotic medications to the residents of Sunnyside Nursing Center. We intend to engage our residents, their families, our caregivers and physicians to reduce the number of residents on antipsychotic medications by 50%.
Many physicians are prescribing antipsychotic medications to the residents of Sunnyside Nursing Center. Part of Sunnyside’s Nursing Improvement Plan is to reduce the number of residents on these medications. Our improvement project will reduce the number of residents on antipsychotic medications by 50% in 3 months.
Examples of Aim Statements
Many physicians are prescribing antipsychotic medications to the residents of Sunnyside Nursing Center. Part of Sunnyside’s Nursing Improvement Plan is to reduce the number of residents on these medications. We intend to engage our residents, their families, our caregivers and physicians to reduce the number of residents on antipsychotic medications by 50% from our current number in 3 months.
Examples of Aim Statements
What three things make up a strong aim statement?
G. A, C, and D
Reflection Question #1
Step #2
How will we know a change is an improvement?
What are we trying to accomplish?
“Although there is no progress without change, not all change is progress.”
-John Wooden
Will what we do lead to improvement?
Outside the system-oriented
Example: reducing antipsychotic medication use without reducing resident and family satisfaction
Three Types of Measures
Use tables and graphs to plot the data over time
Using Measurement
Graph of data over time
Help determine how process is performing
“Average” line shows where normal performance would be
Used to identify shifts, trends, or cycles in a process
Run Charts
Graph data over time
Used to measure if process is in “control”
Within a specified range of “average”
Considered a “special cause” if data is outside of control range
Typically investigated
Control Charts
Select the measurement methods you believe could lead to good data collection for reducing antipsychotic medication use.
Clinical health measures
Reflection Question #2
Step #3
What changes can we make that will result in improvement?
How will we know a change is an improvement?
What are we trying to accomplish?
What can we change?
How to generate ideas
How to generate ideas
Source: Langley, G.J., Nolan T., Nolan K., The Improvement Guide : A Practical Approach to Enhancing Organizational Performance. 1st ed. The Jossey-Bass Business & Management Series. 1996, San Francisco: Jossey-Bass Publishers
Examples of topics to discuss while generating ideas for change
Eliminate Waste
Improve Work Flow
Optimize Inventory
Change the Work Environment
Enhance the Producer/Customer Relationship
Manage Time
Manage Variation
Design Systems to Avoid Mistakes
Focus on a Product/Service
Change Concepts
On Monday, we will begin contacting all residents, families, and physicians who care for residents on antipsychotic medications. We will follow up weekly to discuss changes.
Engage residents, families, and physicians in goal of reducing antipsychotic medication use
Review resident charts to determine residents who are currently prescribed antipsychotic medications
Reduce antipsychotic medication use
Specific and Actionable Ideas
Concepts, Vague, Strategy
From Concept to Idea
What can you do to create ideas for change?
A, B, and D
Reflection Question #3
Step
Step
What changes can we make that will result in improvement?
How will we know a change is an improvement?
What are we trying to accomplish?
Quick re-cap
Plan – Do – Study – Act (PDSA) Cycles
PDSA Cycles in Real Life
What is not one of the four (4) main components of the PDSA Cycle?
Plan
Reflection Question #4
www.scotland.gov.uk
PDSA Cycle for Learning and Improvement
Prove or disprove a change resulted in improvement

Learn quickly from “failure”

Reduce resistance to change

Monitor costs and side-effects
Why must you test change?
painconsortium.nih.gov
Gain more knowledge from multiple tests of change

Collect your data over time with each change
Do sequential tests!
Start small to minimize costs
Build consensus
Move quickly
Ramp up when improvement happens
Keep measuring
Scale your improvement
What are the benefits of starting with small tests of change in PDSA cycles?
All of the above.
Reflection Question #5
Plan
Action steps begin to take place
Measurement begins
Do
Question what you did
Did improvement happen?
At the rate you wanted?
Learn from it
Study
Act on what you studied and learned
Start a new cycle
Strive for further improvement
Act
What is the correct order of events in the Model for Improvement?
Select Measure, Set Aim, Identify Changes to Make, PDSA
Reflection Question #6
http://www.improvement.nhs.uk/lung/?TabId=94
nationalqualitycenter.org/download_resource.cfm?fileID=16577‎
www.lphi.org/LPHIadmin/.../Model-for-Improvement-Collins-24392.ppt‎
Pelletier, Luc and Christy Beaudin. Q Solutions: Essential Resources for the Healthcare Quality Professional. USA: National Association for Healthcare Quality, 2008. Print.
References
Post Test Questions
Post Test Questions
What are you trying to accomplish?
Aligns with your improvement mission
Includes:
A goal for measurement
Time frames for project
Participants
Systems affected
A. It has specific deadlines for accomplishment
B. It aligns with your organization’s strategic financial plan
C. It can be measured
D. It sets numeric goals
E. It is created by one individual
F. A, B, and E
You cannot know what you do not measure
Collect quantitative and/or qualitative data
Test small initially
Just enough data to compare and learn from tests
The Importance of Measurement
Outcome Measures
Result-oriented
How something is affected
Example: number of residents taken off antipsychotic medications
Process Measures
System-oriented
Example: The regularity of conversations between staff and physicians about the use of antipsychotic medications on Sunnyside Nursing Center’s residents
balancing Measures
Make it a daily routine
Integrate new data collection with normal activities
Use simple forms to collect data
Resident observations
Physician questionnaires
All of the above
Auditing resident charts
Brainstorming
Spontaneous idea generation
Observation
Generating ideas based on what you see
Ideal Design
In a perfect world, what would it look like?
Shared experiences
Issues that more than one person faces or faced
Brainstorm with a group
Observe what you want to change
Force your team into one change concept
Share experiences in a group
Step
Dream
Do
Study
Act
Your costs may be lower than large tests.
You can build consensus as improvement happens.
You can make changes faster than larger tests.
Act
Model for Improvement
Set Aim
Select measure
PDSA cycles
Plan
Do
Study
PDSA
CyclE
Identify changes to make
PDSA, Set Aim, Identify Change to Make, Select Measure
Set Aim, Select Measure, Identify Changes to Make, PDSA
Set Aim, PDSA, Identify Changes to Make, Select Measure
None of the Above
Course Objectives:
Describe and execute a Plan-Do-Study-Act (PDSA) Cycle
Understand the Model for Improvement
Identify how to construct a strong aim statement

Recognize the importance of measurement for improvement
Ties in with 3 questions in the Model for Improvement
Prepares you to start your test of change
Check out the video at:
http://cfmc.org/lanncc/video-dlg.html
Full transcript