Tools for Change Tools for Change Plan, Do, Study, ActPlan, Do, Study, Act

The PDSA Cycle ExplainedThe PDSA Cycle Explained

Ronnie VinerRonnie VinerAssistant Collaborative DirectorAssistant Collaborative Director

AimsAims

Understand why we need to research, analyses, plan and structure change

Appreciate the need for measurement

Value the use of tools in changing systems

Explain the purpose of the PDSA cycles

Understanding systemsUnderstanding systems

We use systems in everything we do

To make successful changes you must set out to change the system

To succeed you must try and try again

Changes should be maintained and monitored

Changing systemsChanging systems

Change can be exciting but also threatening

Change takes time in systems and in people

Change means testing things out in the reality of their own setting

Three fundamental questionsThree fundamental questions

What are we trying to achieve?Understand the problem. Know what you are trying to achieve. Have clear and desirable aims and objectives

How will we know that a change is an improvement?Measure processes and outcomes

What changes can we make that will result in an improvement?What have others done? What hunches do we have? What can we learn as we go along and how?

How has it been done so far?How has it been done so far?

What is the best way to approach change that results in improvement?

Trial & error?

Chaos

Too much action, not enough thinking

“Something must be done, this is something therefore we must do

it…”

Detailed prior study?

Paralysis

Too much thinking, not enough action

“We can’t do anything until we know exactly what to do…”

‘Trial & Learning’ Approach

‘‘Trial & Learning’ component partsTrial & Learning’ component parts

Setting challenging aimsIs it worth doing? Not “change for change sake”

Identifying principles/change ideasWhat has worked for someone? What might work for us?

Measuring progressKnowing what’s happening

Testing changesStarting small, reducing risk

Implementing and sustaining changeChange in systems and routines. Developing skills and abilities

PDSAPDSA

•What changes are to be made?

•Next cycle?

•ObjectiveQuestions/predictionsPlan to carry out the cycle (who, what, where, when?)Plan for data collection

•Carry out the planDocument problems and unexpected observationsBegin analysis of •the data

Complete the analysis of the dataCompare data to predictionsSummarise what was learned

Defining the problemDefining the problem

Getting Information

Set impossible timescales

Always speak to someone different

Didn’t specify what I wanted properly

Didn’t check often enough

Not got an accurate brief

Didn’t give manager enough time

Am I dealing with really urgent work?

Not sharing the workload

Haven’t planned time available well

Waiting for line manager’s approval

Other deadlines

What should a PDSA look like?What should a PDSA look like?

Objective Define the problem What are you trying to achieve?

Plan Who, what, where, when? Measurement

Do Just do it

Study What worked? What didn’t?

Act Next steps

Example PDSA formExample PDSA form

Example of a PDSA cycleExample of a PDSA cycle

ObjectiveTo improve BP control for patients with CHD in line with the NSF

PlanPractice Manager to identify 5 CHD patients from the

CHD register with BP greater than 140/85 by 24th May

Receptionists to contact patients by telephone to offer

appointments with the Practice Nurse

Measure date of last attendance, BP, medication

compliance

Example of a PDSA cycleExample of a PDSA cycle

StudyTwo additional patients were seen opportunistically

Six patients seen and one did not attend

All patients had been seen in previous 4 months

Control of BP had been difficult:

4 patients were overweight, 1 obese

All patients did very little or no physical exercise

All patients except one reported that they comply with medication

Example of a PDSA cycleExample of a PDSA cycle

ActMedication compliance is difficult to assess: arrange meeting with doctors to discuss alternative methods of compliance

Patients to be followed up more frequently by Practice Nurse

Exercise programme aimed at this group to be considered

Doctors to review medication again at the next follow-up visit

Developing improvement with PDSAsDeveloping improvement with PDSAs

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Testing andTesting andrefining ideasrefining ideas

Implementing newImplementing newprocedures & systemsprocedures & systems- sustaining change- sustaining change

BrightBrightidea!idea!

Developing improvement with PDSAsDeveloping improvement with PDSAs

Brightidea!

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PDSA cyclesPDSA cycles

Have a long pedigree

Are similar to techniques such as audit cycles, ‘plan-do-check’, etc.

‘Natural’ to health care

Small in scope and build incrementally

Have methodological validity

Used and developed by participants in the Collaborative

Advantages of the PDSA approachAdvantages of the PDSA approach

Makes processes and learning explicit...which is especially useful for team working

Enables testing of ideas to:- customise change for/ to local conditions- evaluate ‘side-effects’- improve the idea based on learning- reduce risks

Minimise problems with getting started- persuading the reluctant- longest journey/first step stuff

Promotes ‘bite sized chunks’

Task: to complete a PDSA within a weekTask: to complete a PDSA within a week

Work in pairs

Identify and define a shared problem

Start to think about solutions

Develop a ‘Plan’ for a PDSA to be completed in no more than 1 week

SummarySummary

Improvement requires change to systems

PDSAs are a tool that help you bring about change in a practical, useful, manageable and managed way

Starting points: remember the three fundamental questions to guide change

Remember that you will never know whether the change is better unless you measure

Keep up the momentum and don’t forget to record what happens

QuestionsQuestions

Thank You!