Conducting PDSA Change Cycles (Plan-Do-Study-Act) April 2009 Follow-up Calls (Call #5)

1. Conducting PDSA Change Cycles (Plan-Do-Study-Act)April 2009 Follow-up Calls (Call #5) Based on the fall 2008 CATES Training Series Contra Costa County, San Bernardino County, & Sutter County October 24, November 7, and November 14, 2008 Call Facilitators: Beth Rutkowski, MPH, and Sherry Larkins, Ph.D. UCLA Integrated Substance Abuse Programs/Pacific Southwest Addiction Technology Transfer Center UCLA

2. Agenda • This month’s topic: Conducting PDSA Change Cycles • Q-A period • Discuss the issues you face in planning and conducting a change project. • What will prevent you from using the process improvement methods we have discussed?

3. Review • Conducting a Walk-Through • Gathering Baseline Data • Setting a Change Objective • Using the Quick Start Road Map • Conducting PDSA Change Cycles

4. What Happens Prior to Implementing a PDSA Cycle? • Management decides on a change objective • A Change Leader convenes a team • Team works to understand the problem • Team brainstorms a number of possible changes • Possibilities are prioritized and one is selected for testing • The test occurs in one portion of the agency

5. Rapid-Cycle Testing Rapid-Cycle changes • Quick experiments; do-able within 2 weeks PDSA cycles • Plan the change • Do the plan • Study the results • Act on the new knowledge

6. Plan • Define the change behaviorally… precisely what will be done? • Who will implement the change? • What preparation needs to be done before starting the change? • Clarify who will measure the change and who will review the data regularly to share with the team.

7. Do • Note the start date for the cycle • How long will the initial test last? • How often will the team meet to assess progress and review data? • During the test, the team considers what improvements might need to be made to improve the results

8. Rapid-Cycle Testing - Example Rapid-Cycle change • “Barrier question” PDSA cycle with 2 counselors PDSA cycles • Plan: Design question • Do: 2 counselors use on 5 clients each • Study: 70% of clients attend 2 post-assessment sessions compared to 50% • Act: Try on another 20 clients 8

9. Study • After the agreed upon test period the team reviews the results • Change leader assembles and graphs the data for the team • The team deliberates what it has learned • Based on the learning, the team considers whether a change in strategy is in order

10. Act • In light of what has been learned, the team decides what to do next • Make an adjustment in the strategy to get closer to the objective • Increase the objective if the initial target has been met and the team believes even more progress can be made • Combine another change with the existing strategy to start a new cycle • Abort the existing strategy and start a new cycle

11. It is important to remember… • It often takes more than one cycle to achieve your objective. • By changing only 1 thing at a time you know the impact of your change. • Sometimes several changes are necessary to maximize the improvement you seek.

12. Change Cycles A A P P S S D D D S P A A P S D Changes That Result in Improvement DATA Cycle 4 Cycle 3 Hunches Theories Ideas Cycle 2 Cycle 1

13. Keys to PDSA success • Be clear about your target objective • Implement only 1 change at a time • Make sure all participants are implementing the change as planned • Implement the change in a small portion of the agency • Study the results data before making a modification to the plan • Do not hesitate to start a new cycle when the data indicates or the team is convinced that a modification will improve results

14. And last… Keep measuring and studying the results until you reach your objective and determine you have improved as much as you can

15. May 2009 Calls (Final Month!)7th at 2:00pm and 15th at 11:00 am Next Steps Topic: Sustaining Change and Resources for Continued Learning Check out the NIATx web site at www.niatx.net