PDSA Cycle for Accelerating Improvement

1. covering kids & families Process Improvement Collaborative PDSA Cycle for Accelerating Improvement Nancy Gantt, Deputy Director Supporting Families National Program Office

2. covering kids & families Process Improvement Collaborative Continue to answer the question… By what method do we learn, adapt, implement, and spread change ideas for improving the effectiveness, efficiency and accuracy of Medicaid/SCHIP eligibility processes. The Southern Institute on Children and Families

3. covering kids & families Process Improvement Collaborative Questions to Ask When Making Improvements What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in an improvement? ©The Improvement Guide

4. covering kids & families Process Improvement Collaborative Act Plan Study Do The Shewhart Cycle for Learning and Improvement Note: You may also see it referred to as the PDCA - Plan, Do, Check, Act Model ©The New Economics

5. covering kids & families Process Improvement Collaborative Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Aim Measurement Cycle for Learning & Improvement ©The Improvement Guide

6. Act Plan • Objective • Questions and • predictions (why) • Plan to carry out • the cycle (who, • what, where, when) • What changes • are to be made? • Next cycle? Study Do • Complete the • analysis of the data • Compare data to • predictions • Summarize what • was learned • Carry out the plan • Document problems • and unexpected • observations • Begin analysis • of the data The PDSA Cycle for Learning and Improvement API - Detroit

7. Test on a small scale Collect data over time Build knowledge sequentially and include a wide range of conditions in the sequence of tests covering kids & families Process Improvement Collaborative 3 Principles for Testing a Change The Southern Institute on Children and Families

8. covering kids & families Process Improvement Collaborative Years Quarters Months Weeks Days Hours Minutes Drop down next “two levels” to plan Test Cycle! Decrease the Time Frame for a PDSA Test Cycle API - Detroit

9. covering kids & families Process Improvement Collaborative Determining the Scale of a Test The Southern Institute on Children and Families

10. covering kids & families Process Improvement Collaborative Small Scale Testing - Other offices - Other departments - Other counties - Other key systems Test Group The Southern Institute on Children and Families

11. covering kids & families Process Improvement Collaborative Speaking PDSA Language • We Planned to…(state the basic plan) • In Order to …(tie it back to the aim) • What we thought would happen…(prediction) • What we did was…(brief description of the activities) • What happened was…(the results, data) • Looking at what happened we learned that…(lessons learned) • What we plan to do next is… • (state changes that will be made to test in next cycle) P D S A Penny Reid, Renewal Workgroup

12. Seek usefulness not perfection Use paper and pencil or an Excel Template Use sampling Design forms, training, and instructions Plot the data over time covering kids & families Process Improvement Collaborative Collect Data Over Time The Southern Institute on Children and Families

13. SignificantResults A P Evidence & Data S D A P S D A P S D A P Learning and improvement Theories, hunches,& best practices S D Sequential Building of Knowledge Include a Wide Range of Conditions in the Sequence of Tests Spread Implement Test new conditions Test a wider group Test on a small scale API - Detroit

14. D S P A A P S D D S P A A P S D A P S D Aim: Reduce by 25% the number of cases being closed each month for failure to return the renewal form within 6 months. Improvement Strategies Package: Improve Policy & Procedures Improved access DATA Cycle 5: Test with entire office. Cycle 4: Standardize procedure of making client contact prior to closure. Cycle 3:Test the process with 3-4 workers Cycle 2 Adjust times that you make contacts. Run test again. Cycle 1:Select two workers who will agree to make contacts with clients prior to case closure. Compare closure rates for one week. The Southern Institute on Children and Families

15. Overall Aim: Increase the Retention Rate by 20% for Families in Medicaid and SCHIP within 6 months. P P P P A A A A D D D D S S S S S S S S D D D D A A A A P P P P A A A A P P P P S S S S D D D D P P P P A A A A D D D D S S S S Specific Test Cycles Simultaneous Testing Mandatory client contact prior to case closure Verification checklist Pre-printed renewal form Improve notices Improvement Strategies The Southern Institute on Children and Families

16. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. G. Langley, K. Nolan, T. Nolan, C. Norman, L. Provost. Jossey-Bass Publishers., San Francisco, 1996. The New Economics for Industry, Government, Education. 2nd Edition. W. Edwards Deming, Massachusetts Institute of Technology, Cambridge,MA, 1994. Quality Improvement Through Planned Experimentation. 2nd edition R. Moen, T. Nolan, L. Provost, McGraw-Hill, NY, 1998. covering kids & families Process Improvement Collaborative References

17. More detail (who, what, where, when) Break tests into smaller tests (but think several cycles ahead) Define your measure and how you plan to collect data More testing of work processes Look for “red beads” Brainstorm and test a new idea (flop chart material?) Observations from your PDSA Cycle Plans API - Detroit