Tools for Change Plan, Do, Study, Act The PDSA Cycle Explained

1. Tools for Change Plan, Do, Study, ActThe PDSA Cycle Explained Carol Reeve Eastern Wakefield Primary Care Trust Castleford, Normanton & District Hospital Lumley Street High Town Castleford West Yorkshire WF10 5LT Tel: 01977 665755 Email: carol.reeve@ewpct.nhs.uk

2. Aims 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

3. Understanding 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

4. Changing 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

5. Three 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?

6. How has it been done so far? 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…” What is the best way to approach change that results in improvement? ‘Trial & Learning’ Approach

7. ‘Trial & Learning’ component parts Setting challenging aims Is it worth doing? Not “change for change sake” Identifying principles/change ideas What has worked for someone? What might work for us? Measuring progress Knowing what’s happening Testing changes Starting small, reducing risk Implementing and sustaining change Change in systems and routines. Developing skills and abilities

8. What changes are to be made? • Next cycle? • Objective • Questions/predictions • Plan to carry out the cycle (who, what, where, when?) • Plan for data collection • Complete the analysis of the data • Compare data to predictions • Summarise what was learned • Carry out the plan • Document problems and unexpected observations • Begin analysis of • the data PDSA

9. Always speak to someone different Getting Information Didn’t specify what I wanted properly Set impossible timescales Didn’t check often enough Am I dealing with really urgent work? Not got an accurate brief Haven’t planned time available well Didn’t give manager enough time Not sharing the workload Other deadlines Waiting for line manager’s approval Defining the problem

10. 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

11. Example PDSA form

12. Example of a PDSA cycle Plan Practice 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 Objective To improve BP control for patients with CHD in line with the NSF

13. Example of a PDSA cycle Study Two 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

14. Example of a PDSA cycle Act Medication 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

15. Implementing new procedures & systems - sustaining change ACT ACT ACT ACT ACT ACT PLAN PLAN PLAN PLAN PLAN PLAN DO DO DO DO DO DO STUDY STUDY STUDY STUDY STUDY STUDY Testing and refining ideas Accumulating information and knowledge Bright idea! Developing improvement with PDSAs

16. Improvement ? Improvement Improvement A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D Improvement Bright idea! Developing improvement with PDSAs

17. PDSA 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

18. Advantages 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’

19. Task: 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

20. Summary 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

21. Questions Thank You!