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Model for Improvement and Tests of Change

This guide explores the Model for Improvement process, testing changes in healthcare settings, setting aims, selecting measures, the PDSA cycle, and common testing guidelines. Learn how to drive improvement faster and reduce harm effectively.

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Model for Improvement and Tests of Change

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  1. Model for Improvement and Tests of Change Denise Remus, PhD, RN Improvement Advisor, Cynosure Health / HRET HEN

  2. 40/20 Goal Reduce Harm by 40% and Reduce Readmissions by 20%

  3. Drive Improvement Faster • Science of improvement • Accountability • Structure change • Document progress • Be fearless, take risks, be wiling to fail

  4. One day Alice came to a fork in the road and saw a Cheshire Cat. “Which road do I take?” she asked. His response was a question “Where do you want to go?” “I don’t know,” Alice answered. “Then,” said the cat “it doesn’t matter.” Lewis Carroll

  5. Aim Statements • What are we trying to accomplish? • Communicate expectations • Measurable (how good?) • Time specific (by when?) • Define the specific population (s) (who?) • Clear, concise and unambiguous

  6. Aim Statement WHERE? WHAT? WHO? HOW MUCH? BY WHEN?

  7. Aim Statement Example VTE: At St. Luke’s Hospital, we will reduce hospital-acquired VTE for all inpatients by 40% by December 31, 2013. • What: Hospital-acquired VTE • Where: St. Luke’s Hospital • Who: All inpatients • By When: December 31, 2013 • How Much: By 40%

  8. Measure

  9. Select Measures • For each clinical topic, must report data for at least 1 Process Measure and 1 Outcome Measure

  10. Measures

  11. Where is your Greatest Opportunity to? Reduce HarmImprove Processes

  12. Consider. . . • What are you already measuring? • What are you planning to measure? Identify existing measures Are they in the HRET HEN Encyclopedia of Measures? If not, user-defined measure option

  13. VTE Example – Potential Measures • Process Measures: • ICU VTE Prophylaxis (JC VTE-2) • VTE Discharge Instructions (JC VTE-5) • Outcome Measures: • Potentially Preventable VTE (JC VTE-6) • Post-op PE or DVT (All Adults) (AHRQ PSI 12)

  14. Does your organization have an aim statement? Which process and outcome measures will you report?

  15. The PDSA Cycle “What will happen if we try something different?” “What’s next? ” “Let’s try it!” “Did it work?”

  16. The Sequence for Improvement Act Plan Study Do Make part of routine operations Sustaining improvements and Spreading changes to other locations Test under a variety of conditions Implementing a change Testing a change Theory and Prediction Developing a change

  17. Repeated Use of the PDSA Cycle for Testing Model for Improvement What are we trying to accomplish? How will we know thata change is an improvement? What change can we make that will result in improvement? Changes That Result in Improvement Spreading DATA Sustaining the gains Implementation of Change Wide-Scale Tests of Change Hunches Theories Ideas Sequential building of knowledge under a wide range of conditions Follow-up Tests Very Small Scale Test

  18. Guidelines For Testing Change • Do not try to get buy-in, consensus • Be innovative to make the test feasible • Collect useful data during each test • Test over a wide range of conditions

  19. Guidelines For Testing Change • Fail early, fail often • What can we do by next Tuesday? • Pick willing volunteers • AIM big, but test small • Steal shamelessly

  20. Remember to. . . • Adapt • Adopt • Abandon

  21. Common Traps • Plan Do, Plan Do • Do Act, Do Act • No testing, only data collection • No ramps of tests, random PDSAs • Undisciplined PDSAs, no documentation • No prediction – what are we going to learn? • Beware of Cycles longer than 30 days

  22. Tips for Testing • Use a form to document your test. • Scale down – think “Drop Two.” • Oneness • Know the situation in your organization.

  23. Value of “Failed” Tests • Learning • Accelerate development • Innovation • Do something. If it works, do more of it. If it doesn't, do something else. • Franklin D. Roosevelt

  24. Failed Test…Now What? • Be sure to distinguish the reason: • Change was not executed • Change was executed, but not effective • If the prediction was wrong – not a failure! • Change was executed but did not result in improvement • Local improvement did not impact the secondary driver or outcome • In either case, we’ve improved our understanding of the system!

  25. Rapid Cycle Test of Change • What are you going to test? • What do you need to conduct the test? • Who will be involved in the test? • How will you educate & inform the participant(s)? • Where will the test occur? • When will the test occur? • How will you know if you’ve been successful?

  26. Rapid Cycle Test of Change

  27. Improvement Project Worksheet

  28. Share . . .

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