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So Now You Have To Lead Your Team Through the Model for Improvement

So Now You Have To Lead Your Team Through the Model for Improvement. Debbie Barnard, SHN PM, CPSI Dannie Currie, SIA Atlantic Node October / November 2007. Objectives. Each participant will be able to: Coach others on the Model for Improvement structure

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So Now You Have To Lead Your Team Through the Model for Improvement

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  1. So Now You Have To Lead Your Team Through the Model for Improvement Debbie Barnard, SHN PM, CPSI Dannie Currie, SIA Atlantic Node October / November 2007

  2. Objectives Each participant will be able to: • Coach others on the Model for Improvement structure • Evaluate and critique aim statements • Evaluate and critique a team’s measurement strategy • Coach teams on the use of the PDSA cycle • Help teams design small scale PDSA cycles for initial tests of change • Help teams design a series of PDSA cycles to implement a change idea Source: Daniel, Donna, “Teaching the Model for Improvement” Collaborative Sponsor Training

  3. Introduction Source: Daniel, Donna, “Teaching the Model for Improvement” Collaborative Sponsor Training

  4. Model for Improvement* • A simple yet powerful tool for accelerating improvement • The model has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes *Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP **The Plan-Do-Study-Act cycle was developed by W. E. Deming

  5. Model for Improvement* • The model has two parts: - Three fundamental questions, which can be addressed in any order. - The Plan-Do-Study-Act (PDSA) cycle** to test and implement changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement. *Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP **The Plan-Do-Study-Act cycle was developed by W. E. Deming

  6. Key ConceptsThree Basic Questions Source: Daniel, Donna, “Teaching the Model for Improvement” Collaborative Sponsor Training

  7. Evaluating Aim Statements • Does the aim statement include recommended elements? • What is expected to happen • The system to be improved • The setting or sub-population of patients • Specific numerical goals • Guidance for the activities such as strategies for the effort and limitations • Is the aim specific enough to be accomplished in the Collaborative time frame? • Does the team match the aim? • Are the goals and population consistent with the mission for the Collaborative?

  8. How Do We Know That a Change Is an Improvement? • The SHN campaign is about making changes to systems, not measurement. But measurement plays a key role role: • Key measures are required to assess progress on team’s aim • Specific measures can be used for learning during PDSA cycles • Balancing measures are needed to assess that other parts of the system are not being negatively impacted.

  9. What Are We Trying to Accomplish? An aim statement should include: • What is expected to happen • The system to be improved • The setting or sub-population of patients • Goals • Guidance for the activities such as strategies for the effort and limitations

  10. What Changes Can We Make That Will Lead to Improvement? • Change Concept: a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement.

  11. Types of Measures

  12. Methods of Measurement • Clinical measures of patients health • Documentation of behaviors • Questionnaires • Assessments • Summary of databases • Chart audits • Observations

  13. Measurement Guidelines How will we know that a change is animprovement? • The Vital Few: a few key measures that clarify a team’s aim and make it tangible • Balanced set of measures • Process, Outcome, Balancing • Integrate measurement into the daily routine

  14. Outcome vs. Process Measures Outcome = Represents the customer / patient: • How is the system performing? • What is the result? • How is the health of the patient affected? What the CEO/Administrator/Director ultimately wants to know Process = Represents the workings of the system: • Are the parts / steps in the system performing as planned? • Are key changes being implemented in the system?

  15. Conceptual, Vague, Strategic Specific Ideas, Actionable Improve Redesign process Move steps in the process closer together Move order receipt and warehouse closer together Move the fax that receives orders into the warehouse Write a work order to have the fax moved on Monday Concepts to Ideas

  16. Key ConceptsPlan, Do, Study, Act Source: Daniel, Donna, “Teaching the Model for Improvement” Collaborative Sponsor Training

  17. What are we trying toaccomplish? Aims Thethreefundamentalquestions forimprovement How will we know that achange is an improvement? Measurement What changes can we make that will result in the improvements we seek ? Act Plan Study Do Model for improvement Ideas, evidence, hunches, Other people etc. The fourthquestion:how to make changes Langley, Nolan et al 1996

  18. Cycles for Testing • Increase your belief that the change will result in improvement • Document how much improvement can be expected from the change • Learn how to adapt the change to conditions in the local environment • Evaluate costs and side-effects of the change • Minimize resistance upon implementation

  19. To Be Considered a PDSA Cycle: The test or observation was planned (including a plan for collecting data) The plan was attempted (do the plan) Time was set aside to analyze the data and study the results Action was rationally based on what was learned

  20. Attributes of Changes That Are Readily Adopted* • The change has a clear advantage over the current system • The change is compatible with current system and values • The change is easy to try and reverse • Understanding and adapting the change requires minimum complexity • The change and its impact can be observed *From Everett Rogers “Diffusion of Innovations”

  21. What is the PDSA Cycle? 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

  22. Tasks at Each Station Act Plan Plan a test (change, theory, prediction) Record plan on planning sheet Keep changes, modify, abandon? Study Do Plot data, interpret results. Compare data to predictions Modify your plane to Incorporate your changes; fly 3 times; record data, unusual events

  23. Testing on a Small Scale • Have others that have some knowledge about the change review and comment on its feasibility • Test the new product or the new process on the members of the team that developed the change before introducing it to others • Incorporate redundancy in the test by making the change side-by-side with the existing process or product

  24. What is the PDSA Cycle? 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

  25. Tasks at Each Station Act Plan Plan a test (change, theory, prediction) Record plan on planning sheet Keep changes, modify, abandon? Study Do Plot data, interpret results. Compare data to predictions Modify your plane to Incorporate your changes; fly 3 times; record data, unusual events

  26. A P S D D S P A A P S D A P S D Repeated Use of the PDSA Cycle Changes That Result in Improvement DATA Implementation of Change Wide-Scale Tests of Change Follow-up Tests Hunches Theories Ideas Very Small Scale Test

  27. A P S D D S P A A P S D A P S D Repeated Use of the PDSA Cycle to Improve LOS for ED patients with X-rays Changes That Result in Improvement EXAMPLE DATA Cycle 1d: Make quick-look standard practice and monitor Cycle 1c: Redesign viewing area and continue quick-look for two weeks Cycle 1b: Revise documentation process and try quick-look for two days Theories Ideas Cycle 1a: Pilot quick-look for extremity x-rays on one shift. Monitor LOS for patients with x-rays and error rate. Review results with Radiology

  28. Decrease the Time Frame for a PDSA Test Cycle • Years • Quarters • Months • Weeks • Days • Hours • Minutes Drop down next “two levels” to plan test cycle!

  29. Successful Cycles to Test Changes • Plan multiple cycles for a test of a change • Think a couple of cycles ahead • Scale down size of test (# of patients, location) • Test with volunteers • Do not try to get buy-in, consensus, etc. • Be innovative to make test feasible • Collect useful data during each test • Test over a wide range of conditions

  30. Testing on a Small ScaleCont. • Conduct the test in one facility or office in the organization, or with one customer • Conduct the test over a short time period • Test the change on a small group of volunteers • Develop a plan to simulate the change in some way

  31. Reasons for Failed Tests • Change not executed well • Support processes inadequate • Hypothesis / hunch wrong: • Successful change did not result in local improvement • Local improvement did not impact global measure Collect data during the “Do” phase of the cycle to help differentiate these situations.

  32. Cycles for Implementation • The change is permanent - need to develop all support processes to maintain change • High expectation to see improvement (no failures) • Increased scope will lead to increased resistance • Generally takes more time than tests

  33. EXERCISE Building Planes and Flying in the Alaska Bush Original Work Developed by IHI.org

  34. Key Activities Review baseline data Study change ideas Learn about Model for Improvement

  35. Problem Short flight distances Nose dives Wanders off-target Changes Use heavier paper Change launch angle Add tape weight to rear Reinforce plane body with clips What the Experts Know “Change Package”

  36. Debbie Barnard, MS, CPHQ Project Manager Safer Healthcare Now! Canadian Patient Safety Institute Suite 1414, 10235 101 Street Edmonton, Alberta T5J3G1 Phone: 780-498-7259 or 1-866-421-6933 Fax: 780-409-8098 Email: dbarnard@cpsi-icsp.ca Website: www.patientsafetyinstitute.ca Questions/Comments The Canadian Patient Safety Institute would like to acknowledge funding support from Health Canada. The views expressed here do not necessarily represent the views of Health Canada

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