1. Planning a Test of Change Using the PDSA Framework
Scottish Improvement Skills
Planning a Test of Change Using the PDSA Framework
SIS: Group D Using the PDSA framework Measurement: Module – Planning using the PDSA framework: Facilitator
In this module, we going to look at an example of planning a test of change using the pdsa framework

2. Model for Improvement The Improvement Guide Langley J et al 2009
Aim of this module
As stated in learning outcome on slide 4
Key message
In terms of the Model for Improvement, we are now moving away from the ‘thinking’ part of the Model for Improvement on to the ‘doing’ part of Model for Improvement – the PDSA cycle
The Improvement Guide Langley J et al 2009

3. System of Profound Knowledge
Aim of this module
As stated in the learning outcome on the next slide
Key messages
In terms of the SoPK, the PDSA cycle involves consideration of all components of the System of Profound Knowledge:
You are testing your theory of knowledge
You need to consider how to engage people in your test
You collect and analyse data, taking into account your understanding of your system.
Deming 2000

4. Planning a test of change using the PDSA framework
By the end of this session you will be able to:
explain all stages of the PDSA framework to others (planning, including theory and prediction; analysing results; applying learning to next cycles)
Lead facilitator will read through the learning outcome or ask the participants to read

5. Aim (overall goal for this project) Lose 7 lbs Change idea
Apples instead of biscuits
Aim for this test of change
What questions do you want answered for this test of change?
Tomorrow, eat an apple instead of biscuits
1. How will I feel emotionally before, during and after eating the apple?
2. How will I feel physically after eating the apple?
DISCOVERY
Aim
Participants to be able to describe the key components and structure of the PDSA approach.
Timing
minutes for the three slides using the ‘New Healthier me’ example of a PDSA cycle
Key messages:
State the aim for the overall project, and specific aim for this test based on the change idea that you are testing. Have a clear link from your project aim, through change idea to test of change
Be clear about what questions you want to answer.
Material
PDSA template (one copy here to make notes on)
Lead facilitator
We are going to use the ‘New Healthier Me’ example, where Vanessa wants to lose 7lbs to look at how we use the PDSA framework.
We are using a standard template to plan and record the different stages of this PDSA framework, and that is what we will see on the next three slides
Lead facilitator talk through this slide and the following 2 slides, as Vanessa’s story, to demonstrate how the different components of the PDSA framework work.

6. Plan Person responsible When to be done Where to be done
Predict what will happen when the test is carried out.
Measures to determine if prediction succeeds
1. I’ll feel pleased that I did it.
2. I’ll still feel hungry.
3. I’ll eat the apple.
Emotional state on a 1-5 scale
Energy level on a 1-5 scale
Number of apples eaten
List the tasks needed to set up this test of change.
Person responsible
When to be done
Where to be done
a. Buy apple
b. Don’t buy biscuits
c. Don’t accept biscuits offered by colleagues Me
Before work
All day
Corner shop
Anywhere
Key messages
What do you predict will happen when you carry out this test – your theory?
How will you know if your prediction succeeds – importance of measures.
Importance of prediction to learn from your tests and build knowledge
Note that numbering predictions is threaded throughout the rest of the pdsa template
Note that a change may mean needing to stop doing something usually done as well as start doing something different
You need to plan your test- what tasks are required, when, where and by whom?
Lead facilitator
Lead facilitator talks through this slide

7. Describe what happened when you ran the test. Do
Describe what happened when you ran the test.
 Ate 1 biscuit, then thought I might as well eat another. Ate another.
Study
Describe the measured results and how they compared to the predictions.
1. Felt miserable before. Didn’t enjoy biscuits. Felt guilty after.
2. A bit buzzy.
3. No apples eaten
Act
Describe what modifications in the plan will be made for the next cycle from what you learned.
 Eat one apple and one biscuit tomorrow.
Key messages
Do - What happened when you ran the test? This should include anything relevant, including things you may not have included in your plan.
Study – what were the results of your test and how did they compare with your predictions?
Act – Based on what you have learned from this test what will you do next time?
Lead facilitator talk through this slide

8. Scale and sequence of tests
On Mon & Weds, eat apples for snacks.
Lose 10lb in three months.
On Mon, Tues, Weds & Thurs, eat apples for snacks.
Tomorrow, eat an apple instead of biscuits.
Within one month replace all biscuit snacks with apples.
Aim
Participants apply ‘how good, by when?’ aims to their project at different levels.
Participants start tests of change at an appropriate scale, and scale up appropriately.
Key messages
Start with small scale tests e.g test one time, with one patient
Gradually increase the scale of your tests as you learn from previous tests. NB You learn something from every test. If a test ‘fails’, your scale may go down for the next cycle.
Timing
5 minutes
Lead facilitator
We are still looking at Vanessa’s weight and health project, a New Healthier Me.
Elicit: On this list, which of these is a test of change?
Answers - a, c, d
Elicit: What are the other items on the list?
Answers:
b – project aim
e – this is an example of an aim that is somewhere between a project aim and an aim for a test of change. It’s sometimes called a ‘process aim’ – it refers to one particular change idea (process).
Elicit: Which of the three tests of change would you expect to do first, second, third and why?
1 – d
2 – a
3 – c

9. Prediction
Aim
Participants don’t plan PDSA cycles in isolation, but have some idea of what they will test next, depending on the outcome of the current cycle.
Key messages
It can be tempting to Plan – Do – Plan – Do and omit the Study and Act elements of the cycle
Have a rough idea of where you are going with testing and be prepared to change if current tests do not go to plan
Predict in detail one step at a time to support learning and don’t predict further until you have some data to analyse and are starting to plan the next test of change.
Many tests of change fail and you can learn a lot from this.
Timing
5 minutes
Lead Facilitator
Talk through the slide to illustrate different results that may arise following initial tests and what different options for next steps could be be depending on results of these tests

10. Planning a Test of Change Using the PDSA Framework: Summary
Where to use PDSA Framework
Elements of PDSA Framework
Scale and sequence of tests
Planning future tests
Aim
To briefly recap the session content to support a sense of learning and accomplishment and to aid recall following the session
Provide the opportunity for participants to ask any outstanding questions
Timing
1- 5 minutes depending on questions asked
Lead Facilitator
Elicit the content covered in each of the bullet points, for example:
How is PDSA associated with the Model for Improvement?
What does abbreviation PDSA stand for?
Why is prediction important?
What elements of the PDSA cycle is it easy to omit?
What can you tell me about the scale of first tests?