1. Overview: Plan-Do-Check-Act Cycle.
Patricia G. Porter, RN, MPH, CHES

2. Overview Background Phases and steps of the PDCA Cycle
Introduction to a QI Tool: Force Field Analysis
Force Field Analysis: Let’s practice

3. Background Walter Shewhart (1920’s) W. Edwards Deming (1950’s)
Common models vary # of steps
Structured QI tools and techniques
Examples:
Force Field Analysis
Nominal Group Technique

4. Four Phases of PDCA Cycle
Plan a change aimed at improvement
Do – Carry out the change
Check/Study the results
Act - Adopt, adapt, or abandon

5. PDCA Cycle Start PLAN ACT DO CHECK 3. Identify root causes
1. Select improvement opportunity
2. Analyze current situation or process
3. Identify root causes
4. Generate and
choose solutions
5. Map out and implement a trial run
6. Analyze the
results
7. Draw conclusions
8. Adopt, Adapt or Abandon
9. Monitor;
hold the gains
ACT DO
CHECK
PLAN
Start

6. Plan: (1) Select Improvement Opportunity
Generate list and select
Redefine team
Write problem/opportunity/aim statement
Management review and support
When planning, some of the ways to gather thoughts are:

7. Plan: (1) Select Improvement Opportunity Common Selection Criteria
Controllable
Measurable results identifiable
Achievable
Data available or easy to capture
Resource availability
Significant importance
Highly visible
High volume
High risk
Problem prone/variation
Timely completion
Probability for success
Team motivation and involvement
Senior Mgt. support

8. Plan: (2) Analyze Current Situation
Define process/problem to be solved
Identify the customer(s).
Baseline data
Performance gaps?
Look at benchmarks, standards, regulatory requirements
Composition of team?
Validate problem and statement
Management review

9. Plan: (3) Identify Root Causes
Very important step
Analyze cause and effect relationships
Fishbone diagrams
Select root cause
Shared decision making
Unbiased and reliable data to verify
Baseline data
Management review

10. Plan: (4) Generate and Choose Solutions
Generate list and select solutions
Directly linked to root cause and supported by data
Team brainstorming and shared decision making
Consider best practices
Be honest about barriers
Change is hard!!
Choose best solution based on criteria
Shared decision making is key to buy-in!
Define and map out solution
Plan to measure (SMART objectives)
Handoffs, resources, outputs, accountabilities
Management review

11. PDCA Cycle Start PLAN ACT DO CHECK 3. Identify root causes
1. Select improvement opportunity
2. Analyze current situation or process
3. Identify root causes
4. Generate and
choose solutions
5. Map out and implement a trial run
6. Analyze the
results
7. Draw conclusions
8. Adopt, Adapt or Abandon
9. Monitor;
hold the gains
ACT DO
CHECK
PLAN
Start

12. Do: (5) Map Out and Implement a Trial Run
Map out a trial run
Communication and education/training are key
Be specific
New forms, handoffs, data etc.
Implement trial run
Small scale but representative
Tests the intervention on a small scale to ensure change will produce desired output

13. PDCA Cycle Start PLAN ACT DO CHECK 3. Identify root causes
1. Select improvement opportunity
2. Analyze current situation or process
3. Identify root causes
4. Generate and
choose solutions
5. Map out and implement a trial run
6. Analyze the
results
7. Draw conclusions
8. Adopt, Adapt or Abandon
9. Monitor;
hold the gains
ACT DO
CHECK
PLAN
Start

14. Check: (6) Analyze the Results
Collect and evaluate results
Team-based analysis and beyond
Flexible and inclusive
Objective and subjective data
Revisit process as it was mapped out
Be honest!

15. Check: (7) Draw Conclusions
Team-based discussion and beyond
Did the desired change occur?
Did the intervention go as planned?
Was the root cause eliminated?
Are outcomes generalizable?
What worked?
What didn’t work?
What could be improved/changed?
What did we learn?

16. PDCA Cycle Start PLAN ACT DO CHECK 3. Identify root causes
1. Select improvement opportunity
2. Analyze current situation or process
3. Identify root causes
4. Generate and
choose solutions
5. Map out and implement a trial run
6. Analyze the
results
7. Draw conclusions
8. Adopt, Adapt or Abandon
9. Monitor;
hold the gains
ACT DO
CHECK
PLAN
Start

17. Act: (8) Adopt, Adapt, or Abandon the Intervention
Team-based discussion and beyond
Adopt
Test again on a larger scale?
Communication, education, and training
Plan to measure
Adapt
Revise plan and repeat trial
Abandon
Revisit root cause analysis and/or list of solutions
Need additional/new members on the team?

18. Act: (9) Monitor; Hold the gains
Standardize the change
Ongoing training
Change to department policy?
Continue to monitor improvement
Same data collection tools and process
Additional metrics?
Continue reporting to staff and management
Move to new improvement opportunity

19. Sage Advice  Team members need to own problem and solution
Don’t sacrifice the process for the product!
Be data driven/evidence-based
Conduct a thorough root cause analysis
Solution directly related to root cause -- not predetermined
Plan to measure
Communication and feedback
Celebrate teamwork and outcomes
Management support and buy-in are critical

20. Questions/Comments??

21. QI Tool: Force Field Analysis
Review overview handout in packet
Break into 4 groups

22. Group Practice: Force Field Analysis
Desired state:
“Achieving a Quality Improvement Culture”
Step 1: Break into 4 groups (corners of room)
Facilitator/recorder
Everyone participates!!!!!
Step 2: Identify (10 min)
What are driving forces?
What are restraining forces?

23. Group Practice: Force Field Analysis
Step 3: Prioritizing and Planning
Identify top 3 driving forces and what could be done to strengthen them; facilitate movement towards the desired state.
Identify top 3 restraining forces and what could be done to modify or eliminate them; facilitate movement towards the desired state.

24. Group Practice: Force Field Analysis
Step 4: Report out on:
Top 3 driving forces and what could be done to strengthen them; facilitate movement towards the desired state. (Front of room)
Top 3 restraining forces and what could be done to modify or eliminate them; facilitate movement towards the desired state. (Back of room)
Step 5: Group discussion: Next steps to achieve a quality improvement culture.

25. Desired State: Quality Improvement Culture
Leadership and infrastructure that supports QI
Staff training
Shared decision making
Data drive and evidence-based decision-making
Accountability
Proactive approach to improvement
“QI not a burden but a way of working smarter and making jobs easier”

26. Questions/Comments??