1. PI Model
Mike Davies, MD FACP

2. “Improving our work IS our work, not a distraction from work!”
“All teach all learn”
“Healthcare is a team sport”

3. Discussion
Think of a “big change” that was not implemented very well….
What Went Wrong?

4. Why change strategies often don’t work
Lots of planning then lots of implementing
Analysis paralysis
Lack of consensus on problem and solution
Risky change process

5. Why change strategies often don’t work
Pushing one solution/idea
One person’s perspective
How do we know it works?
Lack of agreement
Ignores all of the context/circumstances

6. Improvement Involves “Experimentation”
Setting aims/goals
Generating ideas
Testing
Measuring progress
Reflection

7. Lots of activity doesn’t necessarily mean lots of improvement!
Focus changes on aims and goals
Are the changes we’re making really an improvement (according to the aims and goals)?
Avoid the “my idea” trap
Take the emotion out – Measure!
-“It is not enough to be busy, so are the ants. The question is, what are you so busy about?”
Thoreau

8. 3 Questions What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?
Nolan

9. A Model for Improvement
What is our aim?
How will we know a change is an improvement?
What changes can we make to make an improvement?
Plan the test: the experiment
Act differently
the next time
ACT
PLAN
STUDY DO
Execute it
Assess the
results
Langley, Nolan, et.al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass. San Francisco, CA. 1996

10. The ‘unofficial version’!
Hunch
What could be happening here?
Test
Let’s try something different
Reflect
How did it work?
Change
Should we keep doing it?
From Sarah Frasier

11. Review

12. “Kinds” of Data Judgment Improvement Research Performance appraisal
“do something TO you”
Improvement
Process improvement efforts
“do something WITH you”

14. Repeated Use of the PDSA Cycle
Changes That Result in Improvement
Repeated Use of the PDSA Cycle A P S D
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Model for Improvement
DATA D S P A
Implementation of Change A P S D
Wide-Scale Tests of Change A P S D
Review
Follow-up Tests
Hunches Theories Ideas
Very Small Scale Test

15. PDSA Cycles Are Not Plans! Are small in scale
Thinking months – think weeks; thinking weeks – think days; thinking days – think hours
Thinking facility – think unit; thinking unit – think teams; thinking teams, think ONE team
Thinking all patients – think a type of patient; thinking a type of patient, think a sample; thinking sample then 3-5 may be enough

16. Exercise AIM- find the rule underlying a series of numbers
Measure - feedback from the instructor
Changes - are new ideas suggested by the team

17. PDSA Test Results

18. Repeat PDSA Changes Hunch Theory Idea DATA Implementation Wider Tests
Follow-up Tests S A
Small Scale Test

19. How to Implement a Change
High
Successful
Change
Belief that
change will
result in
improvement
Still Needs Further Testing
Unsuccessful Change
Low
Developing
Testing
Implementing
From Lloyd Provost

20. P A D S P A P D A S P A D P S A P D A S D S D P S A A P P A D S S A D P S A P D A S S A A P
Balance
Demand
And Supply S A
Decrease
Appt. Types
Decrease
Demand

21. Readiness for Change
From Lloyd Provost

22. Review

23. Successful PDSA Think multiple tests over wide range of conditions
Think a couple of PDSA’s ahead
Scale down the size
Learn from the last experience

24. 3 Questions What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?
Nolan

25. Change Thinking It is NECESSARY to be successful
So….. get started!
It may not be SUFFICIENT to be successful only a few times
So……keep going!
Build up data, experience and evidence over time!
This is true learning!

26. Summary Keep focused on Aim – Measure – Change
Changes are “small experiments”
Experiment wisely – PSDA
Learn from small changes over wide conditions before implementing widely
Get started and keep going