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Tools for Change Plan, Do, Study, Act The PDSA Cycle Explained Ronnie Viner Assistant Collaborative Director.

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Presentation on theme: "Tools for Change Plan, Do, Study, Act The PDSA Cycle Explained Ronnie Viner Assistant Collaborative Director."— Presentation transcript:

1 Tools for Change Plan, Do, Study, Act The PDSA Cycle Explained Ronnie Viner Assistant Collaborative Director

2 Aims Understand why we need to research, analyses, plan and structure change Appreciate the need for measurement Value the use of tools in changing systems Explain the purpose of the PDSA cycles

3 Understanding systems We use systems in everything we do To make successful changes you must set out to change the system To succeed you must try and try again Changes should be maintained and monitored

4 Changing systems Change can be exciting but also threatening Change takes time in systems and in people Change means testing things out in the reality of their own setting

5 Three fundamental questions What are we trying to achieve? Understand the problem. Know what you are trying to achieve. Have clear and desirable aims and objectives How will we know that a change is an improvement? Measure processes and outcomes What changes can we make that will result in an improvement? What have others done? What hunches do we have? What can we learn as we go along and how?

6 How has it been done so far? What is the best way to approach change that results in improvement? Trial & error? Chaos Too much action, not enough thinking Something must be done, this is something therefore we must do it… Detailed prior study? Paralysis Too much thinking, not enough action We cant do anything until we know exactly what to do… Trial & Learning Approach

7 Trial & Learning component parts Setting challenging aims Is it worth doing? Not change for change sake Identifying principles/change ideas What has worked for someone? What might work for us? Measuring progress Knowing whats happening Testing changes Starting small, reducing risk Implementing and sustaining change Change in systems and routines. Developing skills and abilities

8 PDSA What changes are to be made? Next cycle? Objective Questions/predictions Plan to carry out the cycle (who, what, where, when?) Plan for data collection Carry out the plan Document problems and unexpected observations Begin analysis of the data Complete the analysis of the data Compare data to predictions Summarise what was learned

9 Defining the problem Getting Information Set impossible timescales Always speak to someone different Didnt specify what I wanted properly Didnt check often enough Not got an accurate brief Didnt give manager enough time Am I dealing with really urgent work? Not sharing the workload Havent planned time available well Waiting for line managers approval Other deadlines

10 What should a PDSA look like? Objective Define the problem What are you trying to achieve? Plan Who, what, where, when? Measurement Do Just do it Study What worked? What didnt? Act Next steps

11 Example PDSA form

12 Example of a PDSA cycle Objective To improve BP control for patients with CHD in line with the NSF Plan Practice Manager to identify 5 CHD patients from the CHD register with BP greater than 140/85 by 24th May Receptionists to contact patients by telephone to offer appointments with the Practice Nurse Measure date of last attendance, BP, medication compliance

13 Example of a PDSA cycle Study Two additional patients were seen opportunistically Six patients seen and one did not attend All patients had been seen in previous 4 months Control of BP had been difficult: 4 patients were overweight, 1 obese All patients did very little or no physical exercise All patients except one reported that they comply with medication

14 Example of a PDSA cycle Act Medication compliance is difficult to assess: arrange meeting with doctors to discuss alternative methods of compliance Patients to be followed up more frequently by Practice Nurse Exercise programme aimed at this group to be considered Doctors to review medication again at the next follow-up visit

15 Developing improvement with PDSAs PLAN DO STUDY ACT PLAN DO STUDY ACT PLAN DO STUDY ACT PLAN DO STUDY ACT PLAN DO STUDY ACT PLAN DO STUDY ACT Accumulating information and knowledge Testing and refining ideas Implementing new procedures & systems - sustaining change Brightidea!

16 Developing improvement with PDSAs Bright idea! P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A Improvement P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A ?

17 PDSA cycles Have a long pedigree Are similar to techniques such as audit cycles, plan-do-check, etc. Natural to health care Small in scope and build incrementally Have methodological validity Used and developed by participants in the Collaborative

18 Advantages of the PDSA approach Makes processes and learning explicit...which is especially useful for team working Enables testing of ideas to: - customise change for/ to local conditions - evaluate side-effects - improve the idea based on learning - reduce risks Minimise problems with getting started - persuading the reluctant - longest journey/first step stuff Promotes bite sized chunks

19 Task: to complete a PDSA within a week Work in pairs Identify and define a shared problem Start to think about solutions Develop a Plan for a PDSA to be completed in no more than 1 week

20 Summary Improvement requires change to systems PDSAs are a tool that help you bring about change in a practical, useful, manageable and managed way Starting points: remember the three fundamental questions to guide change Remember that you will never know whether the change is better unless you measure Keep up the momentum and dont forget to record what happens

21 Questions Thank You!


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