Presentation on theme: "Tools for Change Plan, Do, Study, Act The PDSA Cycle Explained"— Presentation transcript:
1Tools for Change Plan, Do, Study, Act The PDSA Cycle Explained Ronnie VinerAssistant Collaborative Director
2AimsUnderstand why we need to research, analyses, plan and structure changeAppreciate the need for measurementValue the use of tools in changing systemsExplain the purpose of the PDSA cycles
3Understanding systems We use systems in everything we doTo make successful changes you must set out to change the systemTo succeed you must try and try againChanges should be maintained and monitored
4Changing systems Change can be exciting but also threatening Change takes time in systems and in peopleChange means testing things out in the reality of their own setting
5Three fundamental questions What are we trying to achieve?Understand the problem. Know what you are trying to achieve. Have clear and desirable aims and objectivesHow will we know that a change is an improvement?Measure processes and outcomesWhat 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?
6How has it been done so far? What is the best way to approach change that results in improvement?Trial & error?ChaosToo much action, not enough thinking“Something must be done, this is something therefore we must do it…”Detailed prior study?ParalysisToo much thinking, not enough action“We can’t do anything until we know exactly what to do…”‘Trial & Learning’ Approach
7‘Trial & Learning’ component parts Setting challenging aimsIs it worth doing? Not “change for change sake”Identifying principles/change ideasWhat has worked for someone? What might work for us?Measuring progressKnowing what’s happeningTesting changesStarting small, reducing riskImplementing and sustaining changeChange in systems and routines. Developing skills and abilities
8PDSA What changes are to be made? Next cycle? Objective Questions/predictionsPlan to carry out the cycle (who, what, where, when?)Plan for data collectionCarry out the planDocument problems and unexpected observationsBegin analysis ofthe dataComplete the analysis of the dataCompare data to predictionsSummarise what was learned
9Defining the problem Getting Information Set impossible timescales Always speak to someone differentDidn’t specify what I wanted properlyDidn’t check often enoughNot got an accurate briefDidn’t give manager enough timeAm I dealing with really urgent work?Not sharing the workloadHaven’t planned time available wellWaiting for line manager’s approvalOther deadlines
10What should a PDSA look like? ObjectiveDefine the problemWhat are you trying to achieve?PlanWho, what, where, when?MeasurementDoJust do itStudyWhat worked? What didn’t?ActNext steps
12Example of a PDSA cycle Objective Plan To improve BP control for patients with CHD in line with the NSFPlanPractice Manager to identify 5 CHD patients from theCHD register with BP greater than 140/85 by 24th MayReceptionists to contact patients by telephone to offerappointments with the Practice NurseMeasure date of last attendance, BP, medicationcompliance
13Example of a PDSA cycle Study Two additional patients were seen opportunisticallySix patients seen and one did not attendAll patients had been seen in previous 4 monthsControl of BP had been difficult:4 patients were overweight, 1 obeseAll patients did very little or no physical exerciseAll patients except one reported that they comply with medication
14Example of a PDSA cycle Act Medication compliance is difficult to assess: arrange meeting with doctors to discuss alternative methods of compliancePatients to be followed up more frequently by Practice NurseExercise programme aimed at this group to be consideredDoctors to review medication again at the next follow-up visit
15Developing improvement with PDSAs PLANDOSTUDYACTAccumulating information and knowledgeTesting andrefining ideasImplementing newprocedures & systems- sustaining changeBrightidea!
16Developing improvement with PDSAs Brightidea!PDSAImprovement?
17PDSA cycles Have a long pedigree Are similar to techniques such as audit cycles, ‘plan-do-check’, etc.‘Natural’ to health careSmall in scope and build incrementallyHave methodological validityUsed and developed by participants in the Collaborative
18Advantages of the PDSA approach Makes processes and learning explicit ...which is especially useful for team workingEnables testing of ideas to: - customise change for/ to local conditions - evaluate ‘side-effects’ - improve the idea based on learning - reduce risksMinimise problems with getting started - persuading the reluctant - longest journey/first step stuffPromotes ‘bite sized chunks’
19Task: to complete a PDSA within a week Work in pairsIdentify and define a shared problemStart to think about solutionsDevelop a ‘Plan’ for a PDSA to be completed in no more than 1 week
20Summary Improvement requires change to systems PDSAs are a tool that help you bring about change in a practical, useful, manageable and managed wayStarting points: remember the three fundamental questions to guide changeRemember that you will never know whether the change is better unless you measureKeep up the momentum and don’t forget to record what happens