1. Improvement Science Consulting Developing concepts of change and PDSA cycles Brandon Bennett

2. Improvement Science Consulting What are we trying to accomplish? Review theories of change Revisit the Model for Improvement Experience leading change Understand the process of transformation

3. Improvement Science Consulting 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 ActPlan StudyDo Langley, et al.

4. Improvement Science Consulting Langley et. al PDSA Learning Cycle: Most important part of any PDSA cycle is the Prediction as it represents current knowledge about how a process or system will behave in the future. When predictions are compared with actual outcomes they can reveal gaps in our current understanding of why a process or system behaves the way it does This comparison/examination generates knew knowledge about what change might work or what modification is needed

5. Improvement Science Consulting Iterative Learning Langley, et al.

6. Improvement Science Consulting The work of improvement Primary Driver 1 Change Idea 1 Change Idea 2 Change Idea 3 Primary Driver 2 Change Idea 1 Change Idea 2 Change Idea 3 Primary Driver 3 Change Idea 1 Change Idea 2 Change Idea 3

7. Improvement Science Consulting And now for Peter

8. Improvement Science Consulting Theory of Change Outcome 1 ⁰ driver 2 ⁰ driver Change Concepts Specific Change Ideas Aim or Outcome 1 ⁰ driver 1 1 ⁰ driver 2 2 ⁰ driver 3 2 ⁰ driver 2 2 ⁰ driver 1 2 ⁰ driver 4 2 ⁰ driver 5 Concept 1 Concept 2 Concept 4 Concept 3 Concept 5 Concept 6 Ideas: 1 2 3 4 5 6 7 8 9. N

9. Improvement Science Consulting What about change concepts? Incomplete list of change concepts 27. Give people access to information Counsel patients on want to expect on Admission Provide electronic patient progress board in surgical waiting area Display patient safety data publically for patients, families and co-workers to see Langley, et al. Develop a radio program Integrate topic in a local soap opera

10. Improvement Science Consulting Where will you intervene? Let theory guide you Outcome of Process Step n…Step 2Step 1

11. Improvement Science Consulting Break out Exercise On your table there is a stack of index cards with numbers written on them Give these to 8 people around your table Each of you has now been assigned a number – you can find your number by locating the middle number on your card (i.e. if your card says 1-4-8, then you are number 4)

12. Improvement Science Consulting Break out Exercise Your current process involves tossing the tennis ball provided from person to person, following the sequence provided on the index cards (i.e. Person 1 tosses to Person 4 who tosses to person 8 and so on, until the ball returns to person 1) Assign a time keeper/ball drop counter (preferably not a ball tosser) Practice your process one time – Time keeper please time how long the team takes to complete the process and the number of times they drop the tennis ball

13. Improvement Science Consulting Break out Exercise Team Aim: We aim to reduce the time taken for every person to touch the ball from X to Y. We also aim to reduce our ball drops from A to B. Form a theory, come up with change ideas, use the MFI to test those ideas Rules: The initial sequence as provided by the cards must be adhered to You may only test one change idea at a time

14. Improvement Science Consulting Break out Exercise CycleChange IdeaTimeBall Drops 1 2 3 4 5 6 7 8

15. Improvement Science Consulting Break out Exercise What is our degree of belief in our changes? Did they lead to the improvement we see? How would I increase my degree of belief if there is doubt about the improvement observed?

16. Improvement Science Consulting Scoping PDSA cycles Learn/Develop change ideas Test under multiple conditions Implement /make permanent P DS A PD S A P D S A P D S A P DS A PD SA P DS A PD SA P DS A PD SA P DS A PD SA P DS A PD SA P DS A P D SA P DS A PD SA P D S A P D S A P DS A P DS A P DS A $ P DS A P DS A P DS A P DS A P DS A P DS A © Improvement Science Consulting

17. Improvement Science Consulting Theory of Change Outcome 1 ⁰ driver 2 ⁰ driver Change Concepts Specific Change Ideas Aim or Outcome 1 ⁰ driver 1 1 ⁰ driver 2 2 ⁰ driver 3 2 ⁰ driver 2 2 ⁰ driver 1 2 ⁰ driver 4 2 ⁰ driver 5 Concept 1 Concept 2 Concept 4 Concept 3 Concept 5 Concept 6 Ideas: 1 2 3 4 5 6 7 8 9. N

18. Improvement Science Consulting The work of improvement Primary Driver 1 Change Idea 1 Change Idea 2 Change Idea 3 Primary Driver 2 Change Idea 1 Change Idea 2 Change Idea 3 Primary Driver 3 Change Idea 1 Change Idea 2 Change Idea 3