P-D-S-A CyCles the art + Science of improvement Developing changes that are new, by definition, requires a creative effort = the art of improvement Studying them forces us to consider the science of improvement Today I’m presenting a short primer on PDSA Cycles because many people are familiar with the term but it is widely misunderstood and misused. To me, it is probably the most vital part we glass over or rush through with any QI effort. Though its meant to promote rapid cycle testing, sometimes the cycle takes longer than we anticipated. Diane Liu, MD Director, UPIQ Utah Pediatric Partnership to Improve healthcare quality

Principles of improvement Knowing why you need to improve Having a feedback mechanism to tell you if the improvement is happening Developing an effective change that will result in improvement Testing a change before implementation Knowing when and how to implement change From The Improvement Guide Langley and Provost page 25 “Key Points from Chapter One)

SCIENCE of IMPROVEMENT - Hypothesis What changes can we make that will result in an improvement? PREDICTIONS! Once you select a change idea, it is time to turn ideas into action and connect action to learning Enter the PDSA cycle! ACTION IDEAS LEARNING

PDSA shorthand for testing a change Plan developing a plan to test the change Do carrying out the test Study observing and learning from the consequences Act take action; determining what modifications should be made to the test (source IHI.org) Using the cycle does take discipline and effort as a method for organizing learning, testing, and implementing during an improvement project.. The cycle is most often used to: To Build knowledge to help answer any one of the 3 questions To test a change To implement a change The PDSA cycle creates a structure for both testing and implementing change

The Improvement Guide Langley/Provost PDSA project planning forms or rods cycle form with checklist format SOURCE: The Improvement Guide Langley/Provost

Example of using PDSA worksheet (from IHI) to track change idea

Knowledge is gained sequentially REMEMBER Improvement is an outcome of the application of (appropriate) knowledge Knowledge is gained sequentially All improvement occur due to changes but not all changes lead to an improvement

Learning and Improvement Theories, hunches, and best practices 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 Breakthrough Results A P S D Evidence & Data D S P A Wide-scale implementation of change A P S D This is how we use PDSAs in practice. We start with some hunch or theory (our predictions; the change ideas) and we test on a very small scale. We evaluate the data from that test and plan the next test; and so on. We don’t implement any change until we have done the sequential building of knowledge we get from running PDSA cycles. Let’s run through an example: Learning and Improvement Test new conditions A P S D Sequential Building of Knowledge with multiple PDSA Test Cycles Figure 7.2 ‘The Improvement Guide’ Langley, et al. 2009 Follow-up tests Theories, hunches, and best practices Small Scale Testing

QUESTIONS? Diane.Liu@hsc.utah.edu THANK YOU! QUESTIONS? Diane.Liu@hsc.utah.edu Diane Liu, MD Director of The Utah Pediatric Partnership to Improve Healthcare Quality