What is The Model for Improvement?

Model for Improvement Plan Do Study Act Small tests of change

A typical approach This slide shows how previous attempts at change and improvement have been designed Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). Cambridge, Massachusetts: Institute for Healthcare Improvement; 2008. Available: www.ihi.org p26

An Applied Science Approach This slide shows how improvement can be achieved using small tests of change Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). Cambridge, Massachusetts: Institute for Healthcare Improvement; 2008. Available: www.ihi.org p26

Why Test Changes? To learn how to adapt the change to conditions in your setting To increase the belief that the change will result in improvements in your setting To evaluate the costs and “side-effects” of changes Overall a fundamental part of reliable implementation which will minimise the resistance when spreading the change throughout the organisation. Why test changes? The more you test it and the more positive changes you make, the better the end result will be.

You can only learn as quickly as you test.

THE VALUE OF “FAILED” TESTS “I did not fail one thousand times; I found one thousand ways how not to make a light bulb.” Thomas Edison

“failing towards success” Brent James is Chief Quality Officer based at intermountain healthcare – he and his teams actively celebrate failure – because failure represents the learning…

What will happen if we try something different? The PDSA Cycle What will happen if we try something different? What’s next? PDSAs have 4 parts to the cycle: Plan: Decide what change you will make, who will do it, and when it will be done. Formulate an hypothesis about what you think will happen when you try the change. What do you expect will happen? Identify data that you can collect (either quantitative or qualitative) that will allow you to evaluate the result of the test. Do: Carry out the change. Study: Make sure that you leave time for reflection about your test. Use the data and the experience of those carrying out the test to discuss what happened. Did you get the results you expected? If not, why not? Did anything unexpected happen during the test? Act: Given what you learned during the test, what will your next test be? Will you make refinements to the change? Abandon it? Keep the change and try it on a larger scale? Did it work? Do It !!!

Key Points to Remember PDSA’s cannot be too small One PDSA will almost always lead to another You can achieve rapid results They help you to be systematic & learn from your work Anyone can use them in any area

Start Small 1 patient 1 day 1 admission 1 clinician “If you think we can test the change in a month, what can you test a day from now?” Small scale, quick tests teams are most effective when they move quickly to testing changes (& maintain momentum) best to first test innovative changes on a small scale okay to test multiple changes at once test under a variety of conditions importance of linking tests of change don’t try to get buy-in or consensus for tests (but will be necessary for implementation)

YOU CAN ONLY LEARN AS QUICKLY AS YOU TEST.

You may want to show delegates the October Sky video – ask them to count the number of PDSAs in the clip – this link to the clip is available on the knowledge website

Improve Compliance with Warfarin Guidelines The next few slides are an example of PDSA testing in NHS Lothian

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin Review of records showing compliance will increase

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin Review of records showing compliance will increase Having guidelines within easy access for use backed up with educational event

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin Review of records showing compliance will increase Having guidelines within easy access for use backed up with educational event 1 Review in the practice who uses the Lothian Guidelines

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin Review of records showing compliance will increase Having guidelines within easy access for use backed up with educational event 2 Email all doctors stating the importance and set up PLT around it 1 Review in the practice who uses the Lothian Guidelines

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin Review of records showing compliance will increase Having guidelines within easy access for use backed up with educational event 3 Ensure the Lothian Guidelines are within easy reach for each GP to use 2 Email all doctors stating the importance and set up PLT around it 1 Review in the practice who uses the Lothian Guidelines

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin Review of records showing compliance will increase Having guidelines within easy access for use backed up with educational event 4 Monitor use of Guideline by developing template for computer system 3 Ensure the Lothian Guidelines are within easy reach for each GP to use 2 Email all doctors stating the importance and set up PLT around it 1 Review in the practice who uses the Lothian Guidelines

Improve Compliance with Warfarin Guidelines Ensure all GPs and nurses use the Lothian Guidelines when treating patients on warfarin Review of records showing compliance will increase Having guidelines within easy access for use backed up with educational event Practices engaging with process 4 Monitor use of Guideline by developing template for computer system 3 Ensure the Lothian Guidelines are within easy reach for each GP to use 2 Email all doctors stating the importance and set up PLT around it 1 Review in the practice who uses the Lothian Guidelines

Any Questions?