Model for Improvement

“The definition of insanity is doing the same thing again and again and expecting a different result” Albert Einstein

Scientific Method Analytic in nature with the focus on the development/discovery of new knowledge

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.

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 Inductive learning begins here

6 Langley et al

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

Appropriate Scope for a PDSA Cycle Current Situation ResistantIndifferentReady Low Confidence that change idea will lead to Improvement Cost of failure large Very Small Scale Test Cost of failure small Very Small Scale Test Small Scale Test High Confidence that change idea will lead to Improvement Cost of failure large Very Small Scale Test Small Scale Test Large Scale Test Cost of failure small Small Scale Test Large Scale Test Implement Staff Readiness to Make Change Langley et. al

Final Thoughts on PDSA The opportunities for learning about many aspects of the change from testing are expected to be significant, including learning from failures. Some percentage of tests—perhaps 25 to 50 percent—is expected to result in no improvement, to “fail,” but to result in substantial learning nevertheless. 9 Langley et al

Let’s try it out 10

Mr Potato Head

Please decide at your table Who will be: –Time Keeper –Quality Assurance Officer –Data Analyst

PDSA Simulation

PDSA Measures Accuracy 3 – All pieces on Mr. P & positioned correctly 2 – All pieces on Mr. P, but one or more is out of place 1 – One or more pieces are not on Mr. P. Time Start: When time keeper says go. Stop: When Assembly indicates last piece is in place AND removes hand.

Plan DoStudyAct PD SA Cy cle # Le velTest Cycle Aim Test Cycle Measures/Learn ing Questions Predicted Cycle Outcomes Capture Relevant Data Observations expected/une xpectedResults Test Cycle Learning Test Cycl e succ essf ul Yes/ No Action Taken Alternate Pathways Uncovered Test Cycl e com plet ed Yes/ No If No, reason 1 2 Start with feet and work to top Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy Time = 120sec Accuracy = 3 2

Plan DoStudyAct PD SA Cy cle # Le velTest Cycle Aim Test Cycle Measures/Learn ing Questions Predicted Cycle Outcomes Capture Relevant Data Observations expected/une xpectedResults Test Cycle Learning Test Cycl e succ essf ul Yes/ No Action Taken Alternate Pathways Uncovered Test Cycl e com plet ed Yes/ No If No, reason 1 2 Start with feet and work to top Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy Time = 120sec Accuracy = 3 Time = 2.37 Accuracy = 3 Struggled to get pieces organized in order. 2

Plan DoStudyAct PD SA Cy cle # Le velTest Cycle Aim Test Cycle Measures/Learn ing Questions Predicted Cycle Outcomes Capture Relevant Data Observations expected/une xpectedResults Test Cycle Learning Test Cycl e succ essf ul Yes/ No Action Taken Alternate Pathways Uncovered Test Cycl e com plet ed Yes/ No If No, reason 1 2 Start with feet and work to top Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy Time = 120sec Accuracy = 3 Time = 2.37 Accuracy = 3 Struggled to get pieces organized in order. Time improved by 20 sec. Accuracy improved from 2 to 3 Organizatio n of parts helps time & accuracy. Yes 2

Plan DoStudyAct PD SA Cy cle # Le velTest Cycle Aim Test Cycle Measures/Learn ing Questions Predicted Cycle Outcomes Capture Relevant Data Observations expected/une xpectedResults Test Cycle Learning Test Cycl e succ essf ul Yes/ No Action Taken Alternate Pathways Uncovered Test Cycl e com plet ed Yes/ No If No, reason 1 2 Start with feet and work to top Can we build Mr P. faster than the demonstrated benchmark and with perfect accuracy Time = 120sec Accuracy = 3 Time = 2.37 Accuracy = 3 Struggled to get pieces organized in order. Time improved by 20 sec. Accuracy improved from 2 to 3 Organizatio n of parts helps time & accuracy. Yes Next test to include orderin g pieces. Need to set order before test. None Yes N/A

3 – All pieces on Mr P & positioned correctly 2 – All pieces on Mr P, but one or more is out of place 1 – One or more pieces are not on Mr P. Time 140 X Second s PDSA Accuracy 3 2 1X PDSA

PDSA Simulation

Accuracy 3 – All pieces on Mr. P & positioned correctly 2 – All pieces on Mr. P, but one or more is out of place 1 – One or more pieces are not on Mr. P. Time Start: When time keeper says go. Stop: When Assembly indicates last piece is in place AND removes hand Mr. P must look exactly like this

3 – All pieces on Mr P & positioned correctly 2 – All pieces on Mr P, but one or more is out of place 1 – One or more pieces are not on Mr P. Time 140 X Second s PDSA Accuracy 3 2 1X PDSA