Developing Learning Cycles

Insights from Science of Improvement Understand interdependencies in the components of the system where the changes are being made Understand the relationship between prediction and knowledge of the system being changed and how predictions about the changes build knowledge Understand the temporal effect of changes made in the system (variation) Understand how separating variation of outcomes of a process or system into common and special causes helps to decide appropriate actions (variation) Understand how to integrate changes in the social system (psychology) Improvement Guide, 2009, p. 140

Gold Standard for Improvement “Satisfactory prediction of the results of tests conducted over a wide range of conditions is the means to increase the degree of belief that the change will result in improvement.” Improvement Guide, 2009, p. 141

Objectives for Test Cycles Increasing degree of belief that the change will result in an improvement Deciding if one or more changes will lead to the desired improvement Deciding which combination of changes will lead to the desired improvement Evaluating how much improvement can be expected if the change is implemented Deciding if the proposed change will work in the actual environment of interest Evaluating cost implications and possible side effects of the change Give individuals a chance to experience the change to minimize resistance upon implementation Improvement Guide, 2009, p. 142

Hints for Planning Useful PDSA Test Cycles Think a couple of cycles ahead of the initial test (future tests, implementation). Scale down the size and decrease the time required for the initial test. Do not require buy-in or consensus as a prerequisite for the test (for instance, recruit volunteers, or run tests to evaluate conflicting ideas). Use temporary supports to facilitate the change during the test. Be innovative to make the test feasible. Improvement Guide, 2009, p. 143

What if a PDSA Test is not Successful? Three Possible Reasons: 1. The change was not properly executed. 2. The support processes required to make the change successful were not adequate. 3. The change was executed successfully, but the predicted results did not occur. Make sure information is collected in the “do” step to help indentify which of these has occurred. Improvement Guide, 2009, p. 143

7 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

Predicted Outcome: Actual Outcome: Fail Succeed ?? ?? When are our greatest opportunities to learn?

Predicted Outcome: Actual Outcome: Fail Succeed Confirmation: Low opportunity for learning Dis- confirmation: High opportunity for learning

The “Act” Step of PDSA Test Cycles Is further testing needed to increase the team’s degree of belief about the change (for example, testing under different conditions)? Do alternative changes need to be tested? Is it important to learn about other implications (such as costs) of the change? Is the team ready to implement the change on a full - scale basis? Should the team modify the proposed change or develop an alternative change? Should the proposed change be dropped from consideration? Improvement Guide, 2009, p. 144

Principles for Testing a Change 1.Test on a small scale and build knowledge sequentially. 2.Collect data over time. 3.Include a wide range of conditions in the sequence of tests. Improvement Guide, 2009, p. 145

Degree Belief and Next PDSA Cycle Improvement Guide, 2009, p. 144

Building Knowledge with PDSA Tests Hunches, Theories, Best Practices Breakthrough Results AP SD A P S D AP SD D S P A Evidence and data Very Small Scale Test Follow-up Tests Tests under new conditions Wide-scale tests of Change Improvement Guide, Chapter 7, p. 146

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

Designing a Small Scale Test Simulate the change (physical or computer simulation). Have others with some knowledge about the change review and comment on its feasibility. Test the new product or the new process on the members of the team that developed the change before introducing it to others. Incorporate redundancy in the test by making the change side-by-side with the existing process or product. Conduct the test in one facility or office in the organization, or with one customer. Conduct the test over a short time period (one hour or one shift). Test the change on a small group of volunteers. Improvement Guide, 2009, p. 144

Break Out Spend time taking one idea you would like to try out or one prediction which requires information through data collection and complete the PLAN portion of a PDSA cycle to be completed next week. Now think 1 to 2 cycles ahead. What barriers await if you succeed; at a larger scale, under varied conditions, etc.? What conditions are most likely to give you opportunities to learn (i.e. failures)?