1. Plan-Do-Study-Act Cycle and QI Tool Refresher
March 27, 2014

2. WELCOME BACK!

3. Today’s Agenda PDSA Refresher Quality Improvement Application
Quality Improvement Fundamentals
Plan-Do-Study-Act Cycle
Quality Improvement Application
Wrap-up – Questions and Training Post-assessment

4. QI Fundamentals Definition Quality Assurance vs. Quality Improvement
Benefits
Four Basic Principles
3 Key Questions

5. QI in Our Terms
“QI is the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.”
Bialek, R., Beitsch, L. M., Cofsky, A., Corso, L., Moran, J., Riley, W., & Russo, P. (2009).
Proceedings from Accreditation Coalition Workgroup: Quality Improvement in Public Health.

6. QA and QI are Not the Same
Quality Assurance
Quality Improvement
Guarantees quality
Raises quality
Relies on inspection
Emphasizes prevention
Uses a reactive approach
Uses a proactive approach
Looks at compliance with standards
Improves the processes to meet standards
Requires a specific fix
Requires continuous efforts
Relies on individuals
Relies on teamwork
Examines criteria or requirements
Examines processes or outcomes
Asks, “Do we provide good services?”
Asks, “How can we provide better services?”

7. QI Can… Reduce cost and redundancy Eliminate waste
Streamline processes
Enhance ability to meet service demand
Increase customer satisfaction
Improve outcomes!

8. QI - Four Basic Principles
Develop a strong customer (client) focus
Continually improve all processes
Involve employees
Mobilize both data and team knowledge to improve decision-making

9. QI – Three Key Questions
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?

10. Where do we begin? The Plan-Do-Study-Act (PDSA) Cycle
PDSA (also known as Plan-Do-Check-Act (PDCA), was made popular by Dr. W. Edwards Deming
Is widely used by quality professionals, process improvement engineers, & health care professionals
Science based, data driven, iterative process improvement methodology
Turns ideas into action and connects that action to learning

11. PDSA – An Overview Four Stages Nine Steps Repeatable Steps
Can be used by one person, a team, or an agency
Used to improve existing processes

12. Step 1 Step 2 Step 3 Step 4 Step 5 Stage One - PLAN Getting Started
Assemble the Team
Step 2
Examine the Current Approach
Step 3
Identify Potential Solutions
Step 4
Develop an Improvement Theory
Step 5

13. Stage Two - DO
Test the Theory
Step 6

14. Stage Three - STUDY
Study the Results
Step 7

15. Step 8 Step 9 Stage Four - ACT
Standardize the Improvement or Develop a New Theory
Step 8
Establish Future Plans
Step 9

16. QI Toolbox for the PLAN Stage
Team Charter - A Tool to Keep You Organized
Aim Statement - A Tool to Define the Goal
Process Mapping - A Tool to Examine Current Process Flow
Fishbone Diagram - A Tool for Identifying Root Causes
Affinity Diagram - A Tool to Identify Potential Solutions

17. A Tool to Keep you Organized: Team Charter

18. QI Team Charter What is it?
One to two page document that describes the team’s purpose and targeted improvement.
Serves as your team’s roadmap
Helps reduce the “now what?” feeling
Helps the team come to agreement regarding:
Communication
Accountability
Delivery of products
Evolves over the course of the project

19. What to Include: Team sponsor Team members and roles
Problem, issue, or opportunity statement
Description of the process improvement
Aim statement
Customers and their needs
Timeline for completing each stage of the PDSA cycle
Timeline and frequency of team meetings
Internal and external stakeholders
Improvement theories (If…Then)

20. A Tool to Define the Goal: Aim Statement
A concise, specific, written statement that defines precisely what the team hopes to accomplish with its QI efforts.
Remember the three fundamental questions when writing your aim:
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?

21. Aim Statements Include a numerical measure for the target
Are time specific and measurable
Define the specific population that will be affected

22. A Tool to Examine Process Flow: Process Mapping
Analyze and improve processes
Identify areas of complexity and re-work
Generate ideas for improvement
Illustrate process improvements

23. Preparing to Process Map1.
Assemble your QI team 2.
Determine which process needs to be documented 3.
Agree on where the process begins and ends 4.
Agree on the level of detail that will be displayed 5.
Create a list of the steps taken in the current process 6.
Construct your process map by ordering the steps 7.
Identify additional staff to review or provide input on your process map

24. Symbols used to Process Map
Start & End: An oval is used to show the materials, information or action (inputs) to start the process or to show the results at the end (output) of the process.
Activity: A box or rectangle is used to show a task or activity performed in the process. Although multiple arrows may come into each box, usually only one arrow leaves each box.
Decision: A diamond shows those points in the process where a yes/no question is being asked or a decision is required.
Flow: An arrow shows the direction or flow of a process.

26. A Few Hints and Tips Map the current process!
It’s okay if team members have different ideas about how the process works.
Keep steps simple; begin each step with an action verb.
Process mapping is dynamic!
Post-it notes, dry-erase markers, & pencils are your friend!

27. A Tool for Root Cause Analysis: Fishbone Diagrams

28. Fishbone Diagrams - Purpose
To identify and examine underlying or root causes of a problem
To identify a target for your improvement that is likely to lead to change
To explore possible causes of a problem

29. Fishbone Diagrams: Construction
Step 1
Write the Problem/Effect in a box on the far right side of your paper, dry erase board, etc.
Step 2
Draw an arrow (backbone) leading to that box
Step 3
Draw smaller arrows (bones) leading to the backbone, and label these arrows with your major causes
Step 4
For each cause, brainstorm minor causes related to each major cause and note them on the diagram by placing lines on each of the major bones.

30. A Tool to Identify Potential Solutions: Affinity Diagrams
Group 1
Group 2
Group 3
Group 4
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea

31. Affinity Diagram: Purpose
Creatively generate a large number of ideas and organize them into natural groupings among them to understand possible solutions to a problem.

32. Affinity Diagrams: When to Use
To generate consensus
When you need your team to think creatively
To breakdown communication barriers
To allow breakthroughs to emerge naturally
To overcome “team paralysis”

33. Affinity Diagrams: Step by Step
Phrase the issue under discussion as a full sentence
Step 2
Brainstorm at least 20 ideas or issues
A “typical” Affinity has items, but 100 or more are not unusual
Step 3
Simultaneously and quickly sort ideas into 5 to 10 related groupings
Step 4
For each grouping, create summary or header cards using consensus
Strive to capture the essence of all the ideas in each grouping

34. Questions?

35. Break

36. PDSA Application

37. Lunch

38. PDSA Application, con’t

39. Next Steps

40. Questions?

41. Evaluation and Adjourn Thank you!