1. PDSA: Plan Do Study Act Testing Improvement ideas
We all want to do the best job we can. So how do we make improvements to ensure we’re being as effective as possible? That’s where the PDSA process comes in.

2. Reasons For Change or Improvement
To gain efficiencies
To reduce complaints
To improve customer service
To accommodate a new mandate
To prevent a sanction
To solve a problem
Many other reasons….
There are many reasons why an organization would want to pursue change or improvement in its business processes or practices. There may be a need to gain efficiencies in order to save time or to save money. Customer feedback may indicate that a process is too complex or difficult to navigate. There may also be problems, such as bottlenecks or high error rates that could drive the need for change. These are just a few of many reasons why an organization might choose to start down the path of process improvement.

3. Reasons to Test Change/Improvement Ideas
To increase your belief that the change will result in improvement.
To decide which of several proposed changes will lead to the desired improvement.
To evaluate how much improvement can be expected from the change.
To decide whether the proposed change will work in the actual environment of interest.
To evaluate cost, social impact, and side effects from a proposed change.
To minimize resistance upon implementation.
In many organizations, ideas for change are simply implemented, before any real data or information is gathered to prove the change will be effective.
Some organizations may be more cautious and decide to do a pilot program for a few months, gather data at the end, and decide then if they should fully implement the pilot process or go back to their old way of doing business.
Other organizations may choose to use small scale “tests” to gather information and data in order to determine if an idea is a good one or a bad one, without radically disrupting how business is done in the long term.
The PDSA methodology provides a tool to accomplish a third option: by “testing” change or improvement ideas. So why might an organization want to “test” an idea before implementation? There are many reasons. It could be to help decide which of several proposed changes will lead to the desired result, or to see whether the proposed change will work in the real world, or to evaluate cost or unforeseen side-effects of a proposed change—just to name a few reasons.

4. What is PDSA?
The PDSA process is a methodology for improvement that utilizes cycles to incrementally test ideas for change.
PLAN: Objective, predictions, and plan to carry out (who, what, when, where).
DO: Carry out the plan, document problems and observations, begin analysis of the data.
STUDY: Complete the analysis of the data, compare data to predictions, summarize what was learned.
ACT: Make decisions on what was learned and make plans for next steps (modify for next test, discontinue, or implement).
So, what exactly is PDSA? PDSA is a methodology for improvement which uses cycles to incrementally test ideas for change. It can also be used to discover, assess, or diagnose problems or to monitor a process.
There are four components to PDSA:
The first is to PLAN: You state your objective, explain the plan you intend to carry out, and make your predictions on the outcome of the test. You also identify the types of data that will need to be collected during the test.
The second component is to DO: Carry out the plan, document the problems and observations, and begin analysis of the data.
The third component is to STUDY: Complete the analysis of the data, compare the data to predictions, and summarize what was learned. Data analysis is a critical component of the PDSA process. By gathering data, you have solid evidence and information to determine if a test idea yielded the desired results, and to what extent the desired results were achieved.
The fourth and final component is to ACT: Make decisions based on what was learned and make a plan for next steps. The next step may be to modify the test plan a bit and to retest it again. It may be to discontinue the idea after identifying that it didn’t yield the desired results. The next step may be full implementation. Or if your PDSA objective was simply to discover or assess a process based on data collected, your next step may be to determine what you will do with this new found information.

5. Difference Between PDSA and a Pilot
Involves a large percentage of the overall population,
Usually runs for months,
Outcomes are not evaluated until the pilot ends,
If the pilot is a failure, significant resources are lost.
A PDSA test:
Smaller in scale (2-3 staff involved in testing),
Designed for rapid results (short period of time per test),
Outcomes are evaluated continuously for sequential learning,
If the test fails there are no major consequences.
You might be thinking, “this still sounds like a pilot program.” Well, it’s not quite. A pilot usually involves a large percentage of the overall population, usually runs for months, and outcomes are not evaluated until the pilot ends. If the pilot was a failure, significant resources are lost…people and processes have been disrupted, and reversing the process away from the pilot can be challenging.
In a PDSA test, ideas are tested on a much smaller scale. Usually only 2-3 staff are involved in testing. Tests are very short…it might be just one day. It shouldn’t be more than one month in each test cycle. Outcomes are evaluated while the test is being run, in addition to the end of the test, and will be used to determine the next steps, which may include tweaking the test to run for a second cycle. Because the tests are on such a small scale, if the test fails, there are generally no major consequences.

6. How is the PDSA used?
A method to discover, assess, or diagnose problems
A method to test ideas for change
A method to monitor
As mentioned in an earlier slide, the PDSA can be used three different ways:
The first way is to discover, assess, or diagnose a problem. For example, one county department wanted to know why they had such a high percentage of mail being returned from the post office. They assumed it was because customers failed to report address changes when they moved. The department used the PDSA tool for a designated test period, where information was gathered, in order to assess and discover the reason for the mail return. Upon receiving the results of the test, they learned that a portion of the returned mail was due to customers failing to report address changes, but they were surprised to learn that the majority of the returned mail was due to their own data entry errors.
The second way is to test ideas for change. You may have a process you would like to change, but before implementing, you would “test” it on a small scale to gather the necessary data to determine if the new process achieves the improvement goals you have set. We will go into more detail on how to do this.
The third way is to monitor. The tool helps to keep you focused on data collection and end results in order to continuously monitor the successfulness of a process.

7. The PDSA Cycle for Learning
This is a visual model of the PDSA cycle for learning. You will always enter the cycle at the point of “Plan”. As you can see, it’s represented as a circle, because you may go through multiple rounds or “cycles” of tweaking an idea or strategy before determining that it’s ready for implementation. You may even determine that you want to go a different route.
It’s important to note that if a test doesn’t yield the desired results, you shouldn’t consider it a failure. Testing an idea, only to find it was a bad one is one of the benefits of this process. You learn from the data you have collected during the small scale test, so you can prevent the mistake of fully implementing an idea that doesn’t work well.

8. So, how do we get started?

9. Selecting an Effective Core Team
Team Leader- Communicator, authority to delegate tasks and request for information, oversight of team’s tasks, timelines, and follow-through.
Policy/Procedures Experts- Complete knowledge of system and it’s functions, understanding of the effects process improvement changes will have on the system, expertise and understanding of policy.
Data Expert- Expertise and understanding of data systems and reports, access to data systems, oversight of the data collection for the team.
The team leader has the authority to make the decisions necessary to test or implement change.
The Policy/Procedures experts might be supervisors and or line staff who understand the processes and their impacts from the ground level. One supervisor and one staff person is typically sufficient.
If neither your team leaders, nor your policy/procedures experts are also data experts, then you will need to add an additional person to your core team. Data collection and analysis is one of the most important components of the PDSA, and we’ll talk more about this in a bit.
Once you have your Core Team in place, you may chose to bring in additional staff to conduct the testing, but your core team will remain the same.

10. Characteristics of an Effective Core Team
Expectations and responsibilities are defined and clarified for each team member.
Cooperation and open, ongoing communication exists among team members.
Team responsibility is assumed by the members, mistakes or “flops” are viewed as opportunities for learning.
Pride and ownership in the outcomes/ achievements of the team effort exist among team members
Success/achievements of the team are celebrated, recognizing the contribution each member makes to the total work of the team.
It’s very important to select a team that is comfortable with change and embraces the idea of process improvement.
They must work well together.

11. Clarify Responsibilities
Who is in charge of tracking progress of plans?
Who assures the tests of change are implemented?
Who oversees the data collection?
Who does the documenting and typing?
Clarifying responsibilities helps to keep everyone on the Core Team on track and engaged in the process. These are some of the important questions you should ask and assign before starting a PDSA.

12. Choosing a process for Improvement
Look for your “Burning Platform”
What is the biggest issue facing your department?
In selecting a process for improvement, the obvious place to start would be your “burning platform”…what process stands out as the biggest problem or issue facing your department? For one department is was addressing timeliness in processing applications….for another was to make a determination on whether or not outsourcing a certain process was a good or bad idea before budget season.
It’s important to remember that this is a PROCESS improvement method. Some problems may not be related to a process…for example, if your problem is that an employee is late 4 out of 5 times per week or that a policy has become so outdated that it is creating a hindrance to progress, then the PDSA methodology would not be appropriate.
Hone in on processes that could be or need to be improved. Slide number two on “reasons for change or improvement” might help.

13. Value Stream Mapping
A value stream map is a picture of a service from end to end.
It encompasses all of the steps in a process that add value to delivering a service and those that do not add value to delivering the service.
It is about movement of people and information.
The goal is to learn about your system from the customer’s perspective and from the perspective of your colleagues. To see where you are at now.
You will also be able to highlight problems to address. It is a learning tool.
Once you have selected your process, the next step is to develop a “Value Stream” map.

14. MCDHS Value Steam Map Prior to Testing
This is an example of the “before testing” value stream map used by the Mesa County Department of Human Services. They wanted to improve the timeliness of processing an application for Assistance Programs, such as Food Assistance.
As you can see, they documented every step, including “in-boxes” or places where a document stopped for a period of time. Because timeliness was the “burning platform” for the Department of Human Services, they additionally tracked a sample of documents moving through this process to measure time. Time was recorded to show how long it took to “process” a document at each step, as well as how long a document sat in the “in-boxes”.
Once you have this value stream map developed, you can use it to help identify and define the problems that exist with the current process.

15. Definition of a Problem
A problem is a gap between the way things are now and the way you want them to be
So what is a “problem”? A problem is defined as a gap between the way things are now and the way you want them to be.

16. Analyzing a Value Stream- Identifying Problems and Waste
Bottlenecks
Excessive wait time
Frequent work arriving at a step “not ready to work” or with mistakes
Too many hands touching the process
Doing things we aren’t required to do.
Doing things that don’t serve a purpose
Areas that cause frustrations for staff or clients
Too many entry points into the workflow
Lack of accountability
Lack of standardization
When analyzing your value stream, these next two slides give some examples of common problems and waste that may be identified when analyzing a the process.

17. Additional types of problems and Waste
Waste of material transportation- unneeded steps, document/data travel distance.
Waste of movement- unneeded data entry, extra steps
Waste of overproduction- preparing unneeded reports, reports not read or acted on, multiple copies in storage
Waste of processing- excessive sign-offs
Waste of underutilized people
Not meeting quality expectations
Not meeting timeliness expectations
Expectations are set too high
Poorly defined work
Here are a few more…

18. Exercise to Help Group Identify Problems and Waste
Post value stream map on the wall
Challenge the Core Team to question the status quo and identify all problems/waste they perceive in the mapped process
Each Core Team member will have a pad of post-it sticky notes to independently label problems/waste on the value stream without discussion.
Take 15 minutes to complete this task
To help identify the problems and waste in a process, this is an example exercise you might use.
*** Read slide***
Once the 15 minutes are up, then as a group go over the identified problems and waste in discussion. Through discussion, you may identify additional problems. Have someone record all the assessed areas in need of improvement.

19. Where Can You Get Ideas to Improve your process?
Best or promising practices in your industry or field
Ideas from Subject Matter Experts (maybe your customers, your clients, your staff, colleagues, or others)
Insight from Research
Or even just brainstorm within your Core Team
So now you have identified the problems and waste, where do you get your ideas for how to fix them? These are a few suggestions.
***Read the slide***
Your goal is to design a new process that you hope will address as many of the identified problems and areas of waste. Once you have a plan for a new idea to test, you then develop a value stream for your new process, and test it.

20. MCDHS Value Stream Map- New Process
MCDHS developed this new process, which they hoped would address all the problems and waste they had uncovered.
The next step is to test the idea and gather data to show if it was successful in accomplishing their aim. This is where the PDSA comes into play.
Note: The data collected in this slide was added after they tested the idea.

21. This slide shows us the top half of the PDSA tool, which is used to guide users through the cycle process. Everyone should have a hard copy of the tool to follow along with the explanation.
Prompts are added to the tool ensure necessary information is collected and documented throughout the PDSA sections to properly test and analyze a change idea, or to assess a current process.
The reporting team is the department or team assigned to this project. The report date is the date you start the PDSA.
The cycle # identifies the number of “tests” you have done with a particular strategy. Each time your project aim changes, or you significantly change your strategy, you will start over with “cycle #1”. If you run a test cycle and decide to simply “tweek” your strategy and re-test, then that would be cycle #2, #3, and so on.
The beginning date is the date you start the test of the new process and the completion date is the date you end the test of the new process. Your test period should be short in nature…maybe a week to a month. Never more than one month per cycle.
We’ll talk more about the Project Aim and Strategy in a moment.
The Plan is where to enter what you are going to do, what you hope to accomplish, what you predict the results of your test will be (hypothesis) and what data will be collected during the test to prove if your change idea was an improvement. We’ll talk a bit more about data in a moment as well.
The Do is where you enter what you did when you ran the test.

22. This slide shows us the bottom half of the PDSA tool.
The Study section is where you complete your analysis of the process…what did the data tell you? What did you learn? What surprised you? Did you run into anything new that you hadn’t realized or considered earlier?
The Act section is where you enter the decisions you have made based on what you learned and what your next steps may be. You may decide that you would like to tweek the test and re-run it. You may decide the idea didn’t accomplish what you had hoped, so you will scrap the idea, or you may decide that the results were right on target and you are ready to implement.
Though the PDSA tool is rather simple, it serves many important purposes. It helps to keep participants clearly focused, to keep the process improvement testing and analysis moving forward within stated timeframes, and to ensure that the test idea and outcomes are documented and that correct data is collected and analyzed. Additionally, it serves as a great resource to share with others who are interested in the idea that has been tested.

23. Aim: What are we Trying to Accomplish?
What is the aim?
Write a clear and concise statement of aim.
Include what is needed to keep the team focused
Use a numerical goal to clearly communicate your aim
Example: By November 1, 2010 the Intake Eligibility team will decrease processing time for Family Medicaid/Food Assistance applications to less than 21 days from date of receipt.
What is the Aim? Basically the Aim is a statement to clearly communicate what you are trying to accomplish. Your aim should be concise…only one sentence preferably, and include important details, like your goal date for completion, who will be involved, what is the process you are impacting, and what is your numerical goal for the new process?
The Aim used by the Mesa County Department of Human Services is shown as an example.

24. What Strategy are We Going to Use to Achieve our Aim?
Your strategy is basically the “how” of what you are going to do in order to achieve your aim.
Keep it simple.
Example:
To schedule initial interviews by appointment, instead of “walk-in” interviews.
The strategy is a simple statement of “how” you hope to achieve your aim in the broadest sense of explanation. Your detail will be explained later in the Plan section.
This is the example used by the MCDHS on their timeliness PDSA.

25. How Do We Know That a Change is an Improvement?
Track data as a measurement for guidance, testing, and learning.
Usually requires more than one measure.
Measures should reflect aim and be specific
Measures are used to guide improvement and test changes
Purpose is for learning and not judgment
Integrate measurement into daily routine
I mentioned earlier that we were going to get back to the importance of data collection in a PDSA. The reason data is so important, is because it tells us if a test idea for change was an improvement or not. It tells us if the idea helped us to accomplish our aim.
Before running a test idea, the Core Team needs to decide what data they will need to have in order to know if their idea for process change was successful.
Usually, more that one measure is required.
The measures should be very specific and reflective of your aim.
It’s important to remember that these measures are for learning and not to judge anyone on their performance.
During the test, recording data on the measurements will be integrated into the daily routine. Some may track data through tracking sheets, some may chose to track data electronically….regardless, data should be collected continuously throughout the course of each test.

26. Ready To Implement
The change is permanent- need to develop all support processes to maintain change
High expectation to see improvement- no failures
Generally takes more time than the tests
Be sure to consider all the other processes that touch the process you are changing, because your change could impact their processes.
Continue to collect data through implementation
So, once you test an idea, your data proves it was a good idea that accomplished your aim, and you decide you are ready to implement, there are a few things you need to consider first.
The change is going to be permanent….you should have tested it thoroughly enough to know it will work and that there is no turning back.
You should have high expectations to see improvement. This isn’t a pilot…it’s a tested and measured process you know will work at this point. Failure should no longer be considered an option.
Implementation generally takes longer than a test, because you are no implementing within a whole team or department, who will need to be trained.
It’s very important to consider all the other processes that feed in or out of your processes, and how your change will impact them, before you implement. Inform everyone who needs to know about the change before you implement.
Continue to collect data during implementation to ensure the new process stays on track.

27. Worker Buy-in
Involve line staff from the very inception of the ideas for change. Not top-down direction.
Involve line staff in testing of the ideas and really listen to their feedback and suggestions for improvement.
Select staff with strong knowledge of the job, processes, and who are respected by teammates to participate in testing.
These staff will serve as your “champions” when it comes time to implement to build excitement and help prepare others for the change.
Worker buy-in is extremely important, especially if you have staff who are reluctant to change. These are just a few tips to help with worker-buy in.
Another benefit of testing is that other staff who aren’t participating in the test get a chance to see the idea in action, before being asked to do it themselves. This reduces a lot of fear of the unexpected.

28. Holding the gains Communication Standardization Documentation
Measurement
Training
Assign ownership
Once you have implemented your tested and true new process, how do you ensure that you hold the gains?
Communication- continue to touch base with staff and management to discuss the process…you may find it ways to further refine and improve the process….you may find there are some “once in a blue moon” situations that may not fit perfectly in the new process and will need to be addressed. Everyone will need to communicate to continue to hold each other accountable to the new process.
Standardization- once you test a process and know it works, everyone needs to follow it to the letter. If you have staff independently tweaking the process on their own, you may end up with ten slightly different processes and none are as effective as the tested process.
Documentation and Measurement go hand in hand- Continue to monitor and measure data through your process, so you know you are staying on track.
Training- Make sure staff are appropriately trained to do what is being asked of them in the new process. Through standardization, you may find the weaknesses of some staff will become glaringly apparent. Be sure to be there to support and train them so they can be successful in the new process.
Assign Ownership- The process belongs to the staff who came up with the idea, who tested it, who implemented it. It is not a process that belongs to management. The success of the process is something the staff should be proud of.

29. Any Questions?

30. ~THANK YOU~