1. Developing Concepts of Change & PDSA Cycles Brandon Bennett

2. Agenda Review the improvement journey Overcoming our barriers to the journey PDSA, one to another to another What about Change Concepts

3. Typical approach Local Barriers to change: Resistant Culture Lack of Human Resources Limited Financial Investment Failure to implement successfully at the local level with resultant improved performance “Just Do it”

4. Improvement Approach Local Barriers to change: Resistant Culture Process Design Structure Human Resources Successfully implement at the local level with resultant improved performance Conceptual Driver Diagram Outco me 1 ⁰ driver 2 ⁰ driver Change Concepts Specific Change Ideas Aim or Out com e 1 ⁰ driv er 1 1 ⁰ driv er 2 2 ⁰ driv er 3 2 ⁰ driv er 2 2 ⁰ driv er 1 2 ⁰ driv er 4 2 ⁰ driv er 5 Conc ept 1 Conc ept 2 Conc ept 4 Conc ept 3 Conc ept 5 Conc ept 6 Ideas : 1 2 3 4 5 6 7 8 9. N Theory of Causality Theory of Change

5. Are we articulating comprehensive theories aimed at overcoming our barriers? Process Design –Do we know what our Model of Care looks like? Do we have a process map with understanding of failure points, bottlenecks, etc. Culture –Do we have a theory of what leverage points exist to encourage the adoption of changes or participation in the improvement journey? Physical Structure –Have we considered whether our physical structure needs rearranging and whether that could us to improve reliability, efficiency, safety, etc.? Human Resources –Have we recruited and oriented a productive team for leading improvement, including local champions who are passionate for the work and local thought leaders who can positively influence the behavior of others?

6. Break out Spend 10 min contemplating these questions

7. Are we articulating comprehensive theories aimed at overcoming our barriers? Process Design –Do we know what our Model of Care looks like? Do we have a process map with understanding of failure points, bottlenecks, etc. Culture –Do we have a theory of what leverage points exist to encourage the adoption of changes or participation in the improvement journey? Physical Structure –Have we considered whether our physical structure needs rearranging and whether that could us to improve reliability, efficiency, safety, etc.? Human Resources –Have we recruited and oriented a productive team for leading improvement, including local champions who are passionate for the work and local thought leaders who can positively influence the behavior of others?

8. Aim or Outcome 1 ⁰ driver 1 1 ⁰ driver 2 2 ⁰ driver 3 2 ⁰ driver 2 2 ⁰ driver 1 2 ⁰ driver 4 2 ⁰ driver 5 Concept 1 Concept 2 Concept 4 Concept 3 Concept 5 Concept 6 Ideas: 1 2 3 4 5 6 7 8 9. N Theory informs testing and in turn testing refines theory

9. Repeated Use of the PDSA Cycle Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change Improvement Guide, Chapter 7, p. 146

10. So what do repeated improvement cycles look like? Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change Improvement Guide, Chapter 7, p. 146 Tangential, related or new ideas arise

11. What do you do with these new ideas? Capture them Integrate them into your theory Begin new PDSA ramps to test them Set them aside if they are related but are deemed relevant to a different improvement journey

12. Primary Driver 1 Change Idea 1 Change Idea 2 Change Idea 3

13. Break out Discuss 2 change ideas: Where is each on the ramp toward implementation? What tangential ideas have arisen as a result of your testing to date and what have you done with those ideas?

14. What about Change Concepts? What are they? How can we use them to generate new change ideas when we encounter failure with our current ideas?

15. Theory of Change Change Concepts Specific Change Ideas Concept 1 Concept 2 Concept 4 Concept 3 Concept 5 Concept 6 Ideas: 1 2 3 4 5 6 7 8 9. N

16. How we use change concepts? Incomplete list of change concepts 27. Give people access to information Counsel patients on want to expect on Admission Provide electronic patient progress board in surgical waiting area Display patient safety data publically for patients, families and co-workers to see Langley, et al. Develop a radio program Integrate topic in a local soap opera

17. Comprehensive list of concepts related to improving quality Langley et al, The Improvement Guide

18. Break out Select 2 change ideas that are a apart of your current theory Review the list of Change Concepts to find which concept(s) relates to each idea Spend 2 min silently at your table brainstorming other ideas that could flow from that concept Share those in a round robin at your table – remember crazy ideas are encouraged later we can analyze them for feasibility

19. Comprehensive list of concepts related to improving quality Langley et al, The Improvement Guide

20. Finally Select 1 idea you might like to develop into a change idea for testing using the Model for Improvement next week when you are back in the day to day of improvement