1. PDSA Cycle for Accelerating Improvement
covering kids
& families
Process
Improvement
Collaborative
PDSA Cycle for Accelerating Improvement
This portion of our agenda wil focus on how to develop PDSA cycles for testing changes.
Nancy Gantt, Deputy Director
Supporting Families National Program Office

2. Continue to answer the question…
covering kids
& families
Process
Improvement
Collaborative
Continue to answer the question…
By what method do we learn, adapt, implement, and spread change ideas for improving the effectiveness, efficiency and accuracy of Medicaid/SCHIP eligibility processes.
The collaborative process is about making changes. Though our focus initially is on small scale testing and rapid improvements the intent is to make changes that will lead to major improvements in the eligibility process.
The Southern Institute on Children and Families

3. When Making Improvements
covering kids
& families
Process
Improvement
Collaborative
Questions to Ask
When Making Improvements
What are we trying to accomplish?
How will we know that a change is an improvement?
These questions should be answered continuously as you go about planning changes and testing improvement strategies.
What change can we make that will result in an improvement?
©The Improvement Guide

4. The Shewhart Cycle for Learning and Improvement
covering kids
& families
Process
Improvement
Collaborative
The Shewhart Cycle for
Learning and Improvement
Act
Plan
Study Do
The model is widely used by many quality improvement methodologies. The cycle outlines a thoughtful, structured approach to making changes that will result in improvements to the work system.
Note: You may also see it referred to as the PDCA -
Plan, Do, Check, Act Model
©The New Economics

5. ©The Improvement Guide
covering kids
& families
Process
Improvement
Collaborative
Model for Improvement
What are we trying to
accomplish?
Aim
How will we know that a
change is an improvement?
Measurement
What change can we make that
will result in improvement?
Cycle for
Learning &
Improvement
Act
Plan
Study Do
When the three questions and the PDSA cycle for improvements are used together they form the Model for Improvement that is outline in The Improvement Guide.
©The Improvement Guide

6. The PDSA Cycle for Learning and Improvement
Act
What changes
are to be made?
Next cycle?
Plan
Objective
Questions and
predictions (why)
Plan to carry out
the cycle (who,
what, where, when)
Study
Complete the
analysis of the data
Compare data to
predictions
Summarize what
was learned Do
Carry out the plan
Document problems
and unexpected
observations
Begin analysis
of the data
PLAN DO
STUDY
ACT
API - Detroit

7. 3 Principles for Testing a Change
covering kids
& families
Process
Improvement
Collaborative
3 Principles for Testing a Change
Test on a small scale
Collect data over time
Build knowledge sequentially and include a wide range of conditions in the sequence of tests
The Southern Institute on Children and Families 29

8. Decrease the Time Frame for a PDSA Test Cycle
covering kids
& families
Process
Improvement
Collaborative
Decrease the Time Frame for a PDSA Test Cycle
Years
Quarters
Months
Weeks
Days
Hours
Minutes
Drop down next “two levels” to plan Test Cycle!
API - Detroit

9. The Southern Institute on Children and Families
covering kids
& families
Process
Improvement
Collaborative
Determining the Scale of a Test
Confidence
Consequences
Low Degree of Belief in Success
High Degree of Belief in Success
Failed Test Would Have Minor Consequences
Medium scale
tests
One cycle to implement the change
Failed Test Would Have Major Consequences
Very small scale tests
Small-to-medium scale tests
The Southern Institute on Children and Families

10. Small Scale Testing covering kids & families Test Group
Process
Improvement
Collaborative
Small Scale Testing
- Other offices Other departments
- Other counties - Other key systems
Test Group
The Southern Institute on Children and Families

11. Speaking PDSA Language
covering kids
& families
Process
Improvement
Collaborative
Speaking PDSA Language
We Planned to…(state the basic plan)
In Order to …(tie it back to the aim)
What we thought would happen…(prediction)
What we did was…(brief description of the activities)
What happened was…(the results, data)
Looking at what happened we learned that…(lessons learned)
What we plan to do next is…
(state changes that will be made to test in next cycle) P D S A
Penny Reid, Renewal Workgroup

12. The Southern Institute on Children and Families
covering kids
& families
Process
Improvement
Collaborative
Collect Data Over Time
Seek usefulness not perfection
Use paper and pencil or an Excel Template
Use sampling
Design forms, training, and instructions
Plot the data over time
Data collection should not be a barrier to improvement, but rather a tool to help guide the actions and testing of the team. Data should be useful to the team. If the team finds that it is collecting more data than is useful for assessing the impact of their tests on their overall goal, then the data collection should be adjusted.
Data collection is often used as a trump (e.g., we can’t do anything until IS sends us the reports). Instead of relying on IS, use sampling and pencil and paper data collection to gather the data that is needed to support your testing. You can always add more sophisticated data at a later time.
The Southern Institute on Children and Families

13. Include a Wide Range of Conditions in the Sequence of Tests
Sequential Building of Knowledge
Include a Wide Range of Conditions in the Sequence of Tests
Significant Results
Theories, hunches, & best practices
Learning and improvement A P S D
Evidence & Data
Spread
Implement
Test new conditions
This slide shows how sequential testing can be used to build knowledge and improve the likelihood that a proposed change will indeed result in an improvement.
Begin testing on a small scale - several workers, the next ten applicants who come in the door, the renewal applications that come in through the mail on Tuesday.
Expand the test group - an entire unit, all of the applications received during a week, the renewal applications for a week.
Test under new conditions - If you are testing the strategy of making a contact with the family prior to case closure and you are not able to reach the families during normal working hours. Ask for volunteers to make the calls after hours.
One you have run multiple testing cycles and the strategy is working well you can move toward wide scale implementation. You have knowledge of what resistance to expect from the staff a nd what support mechanisms need to be in place. Training, manuals,
Test a wider group
Test on a small scale
API - Detroit

14. Aim: Reduce by 25% the number of cases being closed each month for failure to return the renewal form within 6 months.
Improvement Strategies Package: Improve Policy & Procedures
Improved access D S P A A P S D
DATA D S P A
Cycle 5: Test with entire office. A P S D
Cycle 4: Standardize procedure of making client contact prior to closure. A P S D
Cycle 3:Test the process with 3-4 workers
Cycle 2 Adjust times that you make contacts. Run test again.
Cycle 1:Select two workers who will agree to make contacts with
clients prior to case closure. Compare closure rates for one week.
The Southern Institute on Children and Families

15. Improvement Strategies
Overall Aim: Increase the Retention Rate by 20% for Families in Medicaid and SCHIP within 6 months. A P S D A P S D A P S D A P S D
Specific Test Cycles
When you can test more than one change strategy at the time you can maximize the possibility that changes will result in improvement.s
Simultaneous Testing
Mandatory client contact
prior to case closure
Verification checklist
Pre-printed
renewal form
Improve
notices
Improvement Strategies
The Southern Institute on Children and Families

16. References covering kids & families Process Improvement Collaborative
The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. G. Langley, K. Nolan, T. Nolan, C. Norman, L. Provost. Jossey-Bass Publishers., San Francisco, 1996.
The New Economics for Industry, Government, Education. 2nd Edition. W. Edwards Deming, Massachusetts Institute of Technology, Cambridge,MA, 1994.
Quality Improvement Through Planned Experimentation. 2nd edition R. Moen, T. Nolan, L. Provost, McGraw-Hill, NY, 1998.

17. Observations from your PDSA Cycle Plans
More detail (who, what, where, when)
Break tests into smaller tests (but think several cycles ahead)
Define your measure and how you plan to collect data
More testing of work processes
Look for “red beads”
Brainstorm and test a new idea (flop chart material?)
This slide shows how sequential testing can be used to build knowledge and improve the likelihood that a proposed change will indeed result in an improvement.
Begin testing on a small scale - several workers, the next ten applicants who come in the door, the renewal applications that come in through the mail on Tuesday.
Expand the test group - an entire unit, all of the applications received during a week, the renewal applications for a week.
Test under new conditions - If you are testing the strategy of making a contact with the family prior to case closure and you are not able to reach the families during normal working hours. Ask for volunteers to make the calls after hours.
One you have run multiple testing cycles and the strategy is working well you can move toward wide scale implementation. You have knowledge of what resistance to expect from the staff a nd what support mechanisms need to be in place. Training, manuals,
API - Detroit