By the end of this session

Deeper understanding of how methodology can be applied to practice

Appreciate how to minimise the risk of making a change

Understand how to accelerate learning as we test the change

Structure of the session

1. Refresh on methodology

2. Share practical experiences

3. Hints and tips to maximise success

Plan

Reiterate overarching aim

State the objective of the test/cycle

PlanWhat questions do you want answered

Make PREDICTIONS

Who will schedule and conduct the test

What changes will be made

Where will the test be conducted

When will the test be done

What will be measured to confirm/evaluate your predictions

Do

Carry out the test

Describe what actually happened

Document any unexpected outcomes or problems encountered

Gather the data to be reviewed and begin analysis of it

Study

Complete analysis of data

Compare data to the prediction

Reflect on what happened

Set out what learning was gained from the test

Remember - No failures only enhanced learning

Act

Decision time:

Abandon

Adapt

Adopt

Make modifications

State what the next cycle is

Back to planning

Based on slide © IHI 2009

Sequence for improvement

Develop a change

Test a change

Implement a change

Sustain & spread a change to other locations

Support with data and consideration of peopleTheory &

prediction

Test under avariety of conditions

Make partof routineoperations

Study

Act Plan

Do

HINTS and TIPS

Plan

Think a couple of cycles ahead – is it feasible for implementation?

Recruit volunteers rather than get buy-in or consensus for a test

Be innovative to make a test feasible

Planning one large PDSA cycle to get all the answers should be avoided….!

….Planning the perfect test takes time

Think About Size

Current Situation Resistant Indifferent Ready

Low Confidence that current change idea will lead to Improvement

Cost of failure large

Very Small Scale Test

Very Small Scale Test

Very Small Scale Test

Cost of failure small

Very Small Scale Test

Very Small Scale Test Small Scale

Test

High Confidence that current change idea will lead to Improvement

Cost of failure large

Very Small Scale Test Small Scale

TestLarge Scale

Test

Cost of failure small

Small Scale Test

Large Scale Test

Implement

Do

Reasons for unsuccessful tests:

The change was not executed properly - planning and communication not adequate

Support processes to make the change successful were not adequate

Apply your subject matter knowledge to unsuccessful tests

Study

It doesn’t happen

Take time as a team to reflect on learning

Reflect on what actually happened – knowledge of how system works enhanced

Assess to see if your degree of belief in the change has increased

Act

Objective for next test not specifically defined

Pace is crucial for momentum

Differences between cycles to develop, test, implement and spread a change

Cycle attributesDeveloping a change

Start small, 1 child, 1 worker, 1 family

Testing a change

Once change is developed, vary the conditions

Implement a change

Permanent support structures, degree of belief high

Spread a change

Foundation of spread is communication, share data

Reducing level of risk

Simulate the change

Have members of the project team test first

Pass it by knowledgeable staff

Test in parallel with existing process

Small scale, short timeframe

Test with volunteers

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

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