PLAN-DO-STUDY-ACTTHE MODEL FOR IMPROVEMENT

ObjectivesOverview of The Model for

Improvement with PDSA cycles A focused Aim Forming a Team Establishing Measures Achieving Continuous Improvement

Introduction Have you ever attempted to make a

change in your personal or professional life and failed; perhaps a New Year’s resolution?

Your failure to improve was probably not due to a lack of motivation or a desire to improve, but rather to a lack of utilizing a good method proven to be effective at implementing change.

Definition of PDSA PDSA is a four-step model for testing change

and is widely used in health care to implement new improvement projects.

Dr. W. Edwards Deming modified the Plan-Do-Study-Act (PDSA) from Walter A. Shewhart’s original Plan-Do-Check-Act (PDCA) cycle, known as the Shewhart cycle.

Nancy R. Tague’s The Quality Toolbox, Second Edition, ASQ

Quality Press, 2004, pages 390-392.

5

Definition of PDSA, cont. PDSA addresses the fundamental

questions and determines if the change is an improvement

PDSA is based on scientific methodology. It is data driven, iterative process improvement

methodology.

PDSA provides us with a systematic plan to makes things better!

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AIM Statement

Measurement & Metrics

Changes

In order to [purpose] by [timeframe], [who] will [what] by [how much] among [population].

See page 29 of Michigan's Guidebook7

A Focused AimThe Aim defines what the team plans to

accomplish with its improvement. It should provide a specific target population with a time specific measurable goal(s).

What? When? How Much?

For Whom?

What is the team striving to accomplish?What is the timeline?What is the specific numerical measure the team plans to achieve?Who is the population?

Institute of Medicine Quality Reports

In 1999, The Institute of Medicine, Washington, D.C., brought public awareness to the crisis (rate and severity) of preventable medical errors with the release of the report, To Err is Human: Building a Safer Health System.

The IOM issued a second report in 2001, Crossing the Quality Chasm, A New Health System for the 21st Century, which outlined six overarching “Aims for Improvement” to close the quality gap in health care.

To Err Is Human: Building a Safer Health System (2000) Institute of Medicine (IOM)

Institute of Medicine Quality Dimensions

Quality improvement projects should address an IOM quality dimension:

Safety –Is avoiding injury and harm to patients in delivering care that is intended to

help them a property of the project?Effectiveness – Does the project deliver care based on scientific knowledge and

avoid overuse and underuse of best available techniques?Patient-centered – Do patients (families) play a role in the decision making of their

care with emphasis on patients on the preferences, needs and values? Timely – Are waits and harmful delays reduced for those who receive care and those

who give care?Efficient – Care should be delivered without waste, including equipment, supplies,

ideas, or energy. Equitable – Is care outlined in this project offered to everyone equally, regardless of

race, ethnicity, gender and socio-economic status?

Crossing the Quality Chasm: A New Health System for the 21st Century (2001) Institute of Medicine (IOM)

Forming A TEAM Quality improvement can’t be achieved

alone. Consider all of the roles in your

organization that may contribute to the gap in care you are attempting to change, and also consider the roles that may contribute to improving the situation.

Make all of them part of your process improvement team, i.e. management, physicians, pharmacists, nurses, front-line workers, etc.

ESTABLISHING MEASUREMENTS Change must be measured to determine

improvement. There should be a measure for each aim. Measurements should include:

Process Measures- demonstrate that steps in the system are on track and proceeding as planned.

Outcome Measures- demonstrate that improvement resulted from change.

Balancing Measures- demonstrate that unintended consequences didn’t occur due to change.

Establishing Measurements, cont.

See the following examples of process, outcomes and balancing measures using the following scenario.

The aim of a quality improvement project is to improve the management of asthma by using the Asthma Control Test (ACT) at least 90% of the time when assessing patients diagnosed with asthma during 2012 .

Process Measure: percent of patients with a diagnosis of asthma that completed an ACT this past year.

Outcomes Measure: number of Emergency Department visits for asthma in this population of patients in 2012 compared to data collected in previous years.

Balancing Measure: patient satisfaction questionnaire to determine how patients feel about being asked to fill out an ACT at repeated office visits.

• Carry out plan

• Document problems

• Analyze data• Summarize

what was learned

• Objectives• Who, what,

When Where

• Data collection

• What changes need to be made?

• Next cycle?

Act Plan

DoStudy

Measurement Cycle• Data for the change cycle (PDSA) is collected frequently• Data is measured in modest amounts just large enough to test the change • Respond to observations with implementation of changes • Rapidly cycle and test again.

• What changes need to be made?

• Next cycle?

• Objectives• Who, what, When

Where• Data collection

• Carry out plan• Document

problems

• Analyze data• Summarize what

was learned

Act Plan

DoStudy

PDSA Cycle for Learning & Improvement

Rapid Cycle Change

Progress ReportsFeedback reports after each PDSA cycle in

the form of run charts or control charts demonstrate change that has occurred since last cycle and progress over time.

• What changes need to be made?

• Next cycle?

• Objectives• Who, what, When

Where• Data collection

• Carry out plan• Document

problems

• Analyze data• Summarize what

was learned

Act Plan

DoStudy

PDSA Cycle for Learning & Improvement

Rapid Cycle Change

Small Tests of Change

BreakthroughResults

Learning and improvement – several

cycles through to attain goals – each

cycle is a small test of changeA P

S D

Evidence & Data

A PS D

A PS D

A PS D

PDSA Cycles

PDSA Worksheet for Testing Change Aim: (overall goal you wish to achieve) Every goal will require multiple smaller tests of change

Describe your first (or next) test of change: Person responsible

When to be done

Where to be done

Plan List the tasks needed to set up this test of change Person

responsible When to be done

Where to be done

.

Predict what will happen when the test is carried out

Measures to determine if prediction succeeds

Do Describe what actually happened when you ran the test

Study Describe the measured results and how they compared to the predictions

Act Describe what modifications to the plan will be made for the next cycle from what you learned

• What changes need to be made?

• Next cycle?

• Objectives• Who, what,

When Where• Data

collection

• Carry out plan

• Document problems

• Analyze data

• Summarize what was learned

Act Plan

DoStudy

Continuous Improvement

AchievingContinuous Improvement

Many people make the mistake of wanting to leap to the goal line.

Remember to take it in small steps, actually small cycles.

Continuous quality improvement can become part of your culture by focusing on the process of improvement and implementing it into your daily practice.

Once it becomes part of your routine, you may even find yourself acing your New Year’s resolutions!