Rapid Cycle Testing Accelerating changes through the use of PDSA - PDF document

7/11/2017 Rapid Cycle Testing Accelerating changes through the use of PDSA cycles Presented by Chad Glenn  Chad Glenn, Innovation Group 2 1

7/11/2017  Chad Glenn, Innovation Group 3 Discussion Topics • Learning and improvement cycles • Why test? • How to plan successful test cycles • Moving from testing to implementation The goal: Learn how PDSA (Plan-Do-Study-Act) cycles can increase learning and rapidly improve processes through smartly designed, small scale iterative tests .  Chad Glenn, Innovation Group 4 2

7/11/2017 The Model for Improvement What are we trying to accomplish ? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Courtesy of IHI 5 The Model for Improvement AIMS MEASURES CHANGES Courtesy of IHI 6 3

7/11/2017 7  Chad Glenn, Innovation Group Aim: Decrease LBTC% by 40% over the next 6 months Decreased LBTC % A P S D Cycle 5: Pilot Team Triage all days (4 weeks) Cycle 4: Test parallel processing with 1 APP + 1 nurse in Triage (2 weeks) Cycle 3: Test using physician in triage for busy A P days (2 weeks) Theory – S D Cycle 2: Canvas physicians to identify and reach consensus Utilization of on patient criteria for Clinician-in-Triage (2 days) Clinician in Triage Cycle 1: Run demand capacity analysis to evaluate feasibility of will reduce Clinician-in-Triage based on volume and acuity (1 day) LWOT%  Chad Glenn, Innovation Group 8 4

7/11/2017 Aim: Increase APP chart efficiency by 25% over the next 6 month Improved chart efficiency A P Cycle 5: Pilot test S D scribes for all APPs (4 weeks) Cycle 4: Test scribes w/ 2 APPs, one day shift, one night shift (2 weeks) A P Cycle 3: Use 1 scribe, 1 APP, 1 shift (2 days) Theory – S D Cycle 2: Reference scribes playbook and canvas APPs Utilization of and scribes to identify best practices for scribe implementation (2 days) scribes increases chart efficiency Cycle 1: Follow 1 APP through to test theory that they would benefit from the support of a scribe (1 day) Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 9 Can one learn more by diagnosing the current process or system, or by changing something right away? ?  Chad Glenn, Innovation Group 10 5

7/11/2017 Can one learn more by diagnosing the current process or system, or by changing something? Teams often spend too much time thinking about all the possible options, ramifications, and implementation issues before proceeding with a test of a change. • Improvement efforts are frequently struck in the diagnostic journey (analysis paralysis). • The alternative is to very quickly run a test. • Experience has shown this latter approach leads to accelerated learning and improvement What can you do by next Tuesday? Quote from Langley et al. Improvement Guide. p. 142  Chad Glenn, Innovation Group 11 Aim of Discussion Accelerate Changes The aim of this discussion is the introduce the Model for Improvement (MFI) which is a tool for accelerating change in a complex and dynamic environment. The MFI is not meant to replace existing process improvement effort, but rather accelerate them . It truly acts as a catalyst in that it speeds up the changes that we want to see made.  Chad Glenn, Innovation Group 12 6

7/11/2017 The PDSA Cycle Four Steps: P lan, D o, S tudy, A ct KNOWELEDGE TIME  Chad Glenn, Innovation Group 13 The PDSA Cycle AKA ‐ “Rapid Cycle Testing” ‐ “Learning and Improvement Cycles” ‐ “Sequential/ Iterative Testing” A P Learning and S D Improvement A P S D A P S D A P S D  Chad Glenn, Innovation Group 14 7

7/11/2017 Overall Aim: Increase Access Triage Scheduling Treatment Discharge protocols protocols protocols protocols Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 15  Chad Glenn, Innovation Group  Chad Glenn, Innovation Group 16 8

7/11/2017  Chad Glenn, Innovation Group  Chad Glenn, Innovation Group 17  Chad Glenn, Innovation Group 18 9

7/11/2017 Plan/ Predict  Formulate questions to be answered by PDSA cycle  Make predictions about outcome of cycle  Clearly state and document hypothesis that supports prediction  Plan for collection of data to answer questions  Chad Glenn, Innovation Group 19 Do the experiment  Test is performed and data collected  What if test of change is not successful?  1. Change/s not executed well  2. Supporting processes inadequate  3. Hypothesis/ hunch wrong: • Change executed but did not result in local improvement • Local improvement did not impact access or efficiency  Document observations during the Do Phase of the Cycle to help differentiate these situations.  Chad Glenn, Innovation Group Courtesy of IHI 20 10

7/11/2017 Don’t get stuck in the “do-do” phase Don’t get stuck in the “do-do” phase  Chad Glenn, Innovation Group 21 Study the results ACT PLAN Predictions STUDY DO Results  Chad Glenn, Innovation Group Courtesy of IHI 22 11

7/11/2017 Act Accept? Adjust? or Abandon? • Is further testing needed to increase our degree of belief about the change (Scale up? Test under different conditions?) • Do we need to modify the proposed change or develop an alternative change? • Do we need to learn about other implications (such as costs) of the change? • Are we ready to implement the change on a full-scale basis? • Should we drop considerations of the proposed change?  Chad Glenn, Innovation Group 23 PDSA CYCLE PROCESS FLOW MAP Iterative Process Designed by Chad Glenn, IG  Chad Glenn, Innovation Group 24 12

7/11/2017 The PDSA Cycle Why Test?  Chad Glenn, Innovation Group 25 Reduce Risks  Chad Glenn, Innovation Group  Chad Glenn, Innovation Group 26 13

7/11/2017  Chad Glenn, Innovation Group 27 Minimize Resistance  Chad Glenn, Innovation Group 28 14

7/11/2017 Build Consensus  Chad Glenn, Innovation Group 29 Degree of belief Degree of belief that the change will result in an improvement High Change still needs further Moderate testing A B Unsuccessful proposed change C Low Developing Testing a change Implementing a change cycle 1, cycle 2 … a change  Chad Glenn, Innovation Group 30 15

7/11/2017 Deciding on the Scale of a Test Perspective of Participating Perspective of those affected by change Teams Readiness for change Cost of Degree of belief Resistant Indifferent Ready failure (no commitment) (some commitment) (strong commitment) Low degree of Very small-scale Very small-scale Very small-scale belief that a Large test test test change idea will lead to an Very small-scale Very small-scale Small-scale test Small improvement test test High degree of Very small-scale Small-scale test Large-scale test Large belief that a test change idea will lead to an Small-scale test Large-scale test Implement Small improvement Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 31 Repeated Use of the PDSA Cycle Changes That Result in Improvement A P S D Implementation of Change Wide-Scale Tests of Change A P S D Follow-up Hunches Tests Theories Ideas Very Small Scale Test Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 32 16

7/11/2017 Tabletop exercise: Coin Spinning Game – PDSAs Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 33 Which team can spin the coin the longest? Tips for successful • Come up with provocative hypotheses (does age make difference? eye color? gender?...) • Document predictions • Be creative!!!  Chad Glenn, Innovation Group 34 17

7/11/2017 Planning useful PDSA cycles  Chad Glenn, Innovation Group 35 Planning useful PDSA cycles  Think a couple of cycles ahead of the initial test (future tests, implementation)  Scale down size of test (# of patients, location) and decrease the time required for the initial test  Do not try to get buy-in, consensus; test with volunteers  Use temporary supports to make the change feasible during the test  Be innovative to make test feasible Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 36 18

7/11/2017 37 Set a Good Tempo for Testing • Year • Quarter “If we are considering • Month designing a test to take a quarter, consider • Week what test could be • Day designed to take a week.” Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 37 Testing on a Small Scale • Simulate the change (physical or computer simulation) • Have others that have some knowledge about the change review and comment on its feasibility • Test the change on the members of the team that helped develop it before introducing the change to others Courtesy IHI – Institute for Healthcare Improvement  Chad Glenn, Innovation Group 38 19