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

▶
rapid cycle testing accelerating changes through the use
SMART_READER_LITE
LIVE PREVIEW

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

Jan 06, 2024 211 likes •454 views

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

slide-1
SLIDE 1

7/11/2017 1

Presented by Chad Glenn

Rapid Cycle Testing Accelerating changes through the use of PDSA cycles

2  Chad Glenn, Innovation Group

slide-2
SLIDE 2

7/11/2017 2

3  Chad Glenn, Innovation Group 4  Chad Glenn, Innovation Group

Discussion Topics

The goal: Learn how PDSA (Plan-Do-Study-Act) cycles can increase learning and rapidly improve processes through smartly designed, small scale iterative tests.

  • Learning and improvement

cycles

  • Why test?
  • How to plan successful test

cycles

  • Moving from testing to

implementation

slide-3
SLIDE 3

7/11/2017 3

5

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

6

The Model for Improvement

Courtesy of IHI

AIMS MEASURES CHANGES

slide-4
SLIDE 4

7/11/2017 4

7 Chad Glenn, Innovation Group 8  Chad Glenn, Innovation Group

Aim: Decrease LBTC% by 40% over the next 6 months

Theory – Utilization of Clinician in Triage will reduce LWOT% Decreased LBTC %

A P S D A P S D

Cycle 1: Run demand capacity analysis to evaluate feasibility of Clinician-in-Triage based on volume and acuity (1 day) Cycle 2: Cycle 3: Cycle 4: Test parallel processing with 1 APP + 1 nurse in Triage (2 weeks) Cycle 5: Pilot Team Triage all days (4 weeks) Canvas physicians to identify and reach consensus

  • n patient criteria for Clinician-in-Triage (2 days)

Test using physician in triage for busy days (2 weeks)

slide-5
SLIDE 5

7/11/2017 5

9  Chad Glenn, Innovation Group

Aim: Increase APP chart efficiency by 25% over the

next 6 month

Theory – Utilization of scribes increases chart efficiency Improved chart efficiency

A P S D A P S D

Cycle 1: Follow 1 APP through to test theory that they would benefit from the support of a scribe (1 day) Cycle 2: Cycle 3: Cycle 4: Test scribes w/ 2 APPs, one day shift, one night shift (2 weeks) Cycle 5: Pilot test scribes for all APPs (4 weeks) Reference scribes playbook and canvas APPs and scribes to identify best practices for scribe implementation (2 days) Use 1 scribe, 1 APP, 1 shift (2 days)

Courtesy IHI – Institute for Healthcare Improvement 10  Chad Glenn, Innovation Group

Can one learn more by diagnosing the current process or system, or by changing something right away?

?

slide-6
SLIDE 6

7/11/2017 6

11  Chad Glenn, Innovation Group

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

  • ptions, 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

12

Aim of Discussion

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.

Accelerate Changes

 Chad Glenn, Innovation Group

slide-7
SLIDE 7

7/11/2017 7

13  Chad Glenn, Innovation Group

The PDSA Cycle

Four Steps: Plan, Do, Study, Act

TIME KNOWELEDGE

14  Chad Glenn, Innovation Group

The PDSA Cycle

P D S A P D S A P D S A P D S A Learning and Improvement AKA ‐ “Rapid Cycle Testing” ‐ “Learning and Improvement Cycles” ‐ “Sequential/ Iterative Testing”

slide-8
SLIDE 8

7/11/2017 8

15  Chad Glenn, Innovation Group

Triage protocols Scheduling protocols Treatment protocols Discharge protocols

Overall Aim: Increase Access

Courtesy IHI – Institute for Healthcare Improvement 16  Chad Glenn, Innovation Group  Chad Glenn, Innovation Group

slide-9
SLIDE 9

7/11/2017 9

17  Chad Glenn, Innovation Group  Chad Glenn, Innovation Group 18  Chad Glenn, Innovation Group

slide-10
SLIDE 10

7/11/2017 10

19  Chad Glenn, Innovation Group

Plan/ Predict

  • Formulate questions to be answered

by PDSA cycle

  • Make predictions about
  • utcome of cycle
  • Clearly state and document

hypothesis that supports prediction

  • Plan for collection of

data to answer questions

20  Chad Glenn, Innovation Group

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.

Courtesy of IHI

slide-11
SLIDE 11

7/11/2017 11

21  Chad Glenn, Innovation Group

Don’t get stuck in the “do-do” phase Don’t get stuck in the “do-do” phase

22  Chad Glenn, Innovation Group

Study the results

Courtesy of IHI

PLAN STUDY

Predictions Results

DO ACT

slide-12
SLIDE 12

7/11/2017 12

23  Chad Glenn, Innovation Group

  • 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?

Act

Accept? Adjust? or Abandon?

24  Chad Glenn, Innovation Group

PDSA CYCLE PROCESS FLOW MAP

Iterative Process

Designed by Chad Glenn, IG

slide-13
SLIDE 13

7/11/2017 13

25  Chad Glenn, Innovation Group

The PDSA Cycle

Why Test?

26  Chad Glenn, Innovation Group

Reduce Risks

 Chad Glenn, Innovation Group

slide-14
SLIDE 14

7/11/2017 14

27  Chad Glenn, Innovation Group 28  Chad Glenn, Innovation Group

Minimize Resistance

slide-15
SLIDE 15

7/11/2017 15

29  Chad Glenn, Innovation Group

Build Consensus

30  Chad Glenn, Innovation Group

High Moderate Low

Degree of belief that the change will result in an improvement

Developing a change Testing a change cycle 1, cycle 2 … Implementing a change

Unsuccessful proposed change Change still needs further testing

A B C

Degree of belief

slide-16
SLIDE 16

7/11/2017 16

31  Chad Glenn, Innovation Group

Deciding on the Scale of a Test

Perspective of Participating Teams Perspective of those affected by change Degree of belief Cost of failure Readiness for change Resistant

(no commitment)

Indifferent

(some commitment)

Ready

(strong commitment)

Low degree of belief that a change idea will lead to an improvement Large Very small-scale test Very small-scale test Very small-scale test Small Very small-scale test Very small-scale test Small-scale test High degree of belief that a change idea will lead to an improvement Large Very small-scale test Small-scale test Large-scale test Small Small-scale test Large-scale test Implement

Courtesy IHI – Institute for Healthcare Improvement 32  Chad Glenn, Innovation Group

Repeated Use of the PDSA Cycle

Hunches Theories Ideas Changes That Result in Improvement A P S D A P S D Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change

Courtesy IHI – Institute for Healthcare Improvement

slide-17
SLIDE 17

7/11/2017 17

33  Chad Glenn, Innovation Group

Tabletop exercise: Coin Spinning Game – PDSAs

Courtesy IHI – Institute for Healthcare Improvement 34  Chad Glenn, Innovation Group

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!!!
slide-18
SLIDE 18

7/11/2017 18

35  Chad Glenn, Innovation Group

Planning useful PDSA cycles

36  Chad Glenn, Innovation Group

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

slide-19
SLIDE 19

7/11/2017 19

37  Chad Glenn, Innovation Group

Set a Good Tempo for Testing

  • Year
  • Quarter
  • Month
  • Week
  • Day

37

“If we are considering designing a test to take a quarter, consider what test could be designed to take a week.”

Courtesy IHI – Institute for Healthcare Improvement 38  Chad Glenn, Innovation Group

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

slide-20
SLIDE 20

7/11/2017 20

39  Chad Glenn, Innovation Group

Testing on a Small Scale

  • Conduct the test in one facility or office in the
  • rganization, or with one patient
  • Conduct the test over a short time period (one hour or
  • ne day)
  • Test the change on a small group of volunteers

Courtesy IHI – Institute for Healthcare Improvement

1 doctor + 1 nurse + 1 patient + 1 shift

40  Chad Glenn, Innovation Group

Act

  • Next cycle

‐ Abandon? ‐ Adopt? ‐ Accept? 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

  • Run the test
  • Document problems

and unexpected

  • bservations
  • Begin analysis
  • f the data

The PDSA Cycle

slide-21
SLIDE 21

7/11/2017 21

41  Chad Glenn, Innovation Group

Accelerating Learning and Improvement

  • What cycle can we do by next Tuesday?

Act Plan Study Do

Willing to compromise on scope, size, rigor, and sophistication, but the cycle must be completed by Tuesday.

42  Chad Glenn, Innovation Group

Form for planning a PDSA cycle

slide-22
SLIDE 22

7/11/2017 22

Exercise:

  • Take a moment to Map out or discuss a series

(2-4) of PDSA cycles

  • Write out the test, the scope, the timeframe,

who's involved, lessons to learn, and when you will do the After Action Reviews (AARs)

  • Then lay out two subsequent tests-SMART

Format- increasing in learning and complexity

Be sure to include/think through your timelines.

43

44

Muda Action Talk

 Chad Glenn, Innovation Group

slide-23
SLIDE 23

7/11/2017 23

45

References…

46  Chad Glenn, Innovation Group

The Improvement Guide. G. Langley et al., Jossey-Bass Publishers., San Francisco, 1996.

slide-24
SLIDE 24

7/11/2017 24

47  Chad Glenn, Innovation Group

The Health Care Data Guide. L. Provost, S. Murray. Jossey-Bass Publishers., San Francisco, 2011.

48  Chad Glenn, Innovation Group

Quality Improvement Through Planned Experimentation. 2nd ed. R. Moen, et al., McGraw-Hill, NY, 1998.