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.
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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!
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