Making Small Tests of Change for Improvement Stephanie Gething Advanced OT Practitioner Stroke Rehabilitation Model for Improvement Set clear aims ~ what are we trying to achieve? Establish measures that will tell if changes are leading to improvement ~ how will we test that a change has made a difference? Identify changes that are likely to lead to improvement ~ what changes can we make, how will we make them and who needs to be involved? PLAN~DO~STUDY~ACT CYCLE Small scale tests of change in real work settings PLAN ~ Plan a test of change DO ~ Try it out STUDY~ Observe the results ACT ~ Act on what is learned Putting Theory into Practice ~ The PDSA Cycle in Action Overall Aim: To achieve the acute phase care bundle Objective: Accurate documentation of compliance with care bundles PLAN ~ (Test compliance rate of MDT with care bundles) Who? CNS (First Hours Bundle) CNS/Nursing Team (First Day) Nursing Team/Physio (First 3 Days) OT/CNS (First 7 Days) What? Use of Care Bundles Compliance Sheet When? Completed by team members at the time of their intervention DO ~ (Carry out change) Team agreed where the compliance sheet should be kept ie in front of medical notes Start date agreed Carried out for one week and sheets checked to test compliance Team met to discuss issues impacting on the planned change STUDY ~ (Analyse effects) Issue ~ difficult to identify interventions in patients’ notes to confirm/audit compliance Team agreed to introduce stickers in the patients’ notes to identify: Admission to Unit (first day bundle) Swallow Screen (first day bundle) Nutrition Screen (first 3 days bundle) Profession specific assessments (first 37days bundle) Patient Information (first 7 days bundle) ACT ~ (Implement new changes) Team used stickers in patients’ notes to document when assessment/intervention was carried out Further audit carried out a month later showed a higher compliance rate with the 1-7 days acute stroke care bundles What we learned ~ Using the PDSA cycle helps to focus on realistic and achievable steps to achieve change Small changes can lead to a big improvement in patient care Work as a team to share the load Next challenge ~ To maintain the changes now that the spotlight has shifted to TIA/Rehabilitation THANK ANY YOU FOR LISTENING QUESTIONS?