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?