The Improvement Model
and
PDSAs
Aims of this session
• To understand the Model for
Improvement and the PDSA Cycle
• To understand the purpose and
application of The Model to Improve
Healthcare Systems and Processes
Changing systems
• Change is difficult and can be
threatening
• Change can be time-consuming
• Change involves understanding
people, systems and processes
• Healthcare systems are often
complex and fragmented
Why change?
Because:
‘If you always do what you have always
done, you will always get what you have
always got!’
How it has been done so far…
What is the best way to approach change that results in
improvement?
Trial & Error?
Detailed prior study
Chaos
Paralysis
Too much action,
not enough thinking
‘Something must be done,
this is something,
therefore we must do it…’
Too much thinking,
not enough action
‘We can’t do anything
until we know exactly
what to do…’
‘Trial and Learning’ Approach
‘Trial and Learning’
• Setting challenging aims
- is it worth doing? Not ‘change for change sake’
• Identifying principles/change ideas
- what has worked for someone? What might work for us?
• Measuring progress
- knowing what’s happening
• Testing changes
- starting small; reducing risk
• Implementing and sustaining change
- change in systems and routines; developing skills and abilities
Defining the problem
Always speak to
someone different
Didn’t specify
what
I wanted properly
Getting
Information
Didn’t
check
often
enough
Set impossible
timescales
Am I dealing with
really urgent
work?
Other deadlines
Haven’t planned
time available well
Not sharing
workload
Not got an
accurate
brief
Didn’t give
manager
enough time
Waiting for line
Manager’s approval
The fundamental improvement
questions
• What are we trying to achieve?
– Know exactly what you are trying to do – have clear
aims and objectives
• How will we know that change is an improvement?
– Measuring processes and outcomes
• What changes can we make that will result in an
improvement?
– What have others done? What hunches do we have?
What can we learn as we go along?
What is a PDSA?
• A simple tool for staff to use test out ideas that will
improve healthcare systems and processes
• A structured approach for making small incremental
changes to systems
• A full cycle for planning, implementing, testing and
identifying further changes
Plan, Do, Study, Act
What changes
are we going to
make based on
our findings?
What were the
results?
Act
Plan
Study
Do
What exactly
are we going to
do?
When and how
did we do it?
Why use PDSAs?
• The PDSA Cycle was developed for use in healthcare systems
by the Institute for Healthcare Improvement based in the USA. It
has been widely used to deliver improvements in healthcare
systems throughout Europe and the USA
• It is small in scope and builds incrementally – small rapid cycles
lead to improvement
• It is highly effective, changes are quick and immediately evident
• It is a powerful tool for learning. As much is learned from ideas
that don't work as from those that do
The PDSA Cycle
• You need to take time to consider the
following prior to undertaking your first
PDSA:
• What are you trying to accomplish?
• How will you know that a change is an
improvement?
The PDSA Cycle
• What changes can you make that will
result in improvement?
• Remember, not all changes will result in
an improvement. It is essential that
learning from what did work as well as
what didn’t work is captured before
undertaking your next PDSA.
Plan
•
•
•
•
•
•
This stage involves
Identify the changes
Set objectives
Make predictions
Plan how to measure outcomes
Define roles and responsibilities
Do
• This is the stage where the plan is put
into action.
• Remember to keep it small and
manageable, i.e. one patient, one
doctor, one nurse, one day.
Study
•
•
•
•
Review the cycle
Reflect with all relevant stakeholders
Analyse data collected
Generate ideas for improvements prior
to re-testing
Act
• The cycle should be tested again
unchanged under different conditions
• Alternatively, you may decide to amend
your plan to reflect learning from first
cycle and re-test
The principles of PDSAs
• Breaks down change into manageable, bitesized time-limited chunks
• A PDSA cannot be too small!!!!!!
• Small changes can be tested without causing
upheaval to the whole system
• If it doesn’t work, try something different
based on your learning
Repeated use of the PDSA cycle
Implementing new
procedures & systems
- sustaining change
Testing and
refining ideas
Bright
idea!
Your turn!
Develop your own PDSA cycle in relation
to a small part of your working life you
would like to change
Summary
• PDSAs are an efficient, user-friendly way to approach
changes to systems
• PDSAs ensure that you are measuring the effects of
small changes
• PDSAs break change down into a series of bite-sized
manageable chunks
• PDSAs offer confidence to those who are afraid of
change
Questions?