Plan-Do-Study-Act Cycle and
QI Tool Refresher
March 27, 2014
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WELCOME BACK!
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Today’s Agenda
• PDSA Refresher
– Quality Improvement Fundamentals
– Plan-Do-Study-Act Cycle
• Quality Improvement Application
• Wrap-up – Questions and Training
Post-assessment
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QI Fundamentals
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Definition
Quality Assurance vs. Quality Improvement
Benefits
Four Basic Principles
3 Key Questions
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QI in Our Terms
“QI is the use of a deliberate and defined improvement
process, such as Plan-Do-Study-Act, which is focused on
activities that are responsive to community needs and
improving population health. It refers to a continuous
and ongoing effort to achieve measurable
improvements in the efficiency, effectiveness,
performance, accountability, outcomes, and other
indicators of quality in services or processes which
achieve equity and improve the health of the
community.”
Bialek, R., Beitsch, L. M., Cofsky, A., Corso, L., Moran, J., Riley, W., & Russo, P. (2009).
Proceedings from Accreditation Coalition Workgroup: Quality Improvement in Public Health.
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QA and QI are Not the Same
Quality Assurance
Quality Improvement
Guarantees quality
Raises quality
Relies on inspection
Emphasizes prevention
Uses a reactive approach
Uses a proactive approach
Looks at compliance with
standards
Improves the processes to meet
standards
Requires a specific fix
Requires continuous efforts
Relies on individuals
Relies on teamwork
Examines criteria or
requirements
Asks, “Do we provide good
services?”
Examines processes or outcomes
Asks, “How can we provide
better services?”
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QI Can…
• Reduce cost and
redundancy
• Eliminate waste
• Streamline processes
• Enhance ability to
meet service demand
• Increase customer
satisfaction
• Improve outcomes!
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QI - Four Basic Principles
• Develop a strong customer (client) focus
• Continually improve all processes
• Involve employees
• Mobilize both data and team knowledge to
improve decision-making
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QI – Three Key Questions
1. What are we trying to accomplish?
2. How will we know that a change is an
improvement?
3. What changes can we make that will result in
improvement?
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Where do we begin?
The Plan-Do-Study-Act (PDSA) Cycle
• PDSA (also known as Plan-Do-Check-Act
(PDCA), was made popular by Dr. W.
Edwards Deming
• Is widely used by quality professionals,
process improvement engineers, & health
care professionals
• Science based, data driven, iterative process
improvement methodology
• Turns ideas into action and connects that
action to learning
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PDSA – An Overview
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Four Stages
Nine Steps
Repeatable Steps
Can be used by one
person, a team, or an
agency
• Used to improve
existing processes
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Stage One - PLAN
Step 1
• Getting Started
Step 2
• Assemble the Team
Step 3
• Examine the Current Approach
Step 4
• Identify Potential Solutions
Step 5
• Develop an Improvement Theory
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Stage Two - DO
•Test the
Step 6
Theory
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Stage Three - STUDY
•Study the
Step 7
Results
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Stage Four - ACT
Step 8
• Standardize the
Improvement or Develop
a New Theory
Step 9
• Establish Future Plans
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QI Toolbox for the PLAN Stage
• Team Charter - A Tool to Keep You Organized
• Aim Statement - A Tool to Define the Goal
• Process Mapping - A Tool to Examine Current Process Flow
• Fishbone Diagram - A Tool for Identifying Root Causes
• Affinity Diagram - A Tool to Identify Potential Solutions
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A Tool to Keep you Organized: Team Charter
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QI Team Charter
What is it?
One to two page document that describes the
team’s purpose and targeted improvement.
• Serves as your team’s roadmap
• Helps reduce the “now what?” feeling
• Helps the team come to agreement regarding:
• Communication
• Accountability
• Delivery of products
• Evolves over the course of the project
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What to Include:
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Team sponsor
Team members and roles
Problem, issue, or opportunity statement
Description of the process improvement
Aim statement
Customers and their needs
Timeline for completing each stage of the PDSA cycle
Timeline and frequency of team meetings
Internal and external stakeholders
Improvement theories (If…Then)
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A Tool to Define the Goal: Aim Statement
A concise, specific, written statement that defines
precisely what the team hopes to accomplish with
its QI efforts.
Remember the three fundamental
questions when writing your aim:
1. What are we trying to
accomplish?
2. How will we know that a change
is an improvement?
3. What changes can we make that
will result in improvement?
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Aim Statements
• Include a numerical measure for the target
• Are time specific and measurable
• Define the specific population that will be
affected
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A Tool to Examine Process Flow:
Process Mapping
• Analyze and improve
processes
– Identify areas of
complexity and re-work
– Generate ideas for
improvement
– Illustrate process
improvements
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Preparing to Process Map
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• Assemble your QI team
• Determine which process needs to be documented
• Agree on where the process begins and ends
• Agree on the level of detail that will be displayed
• Create a list of the steps taken in the current process
• Construct your process map by ordering the steps
• Identify additional staff to review or provide input on your process map
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Symbols used to Process Map
• Start & End: An oval is used to show the materials,
information or action (inputs) to start the process or to show
the results at the end (output) of the process.
• Activity: A box or rectangle is used to show a task or activity
performed in the process. Although multiple arrows may
come into each box, usually only one arrow leaves each box.
• Decision: A diamond shows those points in the process where
a yes/no question is being asked or a decision is required.
• Flow: An arrow shows the direction or flow of a process.
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A Few Hints and Tips
• Map the current process!
• It’s okay if team members have different
ideas about how the process works.
• Keep steps simple; begin each step with an
action verb.
• Process mapping is dynamic!
• Post-it notes, dry-erase markers, & pencils
are your friend!
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A Tool for Root Cause Analysis:
Fishbone Diagrams
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Fishbone Diagrams - Purpose
• To identify and examine underlying or root
causes of a problem
• To identify a target for your improvement that
is likely to lead to change
• To explore possible causes of a problem
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Fishbone Diagrams: Construction
Step 1
Step 2
Step 3
Step 4
• Write the Problem/Effect in a box on the far right side of your paper, dry
erase board, etc.
• Draw an arrow (backbone) leading to that box
• Draw smaller arrows (bones) leading to the backbone, and label these
arrows with your major causes
• For each cause, brainstorm minor causes related to each major cause and
note them on the diagram by placing lines on each of the major bones.
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A Tool to Identify Potential Solutions:
Affinity Diagrams
Group 1
Group 2
Group 3
Group 4
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
Idea
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Affinity Diagram: Purpose
• Creatively generate a
large number of
ideas and organize
them into natural
groupings among
them to understand
possible solutions to
a problem.
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Affinity Diagrams: When to Use
• To generate consensus
• When you need your team to think creatively
• To breakdown communication barriers
• To allow breakthroughs to emerge naturally
• To overcome “team paralysis”
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Affinity Diagrams: Step by Step
Step 1
Step 2
Step 3
Step 4
• Phrase the issue under discussion as a full sentence
• Brainstorm at least 20 ideas or issues
• A “typical” Affinity has 40-60 items, but 100 or more are not unusual
• Simultaneously and quickly sort ideas into 5 to 10 related groupings
• For each grouping, create summary or header cards using consensus
• Strive to capture the essence of all the ideas in each grouping
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Questions?
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Break
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PDSA Application
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Lunch
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PDSA Application, con’t
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Next Steps
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Questions?
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Evaluation and Adjourn
Thank you!
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