All Wales Stroke Services Improvement
Collaborative
All Nations Centre, Cardiff
4th November 2008
Supporting NHS Wales to Deliver World Class Healthcare
All Wales Stroke Services Improvement Collaborative
The Model for Improvement
Part Two
Dr Alan Willson
Director of Research and Development NLIAH
Director 1000 Lives Campaign
Director AWSSIC
Slide 2
All Wales Stroke Services Improvement Collaborative
Learning Objectives
– the theory
• The 3 questions of the Model for Improvement
(MFI)
• PDSA cycles
• Run charts
– the practice
• Team aim for Stroke Services
• The ‘How’ of measurement
• The PDSA Cycle related to a Stroke service
change
Slide 3
All Wales Stroke Services Improvement Collaborative
Model for Improvement
Slide 4
All Wales Stroke Services Improvement Collaborative
The PDSA Cycle:
Act Objective
Plan
Adapt?
Adopt ?
Abandon?
Next cycle?
Questions and
predictions (why)
Plan to carry out the cycle
(who, what, where, when)
Study Do
Complete the
analysis of the data
Compare data to
predictions
Summarize what
was learned
Slide 5
Carry out the plan
(on a small scale)
Document problems
and unexpected
observations
Begin analysis
All Wales Stroke Services Improvement Collaborative
Test of change have been going on for years
“Negative results on the fish…
Let’s try rubbing two sticks together.”
Slide 6
All Wales Stroke Services Improvement Collaborative
This is different!
A P
S D
Changes That
Result in
Improvement
Implementation of
change
Wide-scale tests of
change
A P
S D
Hunches
Theories
Ideas
Slide 7
Very small scale
test
Follow-up tests
All Wales Stroke Services Improvement Collaborative
Why test?
• Learn
• Design
• Confidence
• Resistance
Slide 8
All Wales Stroke Services Improvement Collaborative
Model for Improvement
What are we trying to
accomplish?
How will we know
that a change is an
improvement?
What change can we make
that will result in
improvement?
Slide 9
AIM
All Wales Stroke Services Improvement Collaborative
Aims
• Overall collaborative aim
• Specific aim
• Your local aim?
Slide 10
To improve the
outcome following
stroke
To increase the
reliability of delivering
4 care bundles for
acute stroke
All Wales Stroke Services Improvement Collaborative
Aim Exercise
Slide 11
All Wales Stroke Services Improvement Collaborative
Model for Improvement
What are we trying to
accomplish?
How will we know
that a change is an
improvement?
What change can we make
that will result in
improvement?
Slide 12
AIM
Goals
&
Measurement
All Wales Stroke Services Improvement Collaborative
What are we trying to
accomplish?
How will we know
that a change is an
improvement?
What change(s) can we
make that will result in
improvement?
Change(s)
Slide 13
AIM
Goals
&
Measurement
All Wales Stroke Services Improvement Collaborative
Share your changes…
Slide 14
All Wales Stroke Services Improvement Collaborative
The PDSA Cycle:
Act Objective
Plan
Adapt?
Adopt ?
Abandon?
Next cycle?
Questions and
predictions (why)
Plan to carry out the cycle
(who, what, where, when)
Study Do
Complete the
analysis of the data
Compare data to
predictions
Summarize what
was learned
Slide 15
Carry out the plan
(on a small scale)
Document problems
and unexpected
observations
Begin analysis
All Wales Stroke Services Improvement Collaborative
How small is small ?
Slide 16
All Wales Stroke Services Improvement Collaborative
Tips for PDSA Cycles
• “What change could you test
by next Tuesday?”
• Start Small
• “Rule of 1”:
•
•
•
•
Slide 17
1 facility
1 office
1 provider
1 patient
•
•
•
•
Volunteers at first
Useful (not perfect) data
Use “huddles” to report
Learning first …
All Wales Stroke Services Improvement Collaborative
MODEL FOR IMPROVEMENT
A
S
PLAN
Objective for this PDSA Cycle
P
D
:
:
QUESTIONS
:
PREDICTIONS
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE
DO
: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
STUDY
ACT:
Slide 18
:
COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED.
ARE WE READY TO MAKE A CHANGE? PLAN FOR THE NEXT CYCLE.
CYCLE
:____ DATE
:____
All Wales Stroke Services Improvement Collaborative
Learning Objectives
– the theory
• The 3 questions of the Model for Improvement
(MFI)
• PDSA cycles
• Run charts
– the practice
• Team aim for Stroke Services
• The ‘How’ of measurement
• The PDSA Cycle related to a Stroke service
change
Slide 19