Corner Stone: The Improvement Model
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Transcript of Corner Stone: The Improvement Model
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Corner Stone: The Improvement Model
Debbie Barnard, MSc, CPHQ January 30, 2013
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AcknowledgementMy thanks to the IHI and API as without them
and the materials they share at IHI.org the pages of this presentation would be blank
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What is this session all about?• Know the theory
– State the three fundamental questions that are the basis of the Model for Improvement:
– Identify the processes that make up the Plan-Do-Study-Act (PDSA) cycle;
• Understand how to apply the theory and– Describe how an improvement team can use the model to make
changes in a real-world setting• Being able to share that knowledge in a way that
empowers the learner to make the knowledge their own
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Foundation forBreakthrough Improvement
• Will to do what it takes to change to a new system– “own the problem” and leadership support to
improvement.• Ideas on which to base the design of the new system
– don’t recreate the wheel, rather learn from the success of others
• Execution of the ideas– use proven quality methods to test and measure.
Source: IHI.org
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The Model for Improvement: Your Engine for Change
IHI.org
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Source: The Improvement Guide, API
Aim
Measures
Changes
Execution
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What are you trying to accomplish?
• Do you know exactly what you are trying to do
• Do you have clearly defined aims/objectives?
• How good do you want to be by when?
Source: NHS Scotland – Science of Improvement Learning Sessions (The Improvement Guide by API)
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PrimaryDriversOutcome
SecondaryDrivers
Ideas for ProcessChanges
AIM:A New
ME!
Calories In
Limit dailyintake
TrackCalories
CaloriesOut
Substitutelow calorie
foods
Avoidalcohol
Work out 5days
Bike towork
PlanMeals
Drink H2ONot Soda
drives
drives
drives
drives
drives
drives
drives
drives
• Weight• BMI• Body Fat• Waist size
• Daily caloriecount
• Exercisecalorie count
• Days betweenworkouts
• Avg drinks/week
• Runningcalorie total
• % ofopportunitiesused
• Sodas/week
• Meals off-plan/week
• Avg cal/day
Exercise
Fidgiting
HackySack inoffice
Percent of dayson bike
Etc...
Our Teaching SampleUnderstanding the System for Weight Loss with Measures
Source: Richard Scoville, Ph.D.
AIM: How much by when?
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How will you know that change results in improvement ?
• Do you have a balanced set of measures (process outcome and balancing measures) in place that will enable you track progress towards your goal?
Source: NHS Scotland – Science of Improvement Learning Sessions (The Improvement Guide by API)
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PrimaryDriversOutcome
SecondaryDrivers
Ideas for ProcessChanges
AIM:A New
ME!
Calories In
Limit dailyintake
TrackCalories
CaloriesOut
Substitutelow calorie
foods
Avoidalcohol
Work out 5days
Bike towork
PlanMeals
Drink H2ONot Soda
drives
drives
drives
drives
drives
drives
drives
drives
• Weight• BMI• Body Fat• Waist size
• Daily caloriecount
• Exercisecalorie count
• Days betweenworkouts
• Avg drinks/week
• Runningcalorie total
• % ofopportunitiesused
• Sodas/week
• Meals off-plan/week
• Avg cal/day
Exercise
Fidgiting
HackySack inoffice
Percent of dayson bike
Etc...
Our Teaching SampleUnderstanding the System for Weight Loss with Measures
Source: Richard Scoville, Ph.D.
Measures: What d
oes succe
ss
look like?
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What Changes Can We Make That Will Result in Improvement?
• What have others done? • What hunches do we have? • What can we learn as we go along?• Principles:
– Everything goes– Think outside the box– Borrow from other disciplines or organizations– Use established change packages
Source: NHS Scotland – Science of Improvement Learning Sessions (The Improvement Guide by API)
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PrimaryDriversOutcome
SecondaryDrivers
Ideas for ProcessChanges
AIM:A New
ME!
Calories In
Limit dailyintake
TrackCalories
CaloriesOut
Substitutelow calorie
foods
Avoidalcohol
Work out 5days
Bike towork
PlanMeals
Drink H2ONot Soda
drives
drives
drives
drives
drives
drives
drives
drives
• Weight• BMI• Body Fat• Waist size
• Daily caloriecount
• Exercisecalorie count
• Days betweenworkouts
• Avg drinks/week
• Runningcalorie total
• % ofopportunitiesused
• Sodas/week
• Meals off-plan/week
• Avg cal/day
Exercise
Fidgiting
HackySack inoffice
Percent of dayson bike
Etc...
Our Teaching SampleUnderstanding the System for Weight Loss with Measures
Source: Richard Scoville, Ph.D.
Action Plan Clearly Defined
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ActWhat changes
are to be made?Next cycle?
Plan
Objective, questions and predictions (why)
Plan to carry out the cycle (who, what, where, when)
Study Complete the
analysis of the dataCompare data to
predictionsSummarize
what was learned
DoCarry out the planDocument problemsand unexpectedobservationsBegin analysis of the data
The PDSA Cycle for Learning and Improvement
Source: NHS Scotland – Science of Improvement Learning Sessions (The Improvement Guide by API)
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Repeated use of the PDSA cycle
Accumulating in
formatio
n and knowledge
PLANPLAN
DODO
STUDY
STUDY
ACTACT
PLANPLAN
DODO
STUDY
STUDY
ACTACT
Testing andrefining ideas
Implementing newprocedures & systems- sustaining change
Brightidea!
PLANPLAN
DODO
STUDY
STUDY
ACTACT
PLANPLAN
DODO
STUDY
STUDY
ACTACT
PLANPLAN
DODO
STUDY
STUDY
ACTACT
PLANPLAN
DODO
STUDY
STUDY
ACTACT
How is the methodology applied?
Source: NHS Scotland – Science of Improvement Learning Sessions (The Improvement Guide by API)
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Source: IHI.org
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Methodology applied to the Frontline e.g. Improving ED Services
Testin
g and a
dapta
tion
A P
S D
A PS D
A P
S D
D SP A
A P
S D
A PS D
A P
S D
D SP A
A P
S D
A PS D
A P
S D
D SP A
A P
S D
A PS D
A P
S D
D SP A
1. Triage 2. Diagnostic Testing
3. Fast TrackPatients
4. Capacity /Demand
Change IdeasSource: NHS Scotland – Science of Improvement Learning Sessions (The Improvement Guide by API)
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What do you say when, you are asked – testing why????
• To learn whether the change will result in an improvement
• To predict the amount of improvement possible• To learn how to adapt the change to different
environments• To understand the costs and impact of change• To reduce resistance
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© 2004 Institute for Healthcare Improvement
Measurement for Learning and Process Improvement
Measurement for
Research
Purpose To bring new knowledge into daily practice
To discover new knowledge
Tests Many sequential, observable tests
One large "blind" test
Biases Stabilize the biases from test to test
Control for as many biases as possible
Data Gather "just enough" data to learn and complete another cycle
Gather as much data as possible, "just in case"
Duration "Small tests of significant changes" accelerates the rate of improvement
Can take long periods of time to obtain results
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Practice:“Make the Invisible, Visible”
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Simulation/Other Resources• Teaching the Model for Improvement: (Airplane Game) Training
Guide available at http://www.nahq.org/uploads/apps/files/PDSA%20Simulation%20Training%20Guide.pdf
• Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.
• The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)
• www.IHI.org
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Thank YouQuestions/Discussion