Practice Key Driver Diagram The Model for Improvement

Practice Key Driver Diagram

The Model for Improvement: The Three Questions Chapter Quality Network ADHD Project Jennifer Powell, MPH, MBA, Quality Improvement Consultant Allie Stevens, MPH, MS, Project Manager, Chapter Quality Network

Commercial Interests Disclosure Jennifer Powell, MPH, MBA Allie Stevens, MPH, MS I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved or investigative use of a commercial product/device in my presentation. 3

Objectives § Outline the 3 components of the Model for Improvement § Describe how to conduct rapid cycle testing using the Plan-Do-Study-Act method

Why Use a Quality Improvement Strategy? § Provides a framework to show us how to get from where we are to where we want to be § Uses measurement to show us where we are on the journey and to let us know when we’ve arrived at our destination

Three Fundamental Questions for Improvement 1. What are we trying to accomplish? AIM 2. How will we know that a change is an improvement? MEASURES 3. What changes can we make that will result in improvement? IDEAS

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? Act Plan PDSA CYCLES Study From: Associates in Process Improvement Do Do AIMS MEASURES IDEAS

PDSA: Break it Down/Simplify… Plan – Figure out the questions you want to answer, plan a answer the questions, and predict results Do – “Just do it” (i. e. do the plan); collect the data Study – What did you learn? Act – What will you do with the knowledge you learned? What do you want to do next? Adapt, Adopt, Abandon? way to

Build a PDSA Ramp Changes That Result in Improvement AIM: Measure for PDSA Ramp: A P A T A D A S Hunches Theories Ideas D P S D D S P A Wide-Scale Tests of Change: A P S D Follow-up Tests: Very Small Scale Test: Implement Change: Multiple PDSA Cycles – Sequential Building of Knowledge – include a wide range of conditions in the sequence of tests before implementing the change

Failure is just succeeding at learning what doesn’t work!

Mr. Potato Head, AKA Sam, Exercise § What we will learn : § How an aim statement will inform testing § Understand rapid cycle PDSA testing § Understand how theory and prediction aid learning § See how to collect real-time measurement § Appreciate the opportunity of collaborative learning

Roles § Master Clinician – will put Sam together based on groups/predictions/theories § Documenter – will record data on data sheet to create our run charts § Time Keeper – will use their stopwatch on mobile phone to report time for each cycle § Score Inspector – judge precision according to the scale on the worksheet § QI Team Members – generate theories for testing, encourage the process

Establishing our Baseline § Our gracious volunteer is going to come up and help us establish our baseline data for this improvement initiative. § We will start the clock when the volunteer starts… stop clock when hands are off Mr. Potato Head § Time Keeper will record; Score Inspector will rank precision; Documenter will put data points on charts

Mr. Potato Head Aim Statement By the end of this session, our master clinician will correctly put Sam together - exactly as pictured in the photo - in 50 seconds or less. We will use iterative testing (plan, do, study and act) to identify implementation strategies.

Mr. Potato Head Data Sheet PDSA# Theory being tested TIME Prediction 80 70 1 60 SECONDS 2 3 50 40 30 20 10 4 1 2 3 4 5 6 PDSA CYCLE # PRECISION 5 Precision 6 3 - All pieces are on Sam and are positioned correctly (as shown in the picture) 2 - All pieces are on Sam, but one or more is out of place or out of position 1 - One or more pieces are not on Sam PRECISION SCORE 3 2 1 1 2 3 4 PDSA CYCLE #

Meet Sam

The PDSA Cycle Plan • Objective • What changes • Questions and predictions (why) are to be • Plan to carry out made? the cycle (who, • Next cycle? what, where, when) Act Study • Complete the analysis of the data • Compare data to predictions • Summarize what was learned Do • Carry out the plan • Document problems and unexpected observations • Begin analysis of the data

Tips for Testing Changes § Stay a cycle ahead § Scale down scope of tests – START SMALL § Pick willing volunteers (work with those that want to work with you) § Avoid the need for consensus, buy-in, or political solutions § Replicate changes made elsewhere § Pick easy/feasible changes to try § Avoid technical slowdowns § Reflect on the results of every test (successful AND failed tests)

What is Important to Understand About Testing? § Change isn’t permanent § No support for change beyond test period § Learning from testing will be significant—up to 50% of tests not expected to yield improvement § Fewer # of people affected by the test (lower risk) § It will provide you with the data to prove that a new way works better Source: Langley et al. 1996. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. p 114.

Objectives § Outline the 3 components of the Model for Improvement § Describe how to conduct rapid cycle testing using the Plan-Do-Study-Act method