Developing Concepts of Change&

PDSA Cycles

Brandon Bennett

Agenda

• Review the improvement journey

• Overcoming our barriers to the journey

• PDSA, one to another to another

• What about Change Concepts

Typical approach

Local Barriers to change:

Resistant CultureLack of Human ResourcesLimited Financial Investment

Failure to implement successfully at the local level with resultant improved performance

“Just Do it”

Improvement Approach

Local Barriers to change:

Resistant CultureProcess DesignStructureHuman Resources

Successfully implement at the local level with resultant improved performance

Conceptual Driver DiagramOutcome

1⁰ driver

2⁰ driver

Change Concepts

Specific Change Ideas

Aim or

Outcome

1⁰ driver 1

1⁰ driver 2

2⁰ driver 3

2⁰ driver 2

2⁰ driver 1

2⁰ driver 4

2⁰ driver 5

Concept 1

Concept 2

Concept 4

Concept 3

Concept 5

Concept 6

Ideas:123456789........N

Theory of Causality Theory of

Change

Are we articulating comprehensive theories aimed at overcoming our barriers?

• Process Design– Do we know what our Model of Care looks like? Do we have a process

map with understanding of failure points, bottlenecks, etc.

• Culture– Do we have a theory of what leverage points exist to encourage the

adoption of changes or participation in the improvement journey?

• Physical Structure– Have we considered whether our physical structure needs rearranging

and whether that could us to improve reliability, efficiency, safety, etc.?

• Human Resources– Have we recruited and oriented a productive team for leading

improvement, including local champions who are passionate for the work and local thought leaders who can positively influence the behavior of others?

Break out

• Spend 10 min contemplating these questions

Are we articulating comprehensive theories aimed at overcoming our barriers?

• Process Design– Do we know what our Model of Care looks like? Do we have a process map

with understanding of failure points, bottlenecks, etc.

• Culture– Do we have a theory of what leverage points exist to encourage the adoption

of changes or participation in the improvement journey?

• Physical Structure– Have we considered whether our physical structure needs rearranging and

whether that could us to improve reliability, efficiency, safety, etc.?

• Human Resources– Have we recruited and oriented a productive team for leading improvement,

including local champions who are passionate for the work and local thought leaders who can positively influence the behavior of others?

Aim or Outcome

1⁰ driver 1

1⁰ driver 2

2⁰ driver 3

2⁰ driver 2

2⁰ driver 1

2⁰ driver 4

2⁰ driver 5

Concept 1

Concept 2

Concept 4

Concept 3

Concept 5

Concept 6

Ideas:123456789.........N

Theory informs testing and in turn testing refines theory

Repeated Use of the PDSA Cycle

Hunches Theories

Ideas

Changes That Result in

Improvement

A P

S D

APS

D

A P

S D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

Improvement Guide, Chapter 7, p. 146

So what do repeated improvement cycles look like?

Hunches Theories

Ideas

Changes That Result in

Improvement

A P

S D

APS

D

A P

S D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

Improvement Guide, Chapter 7, p. 146

Tangential, related or new ideas arise

What do you do with these new ideas?

• Capture them

• Integrate them into your theory

• Begin new PDSA ramps to test them

• Set them aside if they are related but are deemed relevant to a different improvement journey

Primary Driver 1

Change Idea 1

Change Idea 2

Change Idea 3

Break out

• Discuss 2 change ideas:

• Where is each on the ramp toward implementation?

• What tangential ideas have arisen as a result of your testing to date and what have you done with those ideas?

What about Change Concepts?

• What are they?

• How can we use them to generate new change ideas when we encounter failure with our current ideas?

Theory of ChangeChange

ConceptsSpecific Change

Ideas

Concept 1

Concept 2

Concept 4

Concept 3

Concept 5

Concept 6

Ideas:123456789........N

How we use change concepts?Incomplete list of change concepts

27. Give people access to information

Counsel patients on want to expect on Admission

Provide electronic patient progress board in surgical waiting area

Display patient safety data publically for patients, families and co-workers to see

Langley, et al.

Develop a radio program Integrate topic

in a local soap opera

Comprehensive list of concepts related to improving quality

Langley et al, The Improvement Guide

Break out

• Select 2 change ideas that are a apart of your current theory

• Review the list of Change Concepts to find which concept(s) relates to each idea

• Spend 2 min silently at your table brainstorming other ideas that could flow from that concept

• Share those in a round robin at your table – remember crazy ideas are encouraged later we can analyze them for feasibility

Comprehensive list of concepts related to improving quality

Langley et al, The Improvement Guide

Finally

• Select 1 idea you might like to develop into a change idea for testing using the Model for Improvement next week when you are back in the day to day of improvement