Quality Improvement 2.0: PDSA Cycles in Action

AnnaCorona,ProgramManagerChildandAdolescentHealth

LyndaKrisowaty,Sr.ProgramManager

EvidenceBasedPractice

MarciBrewer,BreastfeedingProgramManagerLouisianaDepartmentofHealth

JenniferYoung,SchoolWellnessPolicyCoordinatorOregonDepartmentofEducation

AriannaKeil,MD,QualityImprovementDirector,WIDepartmentof

HealthServices’FamilyHealthSection

Session Goal and Objectives

•  Overarchinggoal:Touseanallteach,alllearnapproachtogrowourcollectiveunderstandingofhowtoapplythemodelforimprovementpracticallytotheworkthatwedo

•  Objectives:•  DiscusstwowaystoapplythemodelforimprovementtoourCHWCoIINwork

•  Strengthentheparticipants’abilitytoproblemsolveusingthePDSACycle

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Before we jump in…

• WhatdoyourememberaboutqualityimprovementfromthefirstLearningSession?

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Focusonqualityimprovement(QI)methodsincludingrapid-cycletestingof

changesandoutcomes

Commongoalsandbenchmarkstodefineandmeasurechanges

Collaborativelearningacross

multiplestateteams

CoIIN Methodology

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Focusonqualityimprovement(QI)methodsincludingrapid-cycletestingof

changesandoutcomes

Commongoalsandbenchmarkstodefineandmeasurechanges

Collaborativelearningacrossmultiplestate

teams

CoIIN Methodology

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CoIIN Aims

Increaseby___%thenumberofschools/programsimplementingcomponentsoftheCSPAPmodel

Establishatleast___(number)newpoliciesorpracticesthataddresssocialandecologicalbarrierstobreastfeeding

InnovativelyintegratenutritionintoTitleVMCHBlockGrantandotherMCHprograms

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Focusonqualityimprovement(QI)methodsincluding

rapid-cycletestingofchangesandoutcomes

Commongoalsandbenchmarkstodefineandmeasurechanges

Collaborativelearningacrossmultiplestate

teams

CoIIN Methodology

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Quality Improvement and CoIIN “Allimprovementischange,butnotallchangeisanimprovement.” 8

Quality Improvement Methods

•  5Whys,Fishbone•  ImpactMatrix,PrioritizationMatrix• PDSACycles,ModelforImprovement•  Lean/SixSigma

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Why Use Improvement Cycles?

10https://www.goodhousekeeping.com/home/craft-ideas/g2638/hilarious-pinterest-diy-fails/?slide=24

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Rapid Cycles of Change

Wide-Scale Tests of Change

Hunches Theories

Ideas

Changes That Result in

Improvement

A PS D

A PS D

D SP A

Very Small Scale Test

Follow-up Tests

Implementation of Change

Making Quality Improvement Effective

•  Identifyrootcauses

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Making Quality Improvement Effective

• Prepareforthechange•  Collectbaselinedatabeforeyoustart•  IdentifyQIchampionstosupporttheQIprocessandanysubsequentchangesimplemented

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Making Quality Improvement Effective

• Document,learnfrom,andshareyourprocess•  Learnfromwhatdoesn’twork•  Documentyourprocess•  Celebratesuccesses!

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Making Quality Improvement Effective

• Thinkingwiththeendinmind•  Long-termprocess•  Ensureoverallperformanceisimproving

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Hunches Theories

Ideas

Changes That Result in

Improvement

A P S D

A P S D

D S P A

Process and Balancing Measures

Outcome Measures

Repeated Use of the PDSA Cycle and PDSA Measures: Often qualitative

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All Teach. All Learn.

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PDSA Cycles

Act Plan

Study Do

• Objectiveofcycle• Questions/predictions• Plantocarryoutthecycle(who,what,where,when)

• Carryouttheplan• Documentproblems/unexpectedobservations

• Beginanalysisofdata

• Completetheanalysisofdata

• Comparedatatopredictions

• Summarizewhatwaslearned

• Whatchangesaretobemade?

• Adapt?OrAbandon?• Nextcycle?

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Robust Testing

4. Implementation testing

1. Early tests are simple and designed to learn then succeed

2. Then test over a variety of conditions to understand scalability and identify weaknesses

3. Later tests are designed to predict and prevent failures

A PS D

A PS D

D SP A

A PS D

D SP A

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PDSA Cycles – Group Reflection

• HowdidyouusePDSAcycles?• Whatchangesdidyoutest?• Whatworkedwell?Whatdidn’t?

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PDSA Cycles – Group Reflection

•  ChooseonePDSAcycleyoucompleted

•  Whatdidyouhopetoaccomplish?(Prediction)

•  Whatdidyoulearn?

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PDSA EXAMPLE- Breastfeeding

www.chawisconsin.org Children’s Health Alliance of Wisconsin

TESTS of CHANGE

www.chawisconsin.org Children’s Health Alliance of Wisconsin

PLAN (& Predict)

www.chawisconsin.org Children’s Health Alliance of Wisconsin

DO, STUDY, ACT

PDSA EXAMPLE- Physical Activity

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PDSA

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Start with the Willing!

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Rule of 1! Start small!

PDSA Test Size CurrentSituation Staff Readiness to Make the Change

Resistant Indifferent Ready LowConfidencethatcurrentchangeideawillleadtoImprovement

Costoffailurelarge

VerySmallScaleTest

VerySmallScaleTest

VerySmallScaleTest

Costoffailuresmall

VerySmallScaleTest

VerySmallScaleTest

SmallScaleTest

HighConfidencethatcurrentchangeideawillleadtoImprovement

Costoffailurelarge

VerySmallScaleTest

SmallScaleTest

LargeScaleTest

Costoffailuresmall

SmallScaleTest

LargeScaleTest

Implement

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Just Start!

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Measure

Useful,notperfect,data

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Keep on keepin’ on

GuideyourPDSA’swithPredictionandScope

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Summary •  QualityImprovementcanlookdifferentindifferentsettings

•  Importanceofmeasurementanddocumentation

•  Createacultureofimprovement•  Shareseamlessly,stealshamelessly!

References and Resources

•  Top10ProblemsEncounteredByQualityImprovementTeams.(2010,December7).Retrievedfromhttp://www.phf.org/phfpulse/Pages/Top_Problems_Encountered_By_QI_Teams.aspx

•  BarrierstoQualityImprovement.Retrievedfromhttp://www.cqeacademy.com/cqe-body-of-knowledge/management-and-leadership/barriers-to-quality-improvement/

•  HRSA.(2011,April).QualityImprovement.Retrievedfromhttps://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf

•  QualityImprovementToolSummarySheet.Retrievedfromhttps://www.mchnavigator.org/transformation/documents/QI/Summary%20of%20QI%20Tools.pdf

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Questions?

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Brain Booster https://vimeo.com/276993503

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Team Time Considerations

• Whatisonethingthatyoucanutilizeinyourworkgoingforward?

• WhatcanyoutestbyTuesday?!

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