The Model for Improvement

The Model for Improvement


10 June 2013

Presenter: Mike Davidge

2006 Sentinel Audit


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Overall Key Indicator Score 200612 indicators: 100 = maximum possible score

“Change is required.

There is a process of change,

just as there is a process of

manufacturing, or for growing

wheat.

How to change is the

problem.”

W Edwards Deming



Model for Improvement


The clinical audit cycle

Differences

Before/after data

Just in case data

Almost no testing of solution


Continuous data

Just enough data

Multiple small tests of change

Early lessons from Acute

Stroke programme


Identify teams

PDSA’s - small and locally relevant (ownership)

Reinforce the improvement message

Learning sets and team lead meetings

Data, data, data

Most important: SUPPORT, SUPPORT,SUPPORT


ActAdapt?

Adopt ?

Abandon?

Next cycle?

PlanObjective

Questions and

predictions (why)

Plan to carry out the cycle

(who, what, where, when)

StudyComplete the

analysis of the data

Compare data to

predictions

Summarize what

was learned

DoCarry out the plan

(on a small scale)

Document problems

and unexpected

observations

Begin analysis

The PDSA Cycle:

Testing: Top Tips

Always use small tests of change.

One patient

One day

One doctor

One nurse

1 3 5 Spread



Why test?

Learning

Confidence

Resistance

Acute stroke driver diagram


Improve

the

outcome

s for

people

following

a stroke

First Hours BundleRapid recognition of symptoms

and diagnosis within 3 hours

First Day BundleEmergency treatment for people

with stroke within 24 hours

First 3 Days

BundleEarly mobilisation following stroke

within 3 days

First 7 Days

BundlePatient centred and goal oriented

specialist care following stroke

within 7 days

Rapid diagnosis using a recognised tool

Confirmation of diagnosis by experienced clinician

Stat aspirin

CT scan

Admission to co-located beds (ASU)

Swallow screen

Prescription of regular aspirin

36 hrs continuous physiological monitoring

Manual handling assessment

Nutritional screening

Physiotherapy assessment commenced

Getting patients out of bed

OT assessment commenced

MDT goal setting meetings

Information sharing with patients/carers

Estimated discharge date

Aim Interventio

ns

Driver

s

7 steps to measurement


1 Decide aim

2 Choose measures

3 Define measures

6 Review measures

5 Analyse & present

7 Repeat steps 4-6

4 Collect data

Data collection plan


For each data item:

Format

Who records this

At what point

Where is it stored

How reliably do we

collect

Issues to resolve

1 Decide aim

2 Choose measures

3 Define measures

6 Review measures

5 Analyse & present

7 Repeat steps 4-6

4 Collect data

The Excel data tool


1 Decide aim

2 Choose measures

3 Define measures

6 Review measures

5 Analyse & present

7 Repeat steps 4-6

4 Collect data

How to interpret

sessions

A common language

between clinicians

and managers

Using the data


1 Decide aim

2 Choose measures

3 Define measures

6 Review measures

5 Analyse & present

7 Repeat steps 4-6

4 Collect data

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60.0%

70.0%

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90.0%

100.0%

1. First Hours Bundle

Values Mean UCL LCL

Progress


1 2 3 4 5

The importance of continuous data

Lessons from Enhanced Recovery after

Surgery (ERAS)


Recent review of bundle 2


Drilling down


Change things if not working

Physio

input



Model for Improvement

Documents

The Model for Improvement