Embed Size (px)
Citation preview
Utilizing PDSA Cycles in a
School Setting
Elizabeth H. Connors, PhD
Nancy Lever, PhD
NH Office of Student Wellness Webinar Series
April 4, 2017
Agenda
Introduction by New Hampshire Office of Student
Wellness
PDSA 101:
What are they?
Why are they valuable in schools?
How to execute a good PDSA (and use data to check
whether its contributing to improvements in your school)
New Hampshire examples
(What helps what hinders)
How Change Happens in Schools
Power of the Status Quo
Need to Move Beyond Just Having
Meetings
Taking on Too Much
Large-Scale Change without Testing
Scale of Change and Improvement Efforts
Improve the
family’s
experience
visiting school
Improve service
provided by 1-5
MH
professionals
Improve one
process (e.g.,
referral
tracking)among
your SMH team
Redesign the
MH triage
system in a
school
Select a new
evidence-based
practice
Redesign a national
system (e.g.
Medicare)
least
formal
and
complex
most
formal
and
complex
formality, documentation, tools, time,
group interaction, measurement, etc. less
required
more
Required
One child
Redesign
services and
supports across
multiple schools
in the district
Build or customize a
new student tracking
data system in the
district
PDSA 101:
The Power of Starting Small
What is a PDSA?
The PDSA cycle is shorthand for testing a change by:
Developing a plan to test the change (Plan)
Carrying out the test (Do)
Observing and learning from the consequences (Study)
Determining what modifications should be made to the
test (Act)
-Institute for Healthcare Improvement www.ihi.org
1. The test or observation was Planned Always includes a prediction about how the change will result in an
improvement Includes a plan for running the test and collecting data to study
2. The plan was attempted (Do the plan ) 3. Time was set aside to analyze the data and Study the results.
Did my prediction hold?
What assumptions need revision?
4. Action was rationally based on what was learned Adapt
Adopt
Abandon
To Be Considered a PDSA Cycle
Why Small Tests ?
Co
ns
eq
ue
nc
es
of
Fa
ile
d T
es
t
Size of your Test
Large Small
Minor
Major
Disaster Zone
Why test?
Forces us to think small (small tests are practical and manageable)
Predict how much improvement can be expected from the change –
and confirm or abandon your prediction
Opportunity for learning without impacting performance
Learn how to adapt the change to conditions in the local environment
Evaluate costs and side-effects of the change
Minimize resistance upon implementation
Localize a good idea to your school/community setting
See how to adapt and make changes before implementing
Increase your belief that the change will result in improvement
Provides a history for how you came to your end result
Ingredients for Success
We have an idea for improvement!
(change idea)
We are going to START SMALL (PDSAs)
We have power, and passion, for the work
in numbers (Teams)
How do we “test” something HUGE?
“It is better to take many small steps in the right direction than to make
a great leap forward only to stumble backward.” Old Chinese proverb
• Start with identifying your AIM – what are you trying to
accomplish? Don’t be vague – use a SMART AIM (specific, measureable, actionable,
realistic and time bound)
Be clear why it’s an important goal
Decide on your timeframe – it might take a while to reach the larger goal
but the small steps can be run sequentially very quickly
• Break down the large goal into small pieces you can accomplish
one by one Approach each smaller part as a test of change
Make a plan and a prediction for what will result and TEST it!
Set mini target goals
The Steps To Change
System (District) changes that will
result in improvement
Develop a change
Implement a change
Prototype a change
Test under a variety of conditions to ID weaknesses
Embed in daily operations
`
AP
DS
APD
S
A
P
D
S
A P
DS
Prerequisites for change
Co
nfi
den
ce t
hat
ch
ang
e is
eff
ecti
ve
Change Ideas
Making a change to day-to-day activities, practices or processes that are predicted to directly or
indirectly result in improvement.
Examples from IHI:
1. Eliminate duplication/create efficiency/improve workflow
2. Optimize service delivery
3. Change the work (school) environment
4. Manage time
5. Reduce variation/Improve consistency
6. Error proofing
7. Improving a product or service
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementSelectingChanges.aspx
School Examples of Change Ideas
Making a change to day-to-day activities, practices or processes that are predicted to directly or indirectly result in improvement.
Examples from School Mental Health Districts in CoIIN Cohort II:
1. School support staff from different schools start meeting together quarterly to drive systematic RtI processes
2. Add feedback loops to school staff following student mental health screening
3. Optimize MH provider time in buildings to ensure 15% or less of their time is spent on non-MH related tasks and increase appropriate services provided to students
Not All Changes are Meaningful
Not all changes are improvements
“All improvement requires
changes, but all change
does not result in
improvement.” Source Unknown
What change have you
experienced that has
NOT resulted in
improvement?
and……not all
failures mean
your change is
doomed
forever!
Repeated Use of the PDSA Cycle
Hunches
Theories
Ideas
A P
S D
A P
S D
Very Small Scale Test – simple
and designed to succeed
Follow-up Tests - over a variety of
conditions to identify weaknesses
Wide-Scale Tests of Change -
designed to predict and prevent
failures
Implementation of
Change
Changes that
Result in
Improvement
Building Confidence for Change
AP D
S
A
P
D
SAP
D S
A
P
D
S
APD
S
A
P
D
S
A P
DS
Change ideas, suggestions,
intuition
System changes that will result in
improvement
Learning from data…
27
Both are necessary but
they are NOT the same!
Test vs. Task
What is a test?
Putting a change into effect on a
temporary basis & learning about its
impact
Actually change something
on a small scale
and study it
What it is NOT!
Data collection
Implementing a solution
A project plan OR an action plan
Rolling out an educational program
Scheduling a meeting
Getting a form, policy, procedure approved by the official committees
Tests v. Tasks
A Test:
Allows you to predict an improvement
Provides quick feedback
Allows you to try something
Allows you to make changes
Helps identify what changes should be made
A Task:
Is the vital behavior that has to happen for the action to take place
Should be identifiable
Should be defined
Might be supported by evidence
Tests v. Tasks
Desired Change – eating a healthier diet.
Tips for PDSA Success
Plan multiple cycles for a test of a change
Think a couple of cycles ahead
Initially, scale down size of test (# of students, staff, schools)
Test with willing volunteers
Do NOT try to get buy-in or consensus for test cycles
Be innovative to make test feasible
Collect useful data during each test
In latter cycles, test over range of conditions
TEST CYCLE EXAMPLE
October Sky Test Launches:
https://www.youtube.com/
watch?v=cP_OM5VVcSo
NH PDSA Example #1: SAU7
CSMH, 2016
NH PDSA Example #2: SAU7
NH PDSA Example #3: Pelham
CSMH, 2016
Next Steps in NH for PDSA Training
Leadership Meeting with the Office of Student Wellness in May 2017 to discuss integration of PDSA Training with larger quality improvement efforts in NH
June 28th and June 29th 2-day Training
Reach out to Office of Student Wellness to learn more about 2 day training or for more support on using PDSAs
Learn from NH leaders working to improve their school mental health systems
Newport
Pelham
SAU-7
Miss Frizzle (Magic School Bus):
“Take chances, make mistakes, get messy.”
Questions and Comments
Contact Information
Elizabeth Connors, Ph.D.
Nancy Lever, Ph.D.
