The Model For Improvement
Joy Whitlock
Aims
• Review the Model for Improvement
• Practical session – develop PDSAs
• Have some fun
Model for Improvement
The Sequence for Improvement
Spreading a
change to other
locations
Developing a
change
Implementing
a change
Testing a
changeAct Plan
Study Do
Theory
and
Prediction
Test
under a
variety of
conditions
Make part
of routine
operations
The MBFC Index
You will need a coin
And two free hands!
Just how competitive can you get?
MBFC Messages
• If you do what you always did you will get what you always got
• It’s no good just trying harder
• Setting goals is important but you have to do something different/make a change
• All improvement requires change but not all change is an improvement
• Some variation is inevitable
PDSA Cycles
• Breaking it down to small detailed tests of change.
Overarching
AIM + 95%bundle compliance
Change Concepts, Theories, Ideas
Concept B
Bundle 1
Concept C
Bundle 2
Concept A
Assessment
Concept D
Bundle 3
Multiple change concepts for a single
Aim
Multiple PDSA Cycle Ramps
Aims – 95% reliability with assessment on admission for all patients by 30th November 2012
95% reliability with all self caring patients on bundle 1 by 30th
November 2012
Assess
mentOwn care
before bed
Change Concepts
Own care in
bathroom
Own care at
bedside –
after
breakfast
What changes can we make that will result in an improvement?
Develop the Plan…• Identify the first tests of change – what
will you do tomorrow?• How will you measure success?• State predictions• Who, what, where, when?• Describe data collection plan
Whatcan you accomplish
by next Friday?
It all depends on the size and
scope of the planned change!
1 patient, 1 nurse, 1 doctor, 1 day
Start small
Do• Attempt to carry out plan
• Document any problems or unexpected events
• Collect planned data
• HUDDLE - Capture feedback or observations from those conducting the plan
Study
• Complete the analysis of the data by comparing your prediction with what actually happened
• Analyse feedback or observations
• Make suggestions
Act• What will happen in the next PDSA
cycle?
• Develop change further?
• Test?
• Implement?
Tips• Take the right action from what you
observe
• Use common sense
• Use the data (run charts) to engage others/celebrate success
Whatcan you accomplish
by next Friday?
It all depends on the size and
scope of the planned change!
1 patient, 1 nurse, 1 doctor, 1 day
Start small
Paper exercise
• My aim – 95% of you will reliably follow this process.
• My prediction/hypothesis – you will succeed–verbal instruction is all you need
• How will I measure success? Count the number of defective products or % of good products
• Test 1 - Close your eyes, listen and follow instructions.
Reliability
• Paper exercise – simple process?• How can we reliably reproduce this paper
exercise?• What steps are involved? • Does everyone understand the instructions?• Can everyone carry them out?• How much variation is acceptable? • Perfection v good enough?• How will you know you have succeeded – is your
data definition good enough?
PDSA Cycles – breaking them down
Set Aim – 95% people will be able to follow the verbal instructions.
Have a go……..
Whatcan you accomplish
by next Friday?
It all depends on the size and
scope of the planned change!
1 patient, 1 nurse, 1 doctor, 1 day
Start small
If you measure.....you can
References/Resources
• 1000 Lives Plus website http://www.wales.nhs.uk/sites3/home.cfm?orgid=781
• 1000 Lives Plus Improvement Guides • http://www.wales.nhs.uk/sites3/page.cfm?orgid=781&pid
=47540
Questions?
Thank You
• Joy Whitlock – global email
• UHW 029 20 745099