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

• joy.whitlock@wales.nhs.uk

• UHW 029 20 745099