“DO” step of the PDSA cycle includes: Carrying out the planCollecting the dataAnd Beginning analysis of the dataEssentially the “Do” step is the central step in a PDSA cycle, and requires time to evaluate and reflect on the cycle or study to ensure efficiency, as well as ensuring that we are essentially on the right track and make changes where we see is necessary.
http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspxAccording to the Institute for Healthcare Improvement; once a team has set an aim, established its membership, and developed measures to determine whether a change leads to an improvement, the next step is to test a change in the real work setting, and this is where implementation of the model is important.
Institute for Healthcare Improvement. (2011). Science of Improvement: Testing Changes. Retrieved from: http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspxReasons to test change according to the Institute for Healthcare Improvement.....In order to increase your belief that the change will result in improvement. To decide which of several proposed changes will lead to the desired improvement. To evaluate how much improvement can be expected from the change. To decide whether the proposed change will work in the actual environment of interest. To decide which combinations of changes will have the desired effects on the important measures of quality. To evaluate costs, social impact, and side effects from a proposed change. To minimize resistance upon implementation. After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the change is ready for implementation on a broader scale-for example, for an entire pilot population or on an entire unit.
So models and tools that could be used in this process include the STAR model, the 5 S’s model, communication and coaching.The STAR and 5 S models I will be explaining in further detail a little later. Communication can be used as part of the “do” process when following the PDSA model, communicating to the people involved in the study; what needs to be completed in order to achieve the desired results. Communication would also be helpful in discussing what those involved or participating in the study have found themselves and their feedback. Coaching involves reflecting on the feedback received and providing further education, support and training where deemed necessary and where needed. In a case study whereby a hospital used a PDSA study to implement patient feedback forms, in the DO section, they implemented the following questions….“What did you observe? Here you will write down observations you have during your implementation. This may include how the patients react, how the doctors react, how the nurses react, how it fit in with your system or flow of the patient visit. You will ask, “Did everything go as planned?” “Did I have to modify the plan?””Taken from:PDSA directions and examples. http://www.ihi.org/knowledge/Pages/Tools/PlanDoStudyActWorksheet.aspx
Microsystem Academy. (2011). Worksheets. Retrieved from: http://www.clinicalmicrosystem.org/materials/worksheets/The 5 S’s tool was originally taken from the Japanese words: seiri, seiton, seiso, seiketsu and shitsuke, which roughly translate to Sort, Straighten, Shine, Standardise and Sustain. This model originally comes from the Lean model, but can be used and applied within PDSA.SORT: Includes sorting through items, keeping only what is needed, and disposing of what is not. STRAIGHTEN : Includes orderliness of the process and the model. SHINE: Includes cleanliness. The cleaning process allows us to inspect and expose abnormal or failure conditions that affect quality.STANDARDIZE: includes creating rules to monitor the first 3 S’s.SUSTAIN: includes self discipline and a stabilized work place.
The Dartmouth Institute. (2011). Microsystems at a glance.Retrieved from www.clinicalmicrosystem.org. This is a diagram of the model and its steps…“The 5S’s essentially come together to create a continuous process for improving the work environment and eliminating waste or “muda”.And…MUDA means activity without value.”
http://www.clinicalmicrosystem.org/materials/worksheets/This is a worksheet that can be used to evaluate and improve a process through the use of the 5 S’s model, with before and after evaluations collected.
The 5 S tool can be used to implement change and essentially trim the fat on a program.Through the use of this tool the PDSA cycle is more effective and ensures the continued success of the rest of the cycle. So the use of this tool for PPE compliance could include…SORT: Would include sorting through items for the study, keeping only what is needed, what works well and is easiest to implement and disposing of what is not. STRAIGHTEN : Would include ensuring the process is efficient, time efficient and works well. SHINE: Inspecting and exposing abnormal or failure conditions that affect quality within the studySTANDARDIZE: Creating rules or guidelines to monitor the first 3 S’s.SUSTAIN: Includes testing the model and ensuring it will still be valid and worthwhile.
Zimmerman, B.J. (1998). Exploring Generative Relationships S T A R. York UniversityThe STAR model stands for separateness, tuning, action, reason to work together. So….S Separateness or differences. There needs to be differences in the background, skills, perspectives, or training of the parties. T Talking and listening (“tuning”). There needs to be real opportunities to talk and listen to each other with permission to challenge the status quo, sacred cows or implicit assumptions of the context. Opportunities for reflection allow the parties to grow and learn. A Action opportunities. The parties need to be able to act together to co-create something new. R Reason to work together. The parties need to have a reason to share resources, ideas or to act as allies even if only for a short period.
So this is a pictorial demonstration of the STAR model, and so as you can see trust is the centre of the model and is important to ensure the team is able to work together to form a common goal.
The use of the STAR model would be beneficial in ensuring PPE compliance as S Separateness or differences – ensuring that there are different professionals reflecting on the current PDSA cycle T Talking and listening:“tuning into one another” – allowing people to reflect on the ongoing study in a safe environment and responding appropriately to the ideas and thoughts that come up. A Action opportunities: being able to work together towards the safety goals requiredR Reason to work together: so the reason to work together would be towards the common goal of completing the cycle and ensuring PPE compliance.
Methods and Tools that have potential to improve PPE compliance PDSA tools – “Do”
“DO” step of the PDSA cycle Carry out the plan Collect the data Begin analysis of the data
“Do” and Implementation According to the Institute for Healthcare Improvement, this next step is to test a change in the real work setting. The Plan-Do-Study-Act (PDSA): planning it, trying it, observing the results, and acting on what is learned.Adapted from: http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImpro vementTestingChanges.aspx
Reasons to test change...according to IHI To increase your belief that the change will result in improvement. To decide which of several proposed changes will lead to the desired improvement. To evaluate how much improvement can be expected from the change. To decide whether the proposed change will work in the actual environment of interest. To decide which combinations of changes will have the desired effects on the important measures of quality. To evaluate costs, social impact, and side effects from a proposed change. To minimize resistance upon implementation.
Models and tools that could be usedin this process: STAR 5 S’s Communication Coaching
The 5 S’s Tool SORT: Sort through items, keep only what is needed, and dispose of what is not. STRAIGHTEN: Orderliness. SHINE: Cleanliness. The cleaning process allows us to inspect and expose abnormal or failure conditions that affect quality. STANDARDIZE: Create rules to monitor first 3 S’s. SUSTAIN: Self discipline. Maintaining a stabilized work place is an ongoing process.
How this tool can be used to ensurePPE compliance The 5 S tool can be used to implement change and essentially trim the fat on a program/study Through the use of this tool the PDSA cycle is more effective and ensures the continued success of the rest of the cycle.
STAR modelS Separateness or differences.T Talking and listening (“tuning”).A Action opportunities.R Reason to work together.