Rapid Cycle Improvement 2009


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Improve patient satisfaction through the implementation of a rapid cycle improvement process.

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  • Any one who has done this activity before must be a quality officer
  • Any one who has done this activity before must be a quality officer
  • 17 Do trial run – enough orientation – you know we need to conserve cost – so we only hire smart people so if you didn’t get it you must not be smart and perhaps need to look somewhere else where pressure is less…
  • Remember what I said about just do it and not just doing it – forget that with
  • Lots of small changes, tests and experiments create improvement. Each cycle can be either the same experiment under different conditions, or different tests like ICU rounding, followed by a cycle of controlling linen distribution, followed by a cycle of substituting less costly drugs.
  • Analysis paralysis
  • Why improve… read .. Or perhaps its counterpart is more true
  • Rapid Cycle Improvement 2009

    1. 1. Learning Objectives <ul><li>This will be a fun, interactive session designed to: </li></ul><ul><ul><li>Review what it takes to accelerate improvement-some key components </li></ul></ul><ul><ul><li>Show how the Model for Improvement and PDSA (Plan-Do-Study-Act) can be practically and quickly applied </li></ul></ul><ul><ul><li>Illustrate how testing things on a small scale can result in faster and sustainable changes and improvements </li></ul></ul>
    2. 2. A Simulation <ul><li>Set Up: </li></ul><ul><ul><li>Work in groups of ?? </li></ul></ul><ul><ul><li>?? people represent key steps in the core process of an Emergency Department patient having a lab test performed </li></ul></ul><ul><ul><li>1 person is the quality officer and data collector </li></ul></ul>
    3. 3. A Simulation <ul><li>Equipment </li></ul><ul><ul><li>1 tennis ball (representing the test itself from the time it is ordered until results received) </li></ul></ul><ul><ul><li>1 stop watch </li></ul></ul><ul><ul><li>Paper to write down times </li></ul></ul><ul><li>Organization </li></ul><ul><ul><li>Group forms a circle representing the steps in the process </li></ul></ul><ul><ul><li>1 (quality officer) stands aside and observes/ records data </li></ul></ul>
    4. 4. Process <ul><li>One person passes the ball to the person across from him/her in the circle, remembering who you threw it to. Then the receiver passes it to another person, remembering who each time. The last person passes it to the person that started. </li></ul><ul><ul><li>Maintain the same sequence </li></ul></ul><ul><ul><li>Start over if execution is done incorrectly or someone “drops the ball”. </li></ul></ul>
    5. 5. Process <ul><li>The quality officer: </li></ul><ul><ul><li>Records time from beginning to end </li></ul></ul><ul><ul><li>Enforces all rules: </li></ul></ul><ul><ul><ul><li>Sequence violated </li></ul></ul></ul><ul><ul><ul><ul><li>start over </li></ul></ul></ul></ul><ul><ul><ul><li>Ball dropped </li></ul></ul></ul><ul><ul><ul><ul><li>start over </li></ul></ul></ul></ul><ul><ul><ul><li>Execution done incorrectly any other manner </li></ul></ul></ul><ul><ul><ul><ul><li>start over </li></ul></ul></ul></ul>
    6. 6. AIM and Quality <ul><li>AIM: </li></ul><ul><ul><li>Improve Turnaround Time for all Labs </li></ul></ul><ul><ul><li>No mistakes/harm (no dropping the ball!!) </li></ul></ul><ul><li>Basic Quality Criteria </li></ul><ul><ul><li>Ball must be touched by each person in sequence </li></ul></ul><ul><ul><li>Start and end with the same person </li></ul></ul><ul><ul><li>Speed </li></ul></ul><ul><li>Quality Officer </li></ul><ul><ul><li>Starts the process by saying “go” </li></ul></ul><ul><ul><li>Start process over if ball is dropped or order is not maintained (time does not stop) </li></ul></ul><ul><ul><li>Baseline data </li></ul></ul><ul><ul><ul><li>Trial run </li></ul></ul></ul>
    7. 7. Not good enough! Patients are waiting and getting angry  Need to cut the time in half! What changes can we make that will lead to improvement?
    8. 8. Debrief: What did we learn? Teamness Aim, Goals & Measures PDSA Cycles
    9. 9. Teamness <ul><li>Multiple views </li></ul><ul><ul><li>which challenge and surface multiple inferences </li></ul></ul><ul><li>Generative </li></ul><ul><ul><li>Build </li></ul></ul>
    10. 10. Measures & Goals <ul><li>Measures </li></ul><ul><ul><li>Overall time </li></ul></ul><ul><li>Stretch goal </li></ul><ul><ul><li>Others achieved </li></ul></ul>
    11. 11. Improvement Approaches <ul><li>Standardization </li></ul><ul><li>Incremental </li></ul><ul><li>Innovation </li></ul>Source: W. Edwards Deming
    12. 12. Cycles Have Been Going on for Years “ Negative results on the fish… Let’s try rubbing two sticks together.”
    13. 13. What is the PDSA Cycle? Act <ul><li>What changes </li></ul><ul><li>are to be made? </li></ul><ul><li>Next cycle? </li></ul>Plan <ul><li>Objective </li></ul><ul><li>Questions and </li></ul><ul><li>predictions (why) </li></ul><ul><li>Plan to carry out </li></ul><ul><li>the cycle (who, </li></ul><ul><li>what, where, when) </li></ul>Study <ul><li>Complete the </li></ul><ul><li>analysis of the data </li></ul><ul><ul><li>Compare data to </li></ul></ul><ul><li>predictions </li></ul><ul><ul><ul><li>Summarize what </li></ul></ul></ul><ul><ul><ul><li>was learned </li></ul></ul></ul>Do <ul><li>Carry out the plan </li></ul><ul><li>Document problems </li></ul><ul><li>and unexpected </li></ul><ul><li>observations </li></ul><ul><li>Begin analysis </li></ul><ul><li>of the data </li></ul>The PDSA cycle provides the means to apply, adapt and implement the changes And ideas.
    14. 14. Rapid Cycle Change Repeated Use of The Cycle Hunches Theories Ideas Changes which result in Improvement After cycles have demonstrated that the change CAN work, use more cycles to help you figure out how the change WILL work, every day Use of Multiple PDSA cycles Adapted from The Improvement Guide P A D S P A D S P A D S P A D S
    15. 15. Aim: Improve HCAHPS score “% of patients who reported their nurses always communicated well”. Use of scripting Improved Score A P S D A P S D A P S D D S P A DATA D S P A Cycle 1A:Develop a script and have one nurse test with one patient. Cycle 1B:Revise script and test with three more patients. Cycle 1C: Revise and have nurses on one shift test script with all patients for one week Cycle 1E: Implement and monitor the feedback
    16. 16. The D cycle  Do
    17. 17. The PDSA cycle  Plan Study Do
    18. 18. The PDSA Cycle  Why Test? Act Plan Study Do
    19. 19. Why Test? <ul><li>Increase the belief that the change will result in improvement in your environment </li></ul><ul><li>Predict how much improvement can be expected from the change </li></ul><ul><li>Learn how to adapt the change to conditions in the local environment </li></ul><ul><li>Evaluate costs and side-effects of the change </li></ul><ul><li>Minimize resistance upon implementation </li></ul>
    20. 20. Change and Information change denial anger bargaining depression acceptance renewal FACTS SUPPORT ENCOURAGEMENT Source: E. Kubler Ross
    21. 21. How to Test on a Small Scale <ul><li>Test the change on the members of the team that helped developed it before introducing the change to others </li></ul><ul><li>Conduct the test in one facility or office in the organization, or with one patient </li></ul><ul><li>Conduct the test over a short time period </li></ul><ul><li>Test the change on a small group of volunteers </li></ul><ul><li>Develop a plan to simulate the change in some way </li></ul>
    22. 22. Accelerating Learning and Improvement <ul><li>What can we complete by “next Tuesday”? </li></ul><ul><li>You may compromise scope, size, rigor, and sophistication, but the Cycle must be completed by “next Tuesday.” </li></ul>Source: Donald Berwick, MD, IHI Act Plan Study Do
    23. 23. When do we implement? Staff/Physician Readiness to Make Change Copyright 2008 Institute for Healthcare Improvement and R.C. Lloyd & Associates Current Situation Resistant Indifferent Ready Low Confidence that current change idea will lead to Improvement Cost of failure large Very Small Scale Test Very Small Scale Test Very Small Scale Test Cost of failure small Very Small Scale Test Very Small Scale Test Small Scale Test High Confidence that current change idea will lead to Improvement Cost of failure large Very Small Scale Test Small Scale Test Large Scale Test Cost of failure small Small Scale Test Large Scale Test Implement
    24. 24. Rapid Cycle Improvement Planner
    25. 25. Let’s Try It…. <ul><li>Ask the patient if they have any questions or concerns prior to leaving him/her. </li></ul><ul><li>Offer the patient a blanket, pillow or some other comfort-maker. If medically appropriate, perhaps a drink or snack. </li></ul><ul><li>Have a volunteer specifically trained in customer service round in the waiting room as a patient liaison—running small errands, meeting comfort needs, explaining ED routines (i.e., delays, why others are seen first). </li></ul><ul><li>Hourly rounding by nurses. </li></ul><ul><li>Senior leader rounding for outcomes. </li></ul>
    26. 26. If you always do what you have always done; You always will get what you always got!!!
    27. 27. For more info <ul><li>Custom Learning Systems </li></ul><ul><li>1800.667.7325 </li></ul><ul><li>www.customlearning.com </li></ul>