Qu Quality Imp mproveme ment 2.0: PDS PDSA Cy Cycles in A les in Actio tion n Marci Brewer, Breastfeeding Program Manager Anna Corona, Program Manager Louisiana Department of Health Child and Adolescent Health Jennifer Young, Lynda Krisowaty, Sr. Program Manager School Wellness Policy Coordinator Evidence Based Practice Oregon Department of Education Arianna Keil, MD , Quality Improvement Director, WI Department of Health Services’ Family Health Section
Session Goal and Obje jectives • Overarching goal: To use an all teach, all learn approach to grow our collective understanding of how to apply the model for improvement practically to the work that we do • Objectives: • Discuss two ways to apply the model for improvement to our CHW CoIIN work • Strengthen the participants’ ability to problem solve using the PDSA Cycle 2
Before we ju jump mp in… • What do you remember about quality improvement from the first Learning Session? 3
CoIIN Method CoIIN M odol olog ogy y Focus on quality improvement (QI) Collaborative methods including learning across rapid-cycle testing of multiple state teams changes and outcomes Common goals and benchmarks to define and measure changes 4
CoIIN Method CoIIN M odol olog ogy y Focus on quality improvement (QI) Collaborative learning methods including across multiple state rapid-cycle testing of teams changes and outcomes Common goals and benchmarks to define and measure changes 5
CoIIN Aims ms Increase by ___ % the number of schools/programs implementing components of the CSPAP model Establish at least ___ (number) new policies or practices that address social and ecological barriers to breastfeeding Innovatively integrate nutrition into Title V MCH Block Grant and other MCH programs 6
CoIIN Method CoIIN M odol olog ogy y Focus on quality improvement (QI) Collaborative learning methods including across multiple state rapid-cycle testing of teams changes and outcomes Common goals and benchmarks to define and measure changes 7
Qu Quality Imp mproveme ment and and CoIIN CoIIN “All improvement is change, but not all change is an improvement.” 8
Qu Quality Imp mproveme ment Methods • 5 Whys, Fishbone • Impact Matrix, Prioritization Matrix • PDSA Cycles, Model for Improvement • Lean/Six Sigma 9
Why Use Imp mproveme ment Cycles? https://www.goodhousekeeping.com/home/craft- 10 ideas/g2638/hilarious-pinterest-diy-fails/?slide=24
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Ra Rapid Cy Cycl cles es of Ch of Change e Changes That Result in A P Improvement S D D S Implementation of P A Change Wide-Scale Tests of A P Change S D Follow-up Hunches Tests Theories Very Small Ideas Scale Test 12
Making Qu Quality Imp mproveme ment Effective • Identify root causes 13
Making Qu Quality Imp mproveme ment Effective • Prepare for the change • Collect baseline data before you start • Identify QI champions to support the QI process and any subsequent changes implemented 14
Making Qu Quality Imp mproveme ment Effective • Document, learn from, and share your process • Learn from what doesn’t work • Document your process • Celebrate successes! 15
Making Qu Quality Imp mproveme ment Effective • Thinking with the end in mind • Long-term process • Ensure overall performance is improving 16
Repeated Use of the PDSA Cycle and PDSA Measures: Often qualitative Changes That Result in Improvement A P S D D S Process and P A Balancing Measures A P S D Hunches Outcome Theories Measures Ideas 17
All ll Teac each. h. All ll Lear Learn. n. 18
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PDS PDSA Cy Cycles les Act Plan • What changes are to • Objective of cycle be made? • Questions/predictions • Adapt? Or Abandon? • Plan to carry out the cycle • Next cycle? (who, what, where, when) Study Do • Complete the • Carry out the plan analysis of data • Document problems/ • Compare data to unexpected predictions observations • Summarize what • Begin analysis of was learned data 20
D S Ro Robust Testing P A A P S D 4. Implementation A P testing S D D S 3. Later tests are P A designed to predict and prevent failures 2. Then test over a variety of A P conditions to understand scalability S D and identify weaknesses 1. Early tests are simple and designed to learn then succeed 21
PDSA Cycles – – Gr Grou oup R Reflect ection on • How did you use PDSA cycles? • What changes did you test? • What worked well? What didn’t? 22
PDSA Cycles – – Gr Grou oup R Reflect ection on • Choose one PDSA cycle you completed • What did you hope to accomplish? (Prediction) • What did you learn? 23
PDS PDSA EX EXAMPLE MPLE- - Br Brea eastfeed eeding 24
TESTS of CHANGE Children ’ s Health Alliance of Wisconsin www.chawisconsin.org
PLAN (& Predict) Children ’ s Health Alliance of Wisconsin www.chawisconsin.org
DO, STUDY, ACT Children ’ s Health Alliance of Wisconsin www.chawisconsin.org
PDS PDSA EX EXAMPLE MPLE- - Ph Physic sical A al Activity tivity 28
PDSA 29
St Start art with with the the Willing! Willing! 30
Rule of 1! Start small! 31
PDSA Test Size Current Situation Staff Readiness to Make the Change Resistant Indifferent Ready Cost of Very Small Very Small Very Small Scale Test Scale Test failure Low Confidence Scale Test that current large change idea will Cost of Very Small Very Small lead to Small Scale failure Improvement Scale Test Scale Test small Test Cost of Very Small Scale Test failure Small Scale Large Scale High Confidence that current large Test Test change idea will lead to Cost of Improvement Small Scale failure Large Scale Implement Test small Test 32
Jus Just t St Start! art! 33
Measur Measure e Useful, not perfect, data 34
Ke Keep on ke keepin’ ’ on n Guide your PDSA’s with Prediction and Scope 35
Summa mmary • Quality Improvement can look different in different settings • Importance of measurement and documentation • Create a culture of improvement • Share seamlessly, steal shamelessly! 36
Re References and Re Resources • Top 10 Problems Encountered By Quality Improvement Teams. (2010, December 7). Retrieved from http://www.phf.org/phfpulse/Pages/ Top_Problems_Encountered_By_QI_Teams.aspx • Barriers to Quality Improvement. Retrieved from http://www.cqeacademy.com/cqe-body-of-knowledge/management- and-leadership/barriers-to-quality-improvement/ • HRSA. (2011, April). Quality Improvement. Retrieved from https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/ qualityimprovement.pdf • Quality Improvement Tool Summary Sheet. Retrieved from https://www.mchnavigator.org/transformation/documents/QI/ Summary%20of%20QI%20Tools.pdf 37
Questions? Qu 38
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Brain Booster 40 https://vimeo.com/276993503
Team m Time me Considerations • What is one thing that you can utilize in your work going forward? • What can you test by Tuesday?! 41
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