Tools for Change Plan, Do, Study, Act The PDSA Cycle Explained

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Tools for Change Plan, Do, Study, ActThe PDSA
Cycle Explained

• Carol Reeve
• Eastern Wakefield Primary Care Trust
• Castleford, Normanton District Hospital
• Lumley Street
• High Town
• Castleford
• West Yorkshire
• WF10 5LT
• Tel [phone]
• Email carol.reeve_at_ewpct.nhs.uk

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Aims

• Understand why we need to research, analyses,
  plan and structure change
• Appreciate the need for measurement
• Value the use of tools in changing systems
• Explain the purpose of the PDSA cycles

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Understanding systems

• We use systems in everything we do
• To make successful changes you must set out to
  change the system
• To succeed you must try and try again
• Changes should be maintained and monitored

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Changing systems

• Change can be exciting but also threatening
• Change takes time in systems and in people
• Change means testing things out in the reality of
  their own setting

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Three fundamental questions

• What are we trying to achieve?
• Understand the problem. Know what you are trying
  to achieve. Have clear and desirable aims and
  objectives
• How will we know that a change is an improvement?
• Measure processes and outcomes
• What changes can we make that will result in an
  improvement?
• What have others done? What hunches do we have?
  What can we learn as we go along and how?

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How has it been done so far?

• What is the best way to approach change that
  results in improvement?

Trial error? Chaos Too much action, not
enough thinking Something must be done, this is
something therefore we must do it
Detailed prior study? Paralysis Too much
thinking, not enough action We cant do
anything until we know exactly what to do
Trial Learning Approach
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Trial Learning component parts

• Setting challenging aims
• Is it worth doing? Not change for change sake
• Identifying principles/change ideas
• What has worked for someone? What might work for
  us?
• Measuring progress
• Knowing whats happening
• Testing changes
• Starting small, reducing risk
• Implementing and sustaining change
• Change in systems and routines. Developing
  skills and abilities

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PDSA
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Defining the problem
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What should a PDSA look like?

• Objective
• Define the problem
• What are you trying to achieve?
• Plan
• Who, what, where, when?
• Measurement
• Do
• Just do it
• Study
• What worked? What didnt?
• Act
• Next steps

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Example PDSA form
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Example of a PDSA cycle

• Objective
• To improve BP control for patients with CHD in
  line with the NSF

Plan Practice Manager to identify 5 CHD patients
from the CHD register with BP greater than 140/85
by 24th May Receptionists to contact patients by
telephone to offer appointments with the Practice
Nurse Measure date of last attendance, BP,
medication compliance
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Example of a PDSA cycle
Study Two additional patients were seen
opportunistically Six patients seen and one did
not attend All patients had been seen in previous
4 months Control of BP had been difficult 4
patients were overweight, 1 obese All patients
did very little or no physical exercise All
patients except one reported that they comply
with medication
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Example of a PDSA cycle
Act Medication compliance is difficult to assess
arrange meeting with doctors to discuss
alternative methods of compliance Patients to be
followed up more frequently by Practice
Nurse Exercise programme aimed at this group to
be considered Doctors to review medication again
at the next follow-up visit
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Developing improvement with PDSAs
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Developing improvement with PDSAs
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PDSA cycles

• Have a long pedigree
• Are similar to techniques such as audit cycles,
  plan-do-check, etc.
• Natural to health care
• Small in scope and build incrementally
• Have methodological validity
• Used and developed by participants in the
  Collaborative

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Advantages of the PDSA approach

• Makes processes and learning explicit...which is
  especially useful for team working
• Enables testing of ideas to- customise change
  for/ to local conditions- evaluate
  side-effects- improve the idea based on
  learning- reduce risks
• Minimise problems with getting started-
  persuading the reluctant- longest journey/first
  step stuff
• Promotes bite sized chunks

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Task to complete a PDSA within a week

• Work in pairs
• Identify and define a shared problem
• Start to think about solutions
• Develop a Plan for a PDSA to be completed in no
  more than 1 week

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Summary

• Improvement requires change to systems
• PDSAs are a tool that help you bring about change
  in a practical, useful, manageable and managed
  way
• Starting points remember the three fundamental
  questions to guide change
• Remember that you will never know whether the
  change is better unless you measure
• Keep up the momentum and dont forget to record
  what happens

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Questions

• Thank You!