Aug Summit Porter

8/12/2019 Aug Summit Porter

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Overview:Plan-Do-Check-Act Cycle.

Patricia G. Porter, RN, MPH, CHES


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Overview

Background

Phases and steps of the PDCA Cycle

Introduction to a QI Tool: Force Field

Analysis

Force Field Analysis: Lets practice


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Background

Walter Shewhart (1920s)

W. Edwards Deming (1950s)

Common models vary # of steps

Structured QI tools and techniques

Examples:

Force Field Analysis

Nominal Group Technique


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Four Phases of PDCA Cycle

Plana change aimed at improvement

DoCarry out the change

Check/Study the results

Act - Adopt, adapt, or abandon


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1. Select

improvement

opportunity

2. Analyze current

situation or

process

3. Identify

root causes

4. Generate and

choose solutions

5. Map out

and

implement atrial run

6. Analyze

the

results

7. Draw

conclusions

8. Adopt, Adaptor Abandon

9. Monitor;

hold the gains

Start

PDCA Cycle


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Plan: (1) Select Improvement Opportunity

Generate list and select

Redefine team

Write problem/opportunity/aim statement

Management review and support


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Plan: (1) Select Improvement Opportunity

Common Selection Criteria Controllable

Measurable results

identifiable Achievable

Data available or easy

to capture Resource availability

Significant importance

Highly visible High volume

High risk

Problem prone/variation

Timely completion

Probability for success

Team motivation andinvolvement

Senior Mgt. support


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Plan: (2) Analyze Current Situation

Define process/problem to be solved

Identify the customer(s).

Baseline data Performance gaps?

Look at benchmarks, standards, regulatory requirements

Composition of team? Validate problem and statement

Management review


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Plan: (3) Identify Root Causes

Very important step

Analyze cause and effect relationships

Fishbone diagrams Select root cause

Shared decision making

Unbiased and reliable data to verify

Baseline data

Management review


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Plan: (4) Generate and Choose Solutions

Generate list and select solutions

Directly linked to root cause and supported by data

Team brainstorming and shared decision making

Consider best practices Be honest about barriers

Change is hard!!

Choose best solution based on criteria

Shared decision making is key to buy-in! Define and map out solution

Plan to measure (SMART objectives)

Handoffs, resources, outputs, accountabilities

Management review


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1. Select

improvement

opportunity

2. Analyze current

situation or

process

3. Identify

root causes

4. Generate and

choose solutions

5. Map out

and


6. Analyze

the

results

7. Draw

conclusions

8. Adopt, Adapt

or Abandon

9. Monitor;

hold the gains

Start

PDCA Cycle


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Do: (5) Map Out and Implement a Trial Run

Map out a trial run

Communication and education/training are key

Be specific

New forms, handoffs, data etc.

Implement trial run

Small scale but representative

Tests the intervention on a small scale to ensure changewill produce desired output


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1. Select

improvement

opportunity

2. Analyze current

situation or

process

3. Identify

root causes

4. Generate and

choose solutions

5. Map out

and


6. Analyze

the

results

7. Draw

conclusions

8. Adopt, Adapt

or Abandon

9. Monitor;

hold the gains

Start

PDCA Cycle


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Check: (6) Analyze the Results

Collect and evaluate results

Team-based analysis and beyond

Flexible and inclusive

Objective and subjective data

Revisit process as it was mapped out

Be honest!


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Check: (7) Draw Conclusions

Team-based discussion and beyond

Did the desired change occur?

Did the intervention go as planned?

Was the root cause eliminated?

Are outcomes generalizable?

What worked?

What didnt work? What could be improved/changed?

What did we learn?


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1. Select

improvement

opportunity

2. Analyze current

situation or

process

3. Identify

root causes

4. Generate and

choose solutions

5. Map out

and


6. Analyze

the

results

7. Draw

conclusions

8. Adopt, Adapt

or Abandon

9. Monitor;

hold the gains

Start

PDCA Cycle


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Act: (8) Adopt, Adapt, or Abandon the

Intervention Team-based discussion and beyond

Adopt

Test again on a larger scale?

Communication, education, and training

Plan to measure

Adapt

Revise plan and repeat trial

Communication, education, and training

Abandon

Revisit root cause analysis and/or list of solutions

Need additional/new members on the team?


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Act: (9) Monitor; Hold the gains

Standardize the change

Ongoing training

Change to department policy?

Continue to monitor improvement

Same data collection tools and process

Additional metrics?

Continue reporting to staff and management Move to new improvement opportunity


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Sage Advice

Team members need to own problem and solution

Dont sacrifice the process for the product!

Be data driven/evidence-based

Conduct a thorough root cause analysis

Solution directly related to root cause -- not predetermined

Plan to measure

Communication and feedback Celebrate teamwork and outcomes

Management support and buy-in are critical


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Questions/Comments??


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QI Tool: Force Field Analysis

Review overview handout in packet

Break into 4 groups


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Group Practice: Force Field Analysis

Desired state:

Achieving a Quality Improvement Culture

Step 1: Break into 4 groups (corners of room)Facilitator/recorder

Everyone participates!!!!!

Step 2: Identify (10 min)What are driving forces?

What are restraining forces?


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Step 3: Prioritizing and Planning

Identify top 3 driving forces and what could be done

to strengthen them; facilitate movement towards the

desired state.

Identify top 3 restraining forces and what could be

done to modify or eliminate them; facilitate

movement towards the desired state.


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Step 4: Report out on:

Top 3 driving forces and what could be done to

strengthen them; facilitate movement towards the

desired state. (Front of room)

Top 3 restraining forces and what could be done to

modify or eliminate them; facilitate movement

towards the desired state. (Back of room)Step 5: Group discussion: Next steps to achieve a

quality improvement culture.


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Desired State:

Quality Improvement Culture Leadership and infrastructure that supports QI

Staff training Shared decision making

Data drive and evidence-based decision-making

Accountability

Proactive approach to improvement

QI not a burden but a way of working smarter and

making jobs easier


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Questions/Comments??

Aug Summit Porter

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