Developing Concepts of Change&
PDSA Cycles
Brandon Bennett
Agenda
• Review the improvement journey
• Overcoming our barriers to the journey
• PDSA, one to another to another
• What about Change Concepts
Typical approach
Local Barriers to change:
Resistant CultureLack of Human ResourcesLimited Financial Investment
Failure to implement successfully at the local level with resultant improved performance
“Just Do it”
Improvement Approach
Local Barriers to change:
Resistant CultureProcess DesignStructureHuman Resources
Successfully implement at the local level with resultant improved performance
Conceptual Driver DiagramOutcome
1⁰ driver
2⁰ driver
Change Concepts
Specific Change Ideas
Aim or
Outcome
1⁰ driver 1
1⁰ driver 2
2⁰ driver 3
2⁰ driver 2
2⁰ driver 1
2⁰ driver 4
2⁰ driver 5
Concept 1
Concept 2
Concept 4
Concept 3
Concept 5
Concept 6
Ideas:123456789........N
Theory of Causality Theory of
Change
Are we articulating comprehensive theories aimed at overcoming our barriers?
• Process Design– Do we know what our Model of Care looks like? Do we have a process
map with understanding of failure points, bottlenecks, etc.
• Culture– Do we have a theory of what leverage points exist to encourage the
adoption of changes or participation in the improvement journey?
• Physical Structure– Have we considered whether our physical structure needs rearranging
and whether that could us to improve reliability, efficiency, safety, etc.?
• Human Resources– Have we recruited and oriented a productive team for leading
improvement, including local champions who are passionate for the work and local thought leaders who can positively influence the behavior of others?
Break out
• Spend 10 min contemplating these questions
Are we articulating comprehensive theories aimed at overcoming our barriers?
• Process Design– Do we know what our Model of Care looks like? Do we have a process map
with understanding of failure points, bottlenecks, etc.
• Culture– Do we have a theory of what leverage points exist to encourage the adoption
of changes or participation in the improvement journey?
• Physical Structure– Have we considered whether our physical structure needs rearranging and
whether that could us to improve reliability, efficiency, safety, etc.?
• Human Resources– Have we recruited and oriented a productive team for leading improvement,
including local champions who are passionate for the work and local thought leaders who can positively influence the behavior of others?
Aim or Outcome
1⁰ driver 1
1⁰ driver 2
2⁰ driver 3
2⁰ driver 2
2⁰ driver 1
2⁰ driver 4
2⁰ driver 5
Concept 1
Concept 2
Concept 4
Concept 3
Concept 5
Concept 6
Ideas:123456789.........N
Theory informs testing and in turn testing refines theory
Repeated Use of the PDSA Cycle
Hunches Theories
Ideas
Changes That Result in
Improvement
A P
S D
APS
D
A P
S D
D SP A
DATA
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
Improvement Guide, Chapter 7, p. 146
So what do repeated improvement cycles look like?
Hunches Theories
Ideas
Changes That Result in
Improvement
A P
S D
APS
D
A P
S D
D SP A
DATA
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
Improvement Guide, Chapter 7, p. 146
Tangential, related or new ideas arise
What do you do with these new ideas?
• Capture them
• Integrate them into your theory
• Begin new PDSA ramps to test them
• Set them aside if they are related but are deemed relevant to a different improvement journey
Primary Driver 1
Change Idea 1
Change Idea 2
Change Idea 3
Break out
• Discuss 2 change ideas:
• Where is each on the ramp toward implementation?
• What tangential ideas have arisen as a result of your testing to date and what have you done with those ideas?
What about Change Concepts?
• What are they?
• How can we use them to generate new change ideas when we encounter failure with our current ideas?
Theory of ChangeChange
ConceptsSpecific Change
Ideas
Concept 1
Concept 2
Concept 4
Concept 3
Concept 5
Concept 6
Ideas:123456789........N
How we use change concepts?Incomplete list of change concepts
27. Give people access to information
Counsel patients on want to expect on Admission
Provide electronic patient progress board in surgical waiting area
Display patient safety data publically for patients, families and co-workers to see
Langley, et al.
Develop a radio program Integrate topic
in a local soap opera
Comprehensive list of concepts related to improving quality
Langley et al, The Improvement Guide
Break out
• Select 2 change ideas that are a apart of your current theory
• Review the list of Change Concepts to find which concept(s) relates to each idea
• Spend 2 min silently at your table brainstorming other ideas that could flow from that concept
• Share those in a round robin at your table – remember crazy ideas are encouraged later we can analyze them for feasibility
Comprehensive list of concepts related to improving quality
Langley et al, The Improvement Guide
Finally
• Select 1 idea you might like to develop into a change idea for testing using the Model for Improvement next week when you are back in the day to day of improvement
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