Plan Do Study Act (PDSA) - YouTube

CHRISTY: Process improvement is a series of actions taken to make a process more

efficient, less costly, safer, etc.

The healthcare reimbursement model is shifting to a pay-for-performance

type system or a value-based purchasing model

and in preparation for reimbursing providers and facilities based on quality of care

that they're providing, the government's requiring providers to

adopt certified electronic health records and use them in a meaningful way.

What this means is that providers will be expected to not just

compile data or information on the patients they care for

but to actually act on that data and it's here

that quality improvement comes into play. There are many methods and quality

improvement being used today.

Some of most commonly used ones are

total quality management or TQM continuous quality improvement

or CQI. Lean. Six

Sigma and PDSA also known as

PDCA. The one that seems to be the fastest

and easiest to teach, as well as utilizes is the

trial and learn approach to quality improvement that combines three

fundamental questions with the plan do study act process.

There three fundamental questions that get asked with the PDSA model.

1. What is it that's trying to be accomplished?

2. How can one know a change is actually an improvement?

3. What changes can be made that will actually result in an improvement?

There are multiple ways to

teach process improvement. I generally gravitate towards workshops that are

are fun and that involve games other games that involve

assembling paper airplanes and flying them. There games that are

that involve assembling paper footballs and using them to shoot

goals and there also games that involve assembling potato heads and

that's when I choose to use.

The "P" segment of PDSA.

This answers the question of what is trying to be accomplished,

provides guidance for the team's specific improvement efforts,

and it ensures that the team's activities align with the strategic

goals of the practice.

It needs to be clearly stated in numerical

as well as represented challenge for the practice and provider.

An example of an effective AIM statement might be

"by June 1st 2013 our practice will be able to identify 100 percent our

patients with hypertension using electronic health record."

One needs to ask questions and make predictions.

The "Do" segment is where the actual plan gets carried out.

Unexpected observations and problems are documented as well as preliminary

analysis of the data that was collected during the "do".

The study process is where a complete data analysis gets performed.

The data collected should be compared to the predictions and a summary of what

was learned should be generated.

The "Act" portion is where it gets decided what changes should be made the next cycle

based on what was discovered in the last cycle

and the process starts all over again. In a nutshell,

the PDSA cycle should be used to predict the effectiveness of change and plan the

next steps,

revise and adapt changes to the patient's and practice's needs,

assess costs and the side effects of the change

as well as to anticipate potential implementation barriers.

It's important to implement changes on a small scale

until one is certain that they will result in improvement. It's also important

to repeat the PDSA cycle until the desired change matches the AIM statement

which means that

what was set out to be achieved has been accomplished. Strategies that will help

ensure that the change was actually for the better,

are to use a small set a patients, do it on a small scale,

to be as specific as possible, to do it over a short period of time like a few

days to a week before evaluating the results of a change.

While all improvements are the result of change, all changes are not necessarily

improvements

By testing and measuring during the PDSA cycle,

one can predict the effectiveness of the change in plan the next cycle.

It's important to collect just enough data

and not to make this part overly complicated. It works best to incorporate

the testing into the daily routine.

It's helpful to ask the following things when evaluating the test results:

Were the changes executed well?

Were the support processes adequate?

Was the original hypothesis or hunch correct?

Despite executing the change well,

did it not result in an improvement? and

did the local improvement impact access or efficiency?

You want to avoid doing the following:

The tendency to make the objective statements too broad.

Confusion between the objective

and the questions. The tendency to not anticipate in the plan step how to

analyze the data that gets collected.

The tendency to do too much

in one PDSA cycle instead of multiple cycles.

and lastly a tendency to use PSA for collecting data on a measure rather than

to test on an idea for change.