Model for Improvement and testing change

1
Model for Improvement and testing change

• Jane Taylor, Ed.D
• Medical Home
• Fall 2005

2
Objectives

• List the three improvement questions
• Identify components of an effective AIM
• Refine team aim and measures during team meeting
• Review testing and create a test (or 2) of change

3
Model for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in
improvement?
4
First Question

• What are we trying to accomplish?

• AIM content
• Explicit over arching description
• Specific actions or focus
• Goals
• AIM characteristics
• Time specific
• Measurable
• Define pilot unit

5
Sample aim with abbreviated goals

• In the next x months, ABC practice will create a
  Medical Home by including parents as partners in
  care, coordinating care and linking parents to
  community resources.
• Our concrete goals include
• Increase MH Index score by 30 percent
• Decrease ED visits to less than 5
• Improve family perceptions to 95 who rate us top
  at compassionate, coordinated,comprehensive,
  accessibility
• Optional items to include in your aim statement
• Our team includes
• We meet x often
• We have unique support from abc for this project
  from Title V and parent team members

6
Align and Match
Collaborative AIM
Collaborative Focus
Collaborative Goal
Team AIM
Team Focus
Team Goals
7
Get feedback on your Aim

• AIM content
• Explicit over arching description
• Specific actions or focus
• Goals
• AIM characteristics
• Time specific
• Measurable
• Define pilot unit

8
Model for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in
improvement?
9
Second Question

• How will we know change is an improvement?

10
(No Transcript)
11
Balanced Set of Measures

• Outcome measures
• Process measures
• Balancing measures

12
Outcome Measures

• Voice of the customer or patient

13
Process Measures

• Voice of the workings of the system

14
Balancing Measures

• Voice of the other parts of the system

15
(No Transcript)
16
Measurement Types Time
PDSA Measures
Changes That Result in Improvement
DATA
Process Measures
Outcome Measures
Hunches Theories Ideas
17
Tips for Measurement 1

• Plot data over time Tracking a few key measures
  over time is the single most powerful tool a team
  can use.

18
Tips for Measurement 2

• Seek usefulness, not perfection.

19
Tips for Measurement 3

• Sampling

Stratification
20
Tips for Measurement 4

• Integrate measurement into the daily routine

21
Tips for Measurement 5

• It is not either or
• it is both and

Q and Q
22
Model for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in
improvement?
23
Third Question

• What changes can
• we make that will
• lead to an
• improvement?

24
Change Concept

• While all changes
• do not lead to improvement,
• all improvement requires change

25
Change concepts and change ideas

• Change concepts
• Change ideas
• Ideas for testing

26

• PDSA Cycles to
• test and learn,
• adapt
• and implement
• changes

27
Plan

• Objective
• Questions and
• predictions (why)
• Plan to carry out
• the cycle (who,
• what, where, when)

28
Do

• Carry out the plan
• Document problems
• and unexpected
• observations
• Begin analysis
• of the data

29
Study

• Complete analysis
• Compare data to
  predictions
• Summarize
• learning

30
Act
Plan

• Objective
• Questions and
• predictions (why)
• Plan to carry out
• the cycle (who,
• what, where, when)

• What changes
• are to be made?
• Next cycle?

Study
Do

• Complete analysis Compare data to
• predictions
• Summarize
• learning

• Carry out the plan
• Document problems
• and unexpected
• observations
• Begin analysis
• of the data

31
Repeated Use of Cycle
Changes That Result in Improvement
Learning from Data
Hunches Theories Ideas
32
Why Test?

• Increase degree of belief
• Document expectations
• Minimize resistance
• Learn and adapt
• Evaluate costs and side-effects

33
Ideas for Change (10 minutes)

• Develop a small
• PDSA cycle based
• on one of the good
• ideas you have
• identified in the
• change package.
• Pair share and get
• feedback

34
PDSA Tip 1 Scale Down

• Years
• Quarters
• Months
• Weeks
• Days
• Hours
• Minutes
• Number of pts

• Drop 2

35
PDSA Tip 2 Oneness

• One

1
36
PDSA Tip 3 Changes in Parallel
Decision Support
Health System
Clinical Information System
Community
37
PDSA Tip 4

38
Task or Test?
Hold team meeting
Decide which care plans to use
Create bulletin board
Learn what parents need most
Implement fax back forms Hold youth focus group
39
How do you make smaller test of change?
Use care plans for a month Develop resource
directory Dedicate phone line for CSHCN Hire
Care Coordinator
40
PDSA Tip 5