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Do. Small Tests of Change
• ALL improvement requires change, but not all changes lead to improvement
• The ability to develop, test, and implement changes is essential for continuous improvement
• A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement. Creatively combining change concepts with knowledge about specific subjects can help generate ideas for tests of change.
• After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to– Test a change or group of changes on a small scale
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DATACycle 5: Make adjustments and implement protocol system wide
Cycle 4: Test protocol on additional units with a larger patient population
Cycle 3: Test protocol with one physician on one unit with one population
Cycle 2: Establish draft protocol for ordering prophylaxis according to best practice
Cycle 1: Develop system for regularly obtaining information regarding appropriate ordering and administration of prophylaxis for surgery patients(SCIP: VTE 1 & VTE 2)
D SP A
A PS D
D SP A
APS
DA PS D
VTE Prophylaxis integrated into
routine care for all
Develop successful
approaches to improve delivery
of VTE Prophylaxis
AimDecrease the number of VTE occurrence during hospitalization
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PLAN State the Objective of the planPlan the Change (what, who, when, where?)Predictions (what is expected to happen?)Data Collection (who, what, when, where?)
DO Describe what actually happened when you ran the test of change
STUDY ASSESS the measured results and EVALUATE how they compare to the predicted results
ACT Describe what changes to the plan will be made for the next cycle from what you learned
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ACT. Implement & Spread
• Implementation is a permanent change to the way work is done – Involves building the change into the organization – Infrastructure are not heavily engaged in the testing phase
• Documentation & written policies?• Hiring, training, and compensation?
*Implementation also requires the use of the PDSA cycle*
Learn optimal sequencing of tasks Work with people to help adoption and adaptation
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Spread is the process of taking a successful implementation process from a pilot unit or pilot population and replicating that change or package of changes in other parts of the organization
*Spread efforts benefit from the use of the PDSA cycle*Plan how to adapt changes to other areaDetermine if the change resulted in the improvement
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RUN CHARTS
Run charts have a variety of benefits: •Help improvement teams formulate aims by depicting how well (or poorly) a process is performing•Help in determining when changes are truly improvements by displaying a pattern of data that can observe as changes are made •Give direction to improvement with information about the value of particular changes
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Useful Strategies to Hold the Gains:
• Establish and document new processes• Make formal changes to job descriptions• Use regular measurements and audits• Factor new goals/processes into staff
training and new hire orientation• Assign ownership of new processes• Address the “social aspects” of change
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IMPROVEMENT Summary
• Step 1: Plan • Plan the test or observation, including a plan for collecting data.• State the objective of the test. • Make predictions about what will happen and why. • Develop a plan to test the change. (Who? What? When? Where?
What data to collected?)
• Step 2: Do • Try out the test on a small scale.• Carry out the test. • Document problems and unexpected observations. • Begin analysis of the data.