Overview:

Plan-Do-Check-Act Cycle.

Patricia G. Porter, RN, MPH, CHES

 Overview
Background
Phases and steps of the PDCA Cycle
Introduction to a QI Tool: Force Field
Analysis
Force Field Analysis: Lets practice
 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
 Four Phases of PDCA Cycle
Plan a change aimed at improvement
Do Carry out the change
Check/Study the results
Act - Adopt, adapt, or abandon
PDCA Cycle

3. Identify
2. Analyze current root causes
situation or
process

4. Generate and
1. Select
improvement choose solutions
opportunity
Start

9. Monitor;

hold the gains

5. Map out
and
implement a
8. Adopt, Adapt or trial run
Abandon

6. Analyze
7. Draw the
conclusions
results
Plan: (1) Select Improvement Opportunity

Generate list and select

Redefine team
Write problem/opportunity/aim statement
Management review and support
Plan: (1) Select Improvement Opportunity
Common Selection Criteria
Controllable Highly visible
Measurable results High volume
High risk
identifiable Problem prone/variation
Achievable Timely completion
Data available or easy Probability for success
to capture
Team motivation and
Resource availability involvement
Significant importance Senior Mgt. support
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
 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
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
PDCA Cycle

3. Identify
2. Analyze current root causes
situation or
process

4. Generate and
1. Select
improvement choose solutions
opportunity
Start

9. Monitor;

hold the gains

5. Map out
and
implement a
8. Adopt, Adapt or trial run
Abandon

6. Analyze
7. Draw the
conclusions
results
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 change
will produce desired output
PDCA Cycle

3. Identify
2. Analyze current root causes
situation or
process

4. Generate and
1. Select
improvement choose solutions
opportunity
Start

9. Monitor;

hold the gains

5. Map out
and
implement a
8. Adopt, Adapt or trial run
Abandon

6. Analyze
7. Draw the
conclusions
results
 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!
 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?
PDCA Cycle

3. Identify
2. Analyze current root causes
situation or
process

4. Generate and
1. Select
improvement choose solutions
opportunity
Start

9. Monitor;

hold the gains

5. Map out
and
implement a
8. Adopt, Adapt or trial run
Abandon

6. Analyze
7. Draw the
conclusions
results
 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?
 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
 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
Questions/Comments??
 QI Tool: Force Field Analysis
Review overview handout in packet
Break into 4 groups
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?
Group Practice: Force Field Analysis
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.
 Group Practice: Force Field Analysis
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.
 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
Questions/Comments??