Introduction to Model for Improvement (Part 2)
In our last video, I began to introduce the Model for Improvement. I covered the first part – The 3 Questions which guide the improvement effort: 1. What are we trying to accomplish? 2. How will we know a change is an improvement? 3. What changes can we make that will result in improvement?
We have found the PDSA Cycle, as part of The Model For Improvement to be the most useful tool to bring rapid team and organisational learning for sustainable improvement.
Once you have identified your idea, potential solution or hypothesis, there are 4 simple steps in the process of a learning cycle:
1. Plan
Using a degree of rigour that is usually associated with scientific trials, plan an experiment to test your idea, potential solution or hypothesis with a focus on learning about how the business system truly works:
- Prepare the test plan, including: How the test will be run, where it will be run, when it will be run, and who will be involved.
- Define the measures and plan how they will be practically gathered and analysed, preparing any data gathering forms you will need to make the process easier.
- Commit to your beliefs by making specific predictions about exactly how the idea you are testing will impact the results. This is crucial for learning in the Study step.
- Assign the resources to complete the test, accounting for the practical issues of everyday work.
2. Do
Conduct the experiment, track results, and observe what goes on during the test. In other words, DO your plan!
- Follow the test as planned
- Begin plotting results graphically, in real-time wherever possible, to maximise learning
- Diarise any suprises or unexpected results
- Document any changes to the test plan that were required due to unexpected circumstances. These are important for your team learning.
- Then begin initial analysis, sharing observations within the team
3. Study
When sufficient data has been collated to gain team learnings, review (or Study) the results to draw conclusions about your experiment:
- Explore observations from the data and any surpises that arose.
- Compare the results with the initial predictions – were they met or surpassed …or were the results less than you expected, or worse?
- Agree, as a team, on your most important learnings from the experiment, particularly about the business system being tested.
4. Act
Based on what you have learned, it is now time to take action:
- If the experiment was not successful, should you abandon it, and explore other possibilities?
- If the test proves positive, is your team and organisation confident enough to go ahead to implement the solution, based on the evidence?
- Were the results inconclusive, or the test too small, to generalise from?
- Do you need to test again, perhaps with different conditions? … Or Start a new cycle?
- Have the accumulated tests proved sufficiently successful that you have achieved the goals of the project?
- And is it time to apply the learnings, make sure the improvements are embedded in the organisation and close up the project?
One mistake that teams often make is to conduct their learning cycles consecutively, one-at-a-time. We encourage our clients to accelerate their learning by running multiple, concurrent PDSA cycles, based on more rigorous planning. We have seen some amazing results come from fast PDSA cycles working in tandem.
What makes the Model For improvement unique is that it can be applied to anything, in any kind of industry:
- Improvement of existing products, services, and customer or patient experiences
- Improvement of existing processes
- Product, service and experience innovation
- Process innovation
- Business Model innovation
- Improvement of complete business systems, or sub-systems
- Spread of known changes what are called collaboratives
If you have questions about how the Model for Improvement can help your organisation build a system of rapid innovation and improvement, let’s talk.
If are interested to know more, contact us.
Music and video editing by Priya Thomas
If you prefer to read the contents of the video, here’s the transcript.
Good morning, good afternoon and good evening, wherever you are watching this from.
This is David Thomas from Profound Knowledge Partners Asia.
In our last video, I talked about how a client of mine was struggling with a challenge of clinic scheduling and efficiency. I began to introduce the Model for Improvement, developed by API and covered the first part, that is, The 3 Questions which guide the improvement effort:
1. What are we trying to accomplish?
2. How will we know a change is an improvement?
3. What changes can we make that will result in improvement?
If you’d like to refer back to that video, see the link in the description below.
In this video, we will cover the 2nd part of the Model For Improvement: PDSA or Learning Cycles
Change is good, but only when it actually results in improvement! Not all changes are an improvement, and that’s why people fear change.
I have spoken to many colleagues and clients who have been victims of organisational change that has been thrust upon them without proof that the solution actually works.
… in fact making things worse.
Whenever a client comes to me with a potential solution to a problem, or an idea to capture an opportunity in the marketplace, one of the questions I ask is: “How can you test it?”.
This forces the client to make their beliefs about how their business system works explicit and to learn whether their assumptions are accurate.
We have found the PDSA Cycle, and the business application of the scientific method to be the most useful tool to bring rapid team and organisational learning for sustainable improvement.
Once you have identified your idea, potential solution or hypothesis, there are 4 simple steps in the process of a learning cycle:
1. Plan
Using a degree of rigour that is usually associated with scientific trials, plan an experiment to test your idea, potential solution or hypothesis with a focus on learning about how the business system truly works:
- Prepare the test plan, including: How the test will be run, where it will be run, when it will be run, and who will be involved.
- Define the measures and plan how they will be practically gathered and analysed, preparing any data gathering forms you will need to make the process easier.
- Commit to your beliefs by making specific predictions about exactly how the idea you are testing will impact the results. This is crucial for learning in the Study step.
- Assign the resources to complete the test, accounting for the practical issues of everyday work.
2. Do
Conduct the experiment, track results, and observe what goes on during the test. In other words, DO your plan!
- Follow the test as planned
- Begin plotting results graphically, in real-time wherever possible, to maximise learning
- Diarise any suprises or unexpected results
- Document any changes to the test plan that were required due to unexpected circumstances. These are important for your team learning.
- Then begin initial analysis, sharing observations within the team
3. Study
When sufficient data has been collated to gain team learnings, review (or Study) the results to draw conclusions about your experiment:
- Explore observations from the data and any surpises that arose.
- Compare the results with the initial predictions – were they met or surpassed …or were the results less than you expected, or worse?
- Agree, as a team, on your most important learnings from the experiment, particularly about the business system being tested.
4. Act
Based on what you have learned, it is now time to take action:
- If the experiment was not successful, should you abandon it, and explore other possibilities?
- If the test proves positive, is your team and organisation confident enough to go ahead to implement the solution, based on the evidence?
- Were the results inconclusive, or the test too small, to generalise from?
- Do you need to test again, perhaps with different conditions? … Or Start a new cycle?
- Have the accumulated tests proved sufficiently successful that you have achieved the goals of the project?
- And is it time to apply the learnings, make sure the improvements are embedded in the organisation and close up the project?
One of the mistakes that teams often make is to conduct their learning cycles consecutively, one-at-a-time. We encourage our clients to accelerate their learning by running multiple, concurrent PDSA cycles, based on more rigorous planning.
We have seen some amazing results come from fast PDSA cycles working in tandem.
At regular intervals, the team should report learnings to the organisation and plan for the further cycles. What more needs to be learned and changed?
If the project is complete, the team will reflect on learnings from the project and close out with the sponsor.
Although these steps in the PDSA cycle are simple, its “simplicity belies its sophistication”, as Reed and Card point out in their BMJ Quality and Safety article: “The problem with Plan-Do-Study-Act cycles”.
They observe, when simplistically applied, taking short cuts, the results are often disappointing. But when applied rigorously, as part of the Model For Improvement, for example they bring exceptional speed and results to improvement initiatives.
I encourage you to read this article, and will leave a link to it in the description below.
For those who are interested in how the PDSA Cycle developed from the work of Deming and Shewhart, you can find an accurate history in our partner’s article: “Circling Back: Clearing up myths about the Deming cycle and Seeing How it Keeps Evolving.”
The link is in the description below as well.
As the article alludes, the Model for Improvement continues to evolve, and in our next video, we will explore the current iteration that we have been using to bring rapid, sustainable improvement when applied strategically. We call this iteration, which was developed by my partners, Jane and Cliff Norman, the Accelerated Model for Improvement – AmiTM.
As I mentioned in my last video, the Model for Improvement is widely used in Healthcare around the globe, and has been adopted and promulgated by the Institute for Health Care Improvement. Beyond that, it has a long history of use in:
- Manufacturing
- Distribution and Retail
- Supply Chain
- Engineering
- Building & Construction
- Oil & Chemical Industries
- Food Processing
- numerous other industries.
What makes the Model For improvement unique is that it can be applied to anything, in any kind of industry:
- Improvement of existing products, services, and customer or patient experiences
- Improvement of existing processes
- Product, service and experience innovation
- Process innovation
- Business Model innovation
- Improvement of complete business systems, or sub-systems
- Spread of known changes what are called collaboratives
If you have questions about how the Model for Improvement can help your organisation build a system of rapid innovation and improvement, let’s talk.
As Improvement Scientists, Business Coaches and Consultants, we can explore your challenges with you and help build solutions that will navigate your organisation’s critical transitions.
Email or message us today. You will find the links in the description below.
And over time we will continue to expand on growth transition methods and case studies in this channel.
Check out our other videos. If you are interested to learn more, hit the subscribe button and leave a thumbs up below.
Thank you for watching and see you in the next one!
Links:
Reed, Julie E. and Card, Allan, J., “The problem with Plan-Do-Study-Act cycles”, BMJ Quality & Safety, 2015, Vol. 25, issue 3
https://qualitysafety.bmj.com/content/25/3/147
Moen, R.D. Norman, C.L., “Circling Back: Clearing up myths about the Deming cycle and Seeing How it Keeps Evolving”, Quality Progress, American Society for Quality, November, 2010
http://www.apiweb.org/circling-back.pdf
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., Provost, L. P., 2009. “The Improvement Guide: A Practical Approach to Enhancing Organizational Performance”, 3rd Ed., 2009, Jossey Bass
https://www.pkpasia.com/recommended-reading/
Associates in Process Improvement
http://www.apiweb.org/index.php
Institute for Healthcare Improvement
http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx