CONTINUOUS IMPROVEMENT
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CONTINUOUS
IMPROVEMENT
A Driver of Results Work
Results Work is Adaptive Work
■
New learnings
■
Experiencing loss
■
Creating accountability
■
Experimental
■
Rooting in failure and learning
Focus on Continuous Improvement –
Working in High Action and High Alignment
Action
■
Pre-Planning - data collected to fully
understand the current situation, to
identify a baseline and a target; to start
the strategy development process
■
Planning/Preparing – the developing of
strategies, the positioning of resources,
identifying missing partners
■
Execution – implementing strategies and
programs, using performance measures to
assess impact
■
Scope and Scale – expanding the work to
broaden reach and/or impact
Alignment
■
Actions and behaviors focused on
understanding others interests, points of
view and potential contributions
■
Expanding the work of the individual/team
to the population level result; Having
difficult conversations required for
alignment
■
Developing shared strategies, shared
performance measures
■
Alignment for Scope/Scale – Thinking and
acting politically to shift systems in order
to create highest impact for results work
Tools and Methods for Continuous
Improvement:
Continuous improvement moves are not
incremental. They are adaptive in nature and
designed to impact the status quo
Quality Improvement tools and methods are used
to support:
■
Action that executes to scope and scale
■
Alignment that supports leveraging the
relationships and contributions of partners to
achieve scope and scale
■
Action Commitment Ratings (First line of QI)
■
Before/After Action Reviews
■
Factor and Root Analysis
■
Critical Incident Work
■
Tracking of Performance Measures
■
PDSA – Rapid Cycle Quality Improvement
■
Data Development Agenda
■
Cognitive/Implicit Bias
■
Thinking and Acting Politically
■
Systems Analysis
Improving the Effectiveness of the Work
■
Action Commitments
■
Factor Analysis
■
Performance measures
■
Working in High Action High Alignment
CI Questions to Explore
■
Are these practices moving the work from
pre-planning towards execution and then
scope and scale?
■
What are the small test of change that can
be implemented to determine if strategies
developed are addressing the priority
factors identified?
■
Are they helping to create greater
alignment to support execution and scope
and scale?
■
What tests of change can be used to
improve impact of the work?
When Things Don’t Go As Planned
■
Before/After Action Reviews
■
Critical Incidents/Critical Response
■
Failure Analysis
■
”Pain Point”
CI Questions to Explore:
■
What is the learning and practice
agenda?
■
What can improve our working in
HA/HA in order to execute towards a
shared result
■
What are the small tests of change
that can be tried based on what we
have learned?
PDSA – Actions to Test Change
Questions to ask
■
What are we trying to accomplish?
■
How will we know that change is an
improvement
■
What change can we make that will
result in improvement
PDSA can improve
■
Quality and Power of Action
Commitments
■
The development and
implementation of strategies
■
The execution towards performance
measures (strategy, program,
and/or role level)
■
Experimenting new actions when
things don’t go as planned
Repeated Use of
the PDSA Cycle
Hunches
Theories Ideas
Changes That Result in
Improvement
Small Scale
Testing
Follow-up
Tests
Test new conditions
Implementation of
Change
Learning and Improvement
Evidence & Data
Multiple PDSA Cycles --
Sequential
Building of Knowledge
– include a
wide range of conditions in the
sequence of tests before
implementing the change
Do’s and Don’ts of PDSA?
When to use PDSA
For trying changes to existing
processes, strategies, methods,
etc.
For trying
new
processes ,
strategies, methods, etc.
For trying
new
tools
For trying
new
measures
Don
’
t need to use PDSA:
For specific project tasks
For gathering data or
information (unless you want
to learn about the data
process)
For general
“
planning
”
or
setting goals, objectives
Successful Cycles to Test and Adapt
Scale down size of test (# of patients, location)
Conduct the test over a short time period
Test with volunteers
Do not try to get buy-in or consensus for the test
Collect
useful
data during each test
Think a couple of cycles ahead
Plan multiple cycles to test and adapt change
In later cycles, test over a wide range of conditions
Some misuses of PDSAs
Tendency to do too much in one PDSA, instead of several cycles
Tendency to use PDSAs for information gathering or collecting data on a
measure rather than beginning to test an idea for change
Tendency to use PDSAs to complete all
‘
tasks
’
on the project
Results Work is Adaptive Work with a focus on Continuous Improvement. It involves experiencing loss, creating accountability, and rooting in failure and learning. The process includes pre-planning, understanding others' perspectives, expanding work to a broader level, and implementing strategies with shared performance measures. Tools and methods such as Action Commitment Ratings, Factor and Root Analysis, and PDSA Rapid Cycle Quality Improvement are utilized to support the improvement process and achieve scope and scale.
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Presentation Transcript
CONTINUOUS IMPROVEMENT A Driver of Results Work
Results Work is Adaptive Work New learnings Experiencing loss Creating accountability Experimental Rooting in failure and learning
Focus on Continuous Improvement Working in High Action and High Alignment Action Alignment Pre-Planning - data collected to fully understand the current situation, to identify a baseline and a target; to start the strategy development process Actions and behaviors focused on understanding others interests, points of view and potential contributions Expanding the work of the individual/team to the population level result; Having difficult conversations required for alignment Planning/Preparing the developing of strategies, the positioning of resources, identifying missing partners Execution implementing strategies and programs, using performance measures to assess impact Developing shared strategies, shared performance measures Alignment for Scope/Scale Thinking and acting politically to shift systems in order to create highest impact for results work Scope and Scale expanding the work to broaden reach and/or impact
Tools and Methods for Continuous Improvement: Continuous improvement moves are not incremental. They are adaptive in nature and designed to impact the status quo Action Commitment Ratings (First line of QI) Before/After Action Reviews Factor and Root Analysis Quality Improvement tools and methods are used to support: Critical Incident Work Action that executes to scope and scale Tracking of Performance Measures Alignment that supports leveraging the relationships and contributions of partners to achieve scope and scale PDSA Rapid Cycle Quality Improvement Data Development Agenda Cognitive/Implicit Bias Thinking and Acting Politically Systems Analysis
Improving the Effectiveness of the Work Action Commitments CI Questions to Explore Factor Analysis Are these practices moving the work from pre-planning towards execution and then scope and scale? Performance measures Working in High Action High Alignment What are the small test of change that can be implemented to determine if strategies developed are addressing the priority factors identified? Are they helping to create greater alignment to support execution and scope and scale? What tests of change can be used to improve impact of the work?
When Things Dont Go As Planned Before/After Action Reviews Critical Incidents/Critical Response Failure Analysis Pain Point CI Questions to Explore: What is the learning and practice agenda? What can improve our working in HA/HA in order to execute towards a shared result What are the small tests of change that can be tried based on what we have learned?
PDSA Actions to Test Change Questions to ask What are we trying to accomplish? How will we know that change is an improvement What change can we make that will result in improvement PDSA can improve Quality and Power of Action Commitments The development and implementation of strategies The execution towards performance measures (strategy, program, and/or role level) Experimenting new actions when things don t go as planned
Repeated Use of the PDSA Cycle Model for Improvement Changes That Result in Improvement What are we trying to accomplish? A P How will we know thata change is an improvement? S D Implementation of Change What change can we make that will result in improvement? Test new conditions Multiple PDSA Cycles -- Sequential Building of Knowledge include a wide range of conditions in the sequence of tests before implementing the change A P S D Follow-up Tests Hunches Theories Ideas Small Scale Testing
Dos and Donts of PDSA? When to use PDSA For trying changes to existing processes, strategies, methods, etc. For trying new processes , strategies, methods, etc. For trying new tools For trying new measures Don t need to use PDSA: For specific project tasks For gathering data or information (unless you want to learn about the data process) For general planning or setting goals, objectives
Successful Cycles to Test and Adapt Scale down size of test (# of patients, location) Conduct the test over a short time period Test with volunteers Do not try to get buy-in or consensus for the test Collect useful data during each test Think a couple of cycles ahead Plan multiple cycles to test and adapt change In later cycles, test over a wide range of conditions
Some misuses of PDSAs Tendency to do too much in one PDSA, instead of several cycles Tendency to use PDSAs for information gathering or collecting data on a measure rather than beginning to test an idea for change Tendency to use PDSAs to complete all tasks on the project
