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[Music] hi everybody Welcome to my session today where I'm going to provide a simple overview of the plan do study act the pdsa model for improvement and I'm going to link it to a practical example of a project that I've been linked with if you find this video helpful remember to give me a thumbs up and you may want to check out some of my other free videos on my YouTube channel so they're helpful for healthcare professional students looking at quality improvement in modules or a dissertation or if you have an interview coming up looking at an overview of the key terms linked to quality improvement and quality assurance in healthcare so I hope you find this video helpful so if we firstly look at the concepts of quality improvement very simply quality improvement aims to standardize processes and structures so variations are reduced in processes systems and practice and that leads to Patient outcomes being improved in some way an example might be a quality improvement project that aims to introduce a screening tool to improve early identification of patients with sepsis So within this example variations are reduced as staff use this standardized screening tool and patient outcomes should improve and as more patients are identified early on with sepsis so the knock-on effect is a decrease in mortality rates for sepsis when we look at quality improvement methods and the quality improvement tools they have different uses and purposes and aims so some tools will aim to measure care against agreed standards to improve quality such as audit understanding the cause of the problem may be the focus of it all which would be an example might be root cause analysis using a fish bone cause and effect diagram and we you identify possible causes linked to a care issue or Service delivery there are tools that plan and test and Improvement such as the plan do study at model that I'm going to talk about today we also have the lean model that focuses on driving out waste and improving flow to improve patient care Six Sigma focuses on reducing variations in processes and using statistics and data analysis to reduce errors and then we have the lean Six Sigma that combines both those approaches we have other tools looking at promoting change in practice such as decision support tool or decision trees that use this tree model of decisions and that looking at the possible consequences of decisions you look at outcomes resources and costs for example a very good practical guide is from the healthcare quality improvement partnership in 2020 a guide to quality improvement tools so if you are looking at quality improvement in your modules as students or as post-registration Healthcare professionals that's a great start and good resource so if we focus on the plan do study act model it's simple and it's the most popular tool for quality improvement in healthcare it's based on this trial and learn approach where you make a small change you measure if it works and then you reflect on it you learn from it you might adapt it you might go through another cycle you might keep it in place because it works well but you have to continually evaluate whether it's worked psychical model is based on the principles of continuous process Improvement that include these four key stages of plan do study Act and the pdsa cycle evolved from William Edward deming's wheel in the 1950s and he originally created this plan to checked act cycle and he was this Trailblazer of the quality management movement at the time as we mentioned earlier about quality improvement the pdsa cycle aims to improve quality and reduce cost and the most it's most effective when a procedure process or system needs changing in a local service so a small scale change and you can introduce quality improvement refine it locally prior to widespread implementation so you've got this trial thing whether it works and testing so prior to starting a quality improvement project and implementing a pdsa cycle you need to think about some key areas and The Institute of healthcare Improvement model of improvement identifies these three key questions that are very helpful and they need to be answered for successful quality improvement by a team and I would say that is key to the success of any quality improvement it's about networking and collaborating positively across teams so the questions what are we trying to accomplish what are you actually trying to achieve how are you going to know that A change is an improvement so how are you going to measure Improvement what is the specific aim it needs to be measurable and time specific what change can we make that will result in Improvement so what measures are you going to use to determine whether the change LED to an improvement or not and these are really important questions to answer and often these questions are very helpful to start focusing down your ideas because at the beginning you've got an idea an area but it needs to be focused down into a measurable Improvement that you can show impact and either it works or it doesn't so there needs to be some measurement and some data collection as part of that quality improvement it's helpful to look at an actual example of a service improvement project linked to a pdsa cycle and I've chosen a project that I was involved with Ariel andada and I wrote a paper on this service improvement project so there's a lot more detail in our article and it aimed to reduce variations in clinical nurse educator roles it's a service improvement project to standardize roles and career Pathways so the issue was a lack of standardization of clinical nurse educator roles there was different job titles job plans in the hospital division linked to different bands and there was a need for Clear career progression pathway for clinical nurse Educators to improve retention so the aim of this project was to reduce variations in clinical nurse educator roles job titles and job Plans by implementing new standardized titles job plans for bands five to seven that aligned to a career progression pathway so the aim was to improve clinical nurse educator and manager satisfaction and to improve retention so it's quite a complex project not one that you would probably choose for a quality improvement or quality service improvement project for a dissertation you'd focus more narrowly on one aspect but it was it's interesting to look at it relating to the pdsa cycle because there's lots of elements to it so I hope you find that helpful the second stage to a pdsa cycle is the planning stage and in many ways this was the one that was most time consuming in our project in that you have to be really clear on your date how you're going to measure um the change progress or whether it's worked or not and think about those data collection tools of how to collect data to show that and it's helpful to reflect on the current situation first of all so what is the problem or the area that needs improving what you're trying to accomplish what change would improve the situation and make it better and using a team approach to that planning is essential you should end up with a clearly stated measurable aim it needs to be time specific and it needs to align with the institution and the profession so thinking about what's going to happen when you implement the change before you do implement it how are you going to measure Improvement what impact will this change have and that's where you might think about your data collection tools there as well and then networking that can take time to gain authorization working across a team and your implementation plan should be underpinned by an Evidence base linking the planning stage to the service improvement project I was linked to the issue was variations in clinical nurse educator job titles and job plans and managers were interpreting those roles in different ways relating to clinical duties administrative and teaching duties for those clinical nurse Educators and there was also this lack of a clear career pathway for clinical nurse Educators so there was a scoping that evaluation um as part of the planning to review perceptions of managers and clinical nurse educators of that role and that was done through questionnaires and focus groups as part of the planning and that showed the frustration of clinical nurse Educators and the differences across areas and there was this need for more standardization so the change that was implemented was standardized job titles and job plans for clinical nurse Educators in a hospital division along with clearly defined career pathway for clinical nurse Educators to measure the change as part of the planning we were going to get clinical nurse Educators and managers to feedback post implementation using questionnaires or interviews focus groups we could use different methods and then looking at retention and career progression data specifically for clinical nurse educators when implementing any quality improvement it's essential to gain authorization from the appropriate people so with our project it was the divisional lead matrons we would not have been able to have implemented a change looking at different job titles and the job plans without buying from our matrons and collaborating with clinical nurse Educators and we found it very helpful to have a divisional Steering group we had an education lead leading the project Ariel lanarda and gaining agreement on the job titles the plans and the career pathway before we implemented the change was essential and this is quite a large larger project that you would do for a dissertation for example but the principles would be the same team supports essential and finding out where you gain authorization another key thing is to start small and also to Pilot any data collection tools any questionnaires if you're going to lead a focus group what questions are you asking and then testing the change on a small scale monitoring progress is very important Thursday stage of the pdsa cycle is the study stage so reflecting on the test the change that was implemented and analyzing data has the change worked as you predicted does it differ or align from what you predicted or what you expected to happen who of the changes affected and how have the effects been positive or negative or what part of the change didn't work and why are the changes worth keeping or do they need adapting so you're summarizing what you learned to inform future work or disseminate success so linking the study part of pdsa to the service improvement project that I was linked to so reflecting and testing and analyzing data we found that it worked having a band five associate clinical practice educator band Six clinical nurse educator and band 7 practice development no nurse with clear job plans and a job profile post implementation there was an increased number of clinical nurse educator roles from 12 to 17. so it was helpful to recruit clinical nurse Educators 90 of senior nurses and 100 of Educators fed back positively post-implementation so one matron for example fed back that the job profiles and career Pathways helped to track five applicants to a previous vacant post so the number of positions was increasing five Educators started post-graduated postgraduate teaching courses two completed Masters and two started a doctorate doctorate but you can see that looking at our measurement for the impact on our quality improvement service improvement project is quite different to say a patient clinical outcome project that might be looking at patient complaints or quantitative data linked to admissions or discharges very much dependent on your project ours related more to sort of these clinical roles and staff experiences essentially so a summary of what we learned it unified our nursing team but it was hard to know what to evaluate when linked to staff development initially and it was only through scoping reviews that it was more clearer to and it was clearer to understand what we could use to show that impact so the final stage of the pdsa cycle where you actually act on your reflection look at what changes should be made for the next cycle so you need to decide whether to spread to stop or to implement the change further are there areas that need modifying or adapting are there any negative effects that need removing implementing change on a small scale is important until certain of improvement and then widen out so with us we embedded it across our change across the division because it worked but you repeat you tweak you change until the desired change matches the aim and then also is helpful to publish your work on average encourage anybody that's doing quality improvement projects to publish your work to share and disseminate and if you're not interested in writing writing and feel that it's too much to collaborate with other authors potentially it's helpful to get your work out there if you're interested in doing a quality improvement project or service improvement project there's some fantastic resources on the NHS and the National Institute for Health and Care research websites for quality improvement Frameworks models tools many employers have quality improvement Qi hubs and local Qi leads and networks and they're fantastic the experienced staff who are able to talk through your project or offer some advice on data collection tools for example there's the healthcare quality improvement partnership website the health Foundation some other professional bodies National forums and then the institute for Health Care Improvement and I also have some key references I've got some videos on my YouTube channel as well you might want to check out and some helpful resources references sorry that I've got some papers of good papers simple overviews um to read so that might be helpful so if you have any questions at all do pop them in the YouTube channel give me a thumbs up if you found this talk helpful you might want to ask me questions more privately on Twitter or on my website and if you're interested in any of my books the links to my books are in the YouTube description and good luck with any projects that you might be doing in the future