#QualityImprovement and #PDSA cycles - how to decide what to DO

Plan Do Study Act (PDSA) cycles are a quality improvement tool used to test process change. Not all change leads to improvement. In order to evaluate the change for its impact on your patients and the care you provide them, you need to test the change.

The Institute for Healthcare Improvement (IHI) uses the Model for Improvement developed by Associates in Process Improvement. Both sites provide resources for using this method, including this worksheet from IHI.

To summarize briefly, the process requires you to develop a PLAN for how you will test the change including how you will measure the change. Then you will DO the change in a small scale or pilot, measuring the outcome before and after implementing the change. After completing the pilot, you will STUDY the results of your test by carefully examining the before and after measurement. Finally, you ACT on what you learned, generally through modifying and re-testing the new change in a new PDSA cycle. You repeat until you are convinced that the change consistently creates more benefit than harm, which constitutes improvement.

There are many great resources on many different websites to help guide you in the PDSA process.

But the biggest challenge for you will be deciding WHAT to do.

STEP 1 - Know your organization’s most pressing problems. Hint - start with your data. Data includes your performance metrics, but it also includes your survey data from patients and staff.

STEP 2 - Prioritize - No organization has enough resources to change everything at once. Besides exhausting your staff, you’ll also contaminate your tests of change. When you change everything at once, you can’t determine which change produced the improvement, if there was improvement. And changing everything at once may produce no overall improvement, hiding real improvement that could be generated from one of the changes.

STEP 3 - Find evidence based innovations to address your priority problems. If you use innovations that have already been tested and found to work, you will have a head start. You will waste less time with more PDSA cycles and you are more likely to reduce unintended harm to your patients and staff from the change.

All this is necessary for successful PLANing of what to DO.

In the next post I’ll dig deeper into the process of how to decide what to do.

 ©TheEvidenceDoc 2018

I just want #clinicalpracticeguidelines we can trust

Ten years ago, the US Congress, through the Medicare Improvements for Patients and Providers Act, asked what was then the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) to identify the best methods for developing clinical practice guidelines. The IOM did so producing what is now considered our national standard for clinical guideline development and appropriately titled, "Clinical Practice Guidelines We Can Trust".

If you are unfamiliar with this report, you can, and should, read it here

You will need to read it, understand it, and be prepared to implement it yourself.

You see, the US resource that used these IOM standards to evaluate clinical guidelines and provide free evaluation and information on #clinicalpracticeguidelineswecantrust has lost its funding and will cease to exist after July 16th of this year. You can read about our loss of the National Guideline Clearinghouse here.

While you're there, explore the resources available on the website, particularly the guideline submission kit that provides detail on how the organization implemented the IOM standards. Better get it quick, before the site comes down.

Not all guidelines are to be trusted. An examination of how well guidelines adhered to the new standards shortly after their release found that the average number of standards met in guidelines sampled was only 46.5%, or just less than half.

Developing trustworthy, evidence based guidelines for clinical care is hard work. The National Guideline Clearinghouse provided more than curated access to guidelines we can trust. Through their detailed methods for guideline inclusion, they also provided training to guideline developers interested in learning and implementing the minimum standards for trustworthy guidelines.

This is a huge loss at a time when we need science more than ever to help us navigate the evidence behind the many medical care choices available.

I don't want access to every clinical practice guideline.

I don't want to waste my time sifting through those that can't meet even half the standards for quality guideline development.

I just want access to clinical practice guidelines we can trust.

TheEvidenceDoc 2018