Be the Change

This interesting article was published in BMJ Quality and Safety Online in January this year. It describes some of the pitfalls of the PDSA methodology which, as we encourage more front-line led change, is a timely reminder that the over-simplification of this model and its application without appropriate support could result in failure.

The article argues that using PDSA cycles is a “powerful approach, and projects that make successful use of PDSA can solve specific quality problems and also help shape the culture of healthcare organisations for the better”.

However, they also are right to point out that “a successful PDSA process does not equal a successful QI project”.

The authors warn of the pitfalls of failing to pay enough attention to each of the phases and simply jumping straight into the implementation of solutions – an all too common problem for NHS organisations.

They also remind us not to underestimate the impact of cultural and organisational factors and not to leave our front-line staff alone with the PDSA tool; “to be successful, the use of PDSA must be supported by a significant investment in leadership, expertise and resources for change”.

The conclusion is that PDSA is simple, but not necessarily easy and that’s why the ASPH ‘Be the Change’ team are here to help.  You can read more tips on how to use PDSA here and about, something we feel passionate about, the ‘human side of change’ here.

I have noted some of the key learning points from the BMJ article here but we would be interested to know your thoughts too:

Successful PDSA ≠ Successful QI Project – the purpose of PDSA is to test changes and learn from the outcome, whether or not the intended goal is achieved.  In my experience, there is always learning to be had from any improvement project and the outcome can sometimes be surprising.

People and organisational factors – PDSA has been adapted from industry, in healthcare there are a lot of ‘people factors’ to take into consideration when undertaking quality improvement work.

Cultural and organisational issues can have a big influence and can easily ‘de-rail’ a simple frontline-led project. Here at ASPH our ‘Be the Change’ team serve to support staff identify and overcome these sorts of issues throughout the life of the project.

Under-investment in planning – oversimplification of what is already a ‘simple’ model for improvement, can result in a ‘Do-Act’ cycle, where planning and studying are sadly lacking. The IHI model for improvement helps to address some of the short falls often encountered in ‘Plan’ by prefacing it with these three specific questions.

The ‘Be the Change’ team always encourage teams to spend plenty of time in this phase and discourage rushing into the ‘Do’ phase.

Identify and engage with people – these should be the people who will be affected by and who can influence the change.  I have fallen into this trap myself, (in my early project management days!), and had to spend some time back-tracking and persuading a certain group of staff to try a new way of working – we got there in the end, but I would have saved some time and heartache if I’d involved all the right people from the start.

Be sure to study the data – lack of a good ‘Plan’ phase can lead to the ‘Study’ phase being totally overlooked, as without sufficient data, there is nothing to study!  Time and effort spent planning will ensure that relevant, reliable and understandable measures are collected as part of ‘Do’.

Try not to fall into ‘Just get on with it!’ or ‘Do, Do, Do!’ – in our outcome and solution focussed NHS, we can easily fall into this mode of operation and easily overlook the very important reflective learning that comes from ‘Study’.

‘Do-Act’ projects will not result in sustainable changes

Involving all stakeholders is vital as teams need to own their changes, they need to see the benefits for themselves and then they will be willing to adopt a new way of working.  PDSA, it is not a tool for imposing your great idea on others!

I hope you find these tips useful.  We think PDSA is a great tool and would recommend that it is used as part of the model for improvement  – and if anyone would like more advice or practical help with using PDSA to improve, just get in touch.

You can also let us know what you think in the comments section below.

Thanks,

Sally – @Sally2PT