One proven approach to quality improvement is the Plan-Do-Study-Act or PDSA cycle. The PDSA cycle has two parts. Answering the questions below will help you get started:
- What are we trying to accomplish? What is your goal and how will you measure it – for example, We want patients to experience a 25% shorter wait time before their appointment than they do now.
- How will we know that a change is an improvement? Thinking through some of the process and consequences can help here – for example, “Our patients currently wait an average of 20 minutes before they are brought to the exam room; reducing this to 15 minutes should be an improvement unless they end up waiting even longer once in the exam room or we miss something important because we’re hurrying too much”.
- What change can we make that will result in the improvement? Looking at current processes is usually helpful – for example, “Checking the forms, questionnaires, and insurance documentation for each patient takes a long time. Often the MA is waiting while this is done; so, perhaps we could have the patient being readied by the MA in the exam room while receptionist checks over the forms and documentation”.
Use the answers to these three questions to enter the PDSA cycle:
- Plan – Decide upon a relatively small and well-defined change in the way you do something that you think will move you toward the desired improvement (something you can accomplish in a day or two).
- Do- Implement your plan for a short period of time (Think days, not weeks or months!).
- Study – While implementing the change, measure the impact of the change and monitor for unexpected consequences. Review with the rest of the team all ideas for an improved implementation or revised strategy.
- Act – Decide what to do next –
- You might want to make the change permanent (and look for additional ways to improve in the future),or
- You might want to revise or modify the change slightly because it didn’t work like you planned,or
- You might want to try another approach altogether because your change didn’t work at all.
The PDSA cycle is meant to be used repeatedly and continuously to result in ongoing quality improvement.
What is a Learning Collaborative?
A Learning Collaborative is an opportunity for health care practices to participate with other practices in a structured process to improve the quality of care they deliver. Every Learning Collaborative includes several important components:
- An initial objective assessment of current practice (e.g., chart audits)
- Participation in a Learning Session to hear the evidence behind the “best practices” and to learn how to implement process improvement in your practice
- Ongoing follow-up and technical assistance, including: periodic assessments/chart audits (to assess whether improvement is happening), conference calls (to get questions answered and learn from other practices), and site visits (to provide focused guidance and hands-on assistance)
- An end-of-Collaborative assessment to measure your improvements, allow comparisons with other practices, and to guide your next efforts
- A formal or informal wrap-up session to help you organize your thoughts and to provide advice on maintaining the improvements in the future
Who should attend a Learning Collaborative?
Effective and sustained quality improvement means changing the way your practice works. Changing a system is best accomplished through a team effort. Depending on the desired change and the practice structure, the team may consist of: a physician or mid-level provider, a nurse or medical assistant, a clerical staff member, an administrator, and often a parent.