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The Improvement Model

The Improvement Model is a simple yet effective tool for improvement. It consists of two parts. The first part, the "thinking part", consists of three fundamental questions to guide improvement work.

What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?

The second part, the "doing part", is made up of rapid, small Plan, Do, Study, Act (PDSA) cycles to test and implement change in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.

What is a PDSA?
PDSA stands for Plan, Do, Study, Act. It's a model for testing ideas that you think may create an improvement. It can be used to test ideas for improvement quickly and easily based on existing ideas, research, feedback, theory, review, audit, etc or practical ideas that have been proven to work elsewhere.

When developing your PDSAs it is beneficial to go through the 'Questions to consider for PDSA cycles'

PDSA Templates
Developing Objectives (3 fundamental ques): Microsoft Word | PDF
PDSA Planning Sheet
PDSA Progress Sheet
PDSA Reporting Form

PDSA Example	PDSA tips & hints

(Langley, Nolan, Nolan, Norman & Provost (1996) "The Improvement Guide" Jossey Bass, USA).

PDSA Example

Objective
To improve BP control for patients with CHD

Plan
Practice Manager to identify 5 CHD patients from the CHD register with BP greater than 140/85 by 24th May. Receptionists to contact patients by telephone to offer appointments with the Practice Nurse. Measure date of last attendance, BP, medication compliance.

Do
Plan is carried out

Study
Two additional patients were seen opportunistically.
Six patients seen and one did not attend.
All patients had been seen in previous 4 months.
Control of BP had been difficult:
4 patients were overweight, 1 obese.
All patients did very little or no physical exercise.
All patients except one reported that they comply with medication.

Act
Medication compliance is difficult to assess: arrange meeting with doctors to discuss alternative methods of compliance.
Patients to be followed up more frequently by Practice Nurse.
Exercise program aimed at this group to be considered.
Doctors to review medication again at the next follow-up visit.

(NPDT, UK)

PDSA Tips & Hints

Keep it simple and very specific.
Keep it small and managable to start - Massive projects can be broken down into a number of small, quick PDSA cycles.
Cycles should happen quickly - think in terms of a week not a month!
There is no wrong answer, if you find something that works - use it!
Copy and adapt other people's ideas if you think they might be useful.
Many make the error of filling in the "Plan - Do - Study - Act" columns at the outset. You can of course only complete Plan and DO until the cycle has run.

The 8-day PDSA Challenge

The APCC 8-day PDSA Challenge is designed to assist participants with their first PDSA. Following Learning Workshop 1 each practice has 8 days to complete and document one entire PDSA cycle, including the "Do" - "Study" - "Act" components.

Participants are encouraged to act immmediately on ideas gained at the Workshop and literally put those ideas into practice.

Feedback is provided by the APCC to each practice who submitted a PDSA in the Challenge and data completeness is assessed based the percentage of practices who submitted a complete PDSA by the 8-day deadline.

Popular topics for PDSAs in the Challenge are:

Developing a Diabetes Register
Evaluating Current Diabetes Register
Identifying Patients with Ischaemic heart disease or related diagnoses
Understanding the profile of demand

Wave 1 PDSA Challenge Results:

91% data completeness
181 PDSAs submitted
38% majority in the Diabetes topic followed closely by 35% in Better Access
14 Divisions/Divisional Consortiums achieved 100% completeness

Wave 2 PDSA Challenge Results:

92% data completeness
242 PDSAs submitted
48% majority of PDSAs in the Diabetes topic
15 Divisions/Divisional Consortiums achieved 100% data completeness

Wave 3 PDSA Challenge Results:

94% data completeness
659 PDSAs submitted
47% of PDSAs in the Diabetes topic
17 Divisions/Divisional Consortiums achieved 100% data completeness