13 October 2021
46 active QI projects showing improvement across CNWL
Photo: Colchicum cilicicum (Autumn crocus), Peter Smith
QI in mid-Autumn
This month we bring you an article about Plan Do Study Act (PDSA) cycles, looking at what they are and how best to use them in your improvement project work. Testing change ideas with PDSA cycles is the ‘engine’ that drives improvement and we see that to get an improvement, we have to make change. The PDSA approach helps us do this in a methodical and mindful way.
Also in this issue, we have our usual roundup of news about what is happening in the CNWL QI Practicum and details of the training available to staff.
New for this month, we include information about our QI Coach Development Programme which is due to start in February 2022. The role of a QI coach is to help colleagues with their improvement work, so it is a varied and richly rewarding use of your time. Read on to find out details about what the programme involves and who it is designed for. Applications are now open until 19 November and we look forward to hearing from any staff who are interested in becoming a QI Coach.
Reporting on the first Service User and Carer Quality Improvement Forum and a welcome to Peter Toohey, the newest member of the QI Team, round off this issue.
We welcome your feedback and if there is anything you would like to see in future editions of the newsletter, do please get in touch by e-mailing firstname.lastname@example.org.
Using Plan Do Study Act (PDSA) Cycles
This month we focus on the Plan Do Study Act (PDSA) cycle to explore what it is and how you should use it in your QI project. Let us start with a great quote from The Institute for Health Improvement (IHI), adapted from William Edwards Deming.
Every system that we work in, so including health service systems or service settings, produces output or performance exactly as it is designed. This is an important concept in improvement work because if you want a different output or result, you have to change the system in some way. This is where the PDSA cycle comes into play, to test changes to our system in a methodical and mindful way.
A PDSA cycle is systematic approach to ‘trying out’ or testing a change in your system, consisting of four stages:
Plan – think about what part of your system you want to test and what it is that you are going to do differently. You can at this stage, develop a hypothesis about what you think will happen when you make the change. An example of this might be a change to an assessment form; ‘if we fill out the form with different information or in a different way, we think that the assessment process will take less time to complete’. You also need to plan who is going to test your change, when the change is going to happen and how you are going to collect information (data) about whether the change makes an improvement. So, in the assessment form example, you would assign someone to try the form out and ask them to note whether the form was easier to fill in and to record how much time it took them.
Do – literally you ‘do the test’, so your assigned person uses the form and makes those observations about ease of use and time taken.
Study – compare what actually happened in the do stage with what you predicted would happen in the plan stage. In our example, ask yourself if the time to fill in the form decreased as you wanted it to and also was the form still easy to use? In effect you are analysing what happened in your PDSA cycle. You can then ask yourself if you wish to Adopt (keep the change because it worked), Adapt (try something similar in your next PDSA, but ‘tweaking’ it because it did not fully meet your predictions) or Abandon (because it did not work as well as you hoped that it would).
Act – in this stage you use your thoughts from the Study stage to inform what you might do in the next PDSA cycle. You may choose to test the form again at a larger scale or in a different way (such as another member of staff testing it) or you may change it and re-test or decide that the test is not going to work and stop doing any further testing.
So, knowing what a PDSA cycle is, how do we apply it? To do this we need to think about the list of change ideas that we have developed on our Driver Diagram, deciding which of the change ideas might have greatest impact on our aim and starting to test that aim first is a good way to start.
Once that decision is made, we use the PDSA cycle in an iterative and repeated process that we refer to as a PDSA ramp, which is quite simply a set of consecutive PDSA cycles; each cycle providing you with more knowledge about what works and what does not, leading to an overall improvement in your system. As you progress through the cycles, it is recommended that you increase the scale of your testing; from ‘small to all’ as we say. By the time that you have done enough cycles, you can be confident that your change is making a consistent improvement. You may need to gather data specifically to do this. In our example you may wish to plot a chart of data points of how long each form takes to fill in.
In summary, PDSA cycles are used in ramps to test out our change ideas and in so doing, learn about what works to help achieve our project aim and just as importantly, what does not work or help. It is easy to feel down-hearted when a PDSA does not work or fails to make an improvement, but it is better to think of such an outcome as good learning; we have ‘failed forward’ by learning what does not work. And that is something that is very positive!
Three final words: document, document, document! Whether you capture your PDSA records on paper or any other means, it is really important to get into the habit of recording your PDSA cycles on the Life QI system and this will pay dividends as you get further into your project. Memory about what you learnt at the start of your testing may not be perfect after three months of working on PDSA ramps? The PDSA tab on your Life QI project is designed to lead you through recording your PDSA cycles and this is invaluable for when you want to tell your QI story by developing a QI poster. So, we recommend that you get familiar with using the facility on the system and get into the habit of filling the boxes in on a regular basis as you do your PDSA tests.
Don’t forget that a QI coach can help you work through your testing using PDSA ramps or alternatively, book a QI Clinic slot and discuss your plans with members of the QI Team.
News from the Practicum 2021
On 20 and 22 September, each set of practicum project teams attended a bespoke themed workshop for Violence Reduction, Flow, Pressure Ulcers and Safety respectively. We spent our time together talking about hopes, fears and challenges and barriers specific to each theme. Teams were asked to present a short snapshot of where they are in their project, so that we can learn from each other and benefit from shared learning.
Colleagues from the Service User and Carer Involvement Team took part to reflect back what they were seeing in the progress of incorporating co-production across the QI projects. There are challenges to getting meaningful SU&C involvement underway, but it is great to see some teams have made headway on this important aspect of any QI project.
We also spent some time looking at subjects such as why data is important and how teams can engage with fellow staff in their services.
We are now looking forward to the next learning session, which will cover the use of PDSA cycles and training on measures for improvement.
Applications now open for CNWL QI Coach Development Programme Starting 1 February 2022
The CNWL QI Coach Development programme will give you the skills needed to successfully coach and facilitate improvement teams, while supporting the implementation of improvement strategies throughout CNWL.
Starting in February 2022, this course runs over a six month period, during which you will actively coach a project towards improvement whilst attending ten taught days which will be delivered virtually. There will be space for 20 participants.
Staff completing Improvement Coach training will be expected to provide QI advice and guidance in their local area and coach priority improvement projects.
As a result of this programme, participants will:
- Learn how to coach improvement teams on how to develop, test, and implement changes
- Learn how to use the Model for Improvement and Six Stages of Improvement as a roadmap to improvement
- Support teams to identify change ideas and testing them using PDSA cycles
- Become skilled in how to use data for improvement, including how to use run charts, and other key quality improvement tools
- Build skills in team facilitation, communication, decision making, and understanding team culture
- Apply just-in-time teaching of improvement skills to team members in order to advance the team’s work
- Learn change theory
- Learn concepts of implementation, sustainability, and scale-up
- Leave with a specific plan for how you will continue coaching your team and prepare yourself to coach subsequent teams
Essential Criteria for application
- CNWL Member of Staff
- Experience of being part of a QI project team
- Evidence of undertaking previous QI training
- Managerial support for application
- Deadline for applications: 19 November 2021
Please see the QI Microsite for more information.
If you have any questions regarding the QI Coach Development Programme please email email@example.com
Our first Service User and Carer Quality Improvement Forum
On the 23rd of September, we held our first Service User and Carer Quality Improvement Forum. This forum is for all service users and carers involved in QI projects across the Trust to come together to share their views and experiences and support each other in QI.
The first session was an energised event, chaired by Sandra Jayacodi, Service user representative. We welcomed 14 CNWL service users, carers and staff, and began the session by sharing our vision for QI i.e. to ensure service users and carers are meaningfully involved and supported within all QI work at CNWL. After listening to couple of practical tips for involvement, the discussion was open to the entire group, where each service user and carer shared their current experiences of QI and what they hope to get from the group going forward.
In future, the forum will be held quarterly, where each service user and carer will be given time to share their experiences and learnings from their individual QI projects. The aim is to learn from and support each other.
If you have any further questions, concerns or comments at any time, please contact the CNWL Patient and Carer Involvement Team on firstname.lastname@example.org, tel: 020 3317 3735, asking for Lucy Palmer, Grace Levy or Sam Gutteridge.
Meet the Team
Hello to Peter Toohey
Hello my name is Peter.
I am a paediatric intensive care nurse by background.
I have work in both clinical and non-clinical leadership roles within the NHS. Most recently, I have come from an operations management role with Theatres & intensive care at the Royal Free London NSHFT. I have led safety improvement collaboratives at both a regional and local level with UCL Partners and Royal Free London in collaboration with the IHI.
I am passionate about safety and improvement and am looking forward to working with teams at CNWL to support quality improvement across the system.
Upcoming Training Dates
Bitesize QI – New dates into 2022!
Dates for the ever-popular monthly 3-hour virtual QI training on the model for improvement and how to set out on a QI project are bookable on LDZ at: https://cnwllearning.org/login/index.php
Search for ‘Bitesize QI’ to find the course, which is available on these dates all starting at 9.30am:
- Tuesday 14 December 2021
- Tuesday 11th January 2022
- Tuesday 15th February 2022
- Tuesday 15th March 2022
More dates through to the end of 2022 coming soon…
Contact information for Improvement Advisors:
|Diggory Division||Peter Tooheyemail@example.com|
|Goodall Division and Corporate||Peter Smithfirstname.lastname@example.org|
|Jameson Division||Bridget Browneemail@example.com|
If you want to get in touch, please contact us on