Model for Improvement
“The definition of insanity is doing the same
thing again and again and expecting a
different result”
Albert Einstein
Scientific Method
• Analytic in nature with the focus on the
development/discovery of new knowledge
Model for Improvement
What are we trying to
accomplish?
What change can we make
that will result in improvement?
How will we know that a change
is an improvement?
Act
Plan
Study
Do
Langley, et al.
This comparison/examination
generates knew knowledge
about what change might
work or what modification is
needed
PDSA Learning Cycle:
Most important part of any
PDSA cycle is the
Prediction as it represents
current knowledge about
how a process or system
will behave in the future.
Inductive learning begins
here
When predictions are
compared with actual
outcomes they can
reveal gaps in our
current understanding of
why a process or system
behaves the way it does
Langley et. al
6
Langley et al
Scoping PDSA cycles
• Learn/Develop
change ideas
• Test under multiple
A
conditions
A
P
S
A
D
S
P
D
A
P
S
A
D
S
P
D
S
D
D
P
P
A
A
S
S
D
D
P
P
A
A
S
A
P
S
A
D
S
P
D
A
P
S
A
D
S
P
D
S
D
D
P
P
A
A
S
S
D
D
P
P
A
A
S
P
S
A
D S
P D
S D
D
P
P A
A S
• Implement/make
$
permanent
© Improvement Science Consulting
A
P
A
P
A
P
S
D
S
D
S
D
A
P
A
P
A
P
S
D
S
D
S
D
A
P
A
P
A
P
S
D
S
D
S
D
Appropriate Scope for a PDSA Cycle
Staff Readiness to Make Change
Current Situation
Low
Confidence
that change
idea will lead to
Improvement
High
Confidence
that change
idea will lead to
Improvement
Resistant
Indifferent
Ready
Cost of
failure
large
Very Small Scale
Test
Very Small Scale
Test
Very Small Scale
Test
Cost of
failure
small
Very Small Scale
Test
Very Small Scale
Test
Small Scale Test
Cost of
failure
large
Very Small Scale
Test
Small Scale Test
Cost of
failure
small
Small Scale Test
Large Scale Test
Large Scale Test
Implement
Langley et. al
9
Final Thoughts on PDSA
• The opportunities for learning about many
aspects of the change from testing are
expected to be significant, including
learning from failures. Some percentage
of tests—perhaps 25 to 50 percent—is
expected to result in no improvement,
to “fail,” but to result in substantial
learning nevertheless.
Langley et al
Let’s try it out
10
Mr Potato Head
Please decide at your table
• Who will be:
–Time Keeper
–Quality Assurance Officer
–Data Analyst
PDSA
Simulation
PDSA Measures
Accuracy
Time
• 3 – All pieces on Mr. P • Start: When time
& positioned correctly
keeper says go.
• 2 – All pieces on Mr.
• Stop: When
P, but one or more is
Assembly indicates
out of place
last piece is in place
AND removes hand.
• 1 – One or more
pieces are not on Mr.
P.
Plan
PD
SA
Cy
Test Cycle
cle Le
Measures/Learn Predicted Cycle
# vel Test Cycle Aim ing Questions Outcomes
Can we build
Mr P. faster than
the
demonstrated
Start with feet benchmark and
and work to with perfect
Time = 120sec
1 2 top
accuracy
Accuracy = 3
2
Capture
Relevant
Data
Do
Study
Act
Observations
expected/une
xpected
Results
Test
Cycl
e
succ
essf
ul
Alternate
Test Cycle Yes/ Action Pathways
Learning No Taken Uncovered
Test
Cycl
e
com
plet
ed
Yes/ If No,
No reason
Plan
PD
SA
Cy
Test Cycle
cle Le
Measures/Learn Predicted Cycle
# vel Test Cycle Aim ing Questions Outcomes
Can we build
Mr P. faster
than the
demonstrated
benchmark
Start with feet and with
and work to perfect
Time = 120sec
1 2 top
Accuracy = 3
accuracy
2
Do
Capture
Relevant
Data
Observations
expected/une
xpected
Results
Struggled to
get pieces
Time = 2.37 organized in
Accuracy = 3 order.
Study
Act
Test
Test
Cycl
Cycl
e
e
succ
com
essf
plet
ul
Alternate ed
Test Cycle Yes/ Action Pathways Yes/ If No,
Learning No Taken Uncovered No reason
Plan
PD
SA
Cy
Test Cycle
cle Le
Measures/Learn Predicted Cycle
# vel Test Cycle Aim ing Questions Outcomes
Can we build
Mr P. faster
than the
demonstrated
benchmark
Start with feet and with
and work to perfect
Time = 120sec
1 2 top
Accuracy = 3
accuracy
2
Capture
Relevant
Data
Do
Study
Observations
expected/une
xpected
Results
Test
Test
Cycl
Cycl
e
e
succ
com
essf
plet
ul
Alternate ed
Test Cycle Yes/ Action Pathways Yes/ If No,
Learning No Taken Uncovered No reason
Time
improved
by 20 sec.
Struggled to Accuracy Organizatio
Time = 2.37 get pieces
improved n of parts
Accuracy = organized in from 2 to helps time
3
order.
3
& accuracy. Yes
Act
Plan
PD
SA
Cy
Test Cycle
cle Le
Measures/Learn Predicted Cycle
# vel Test Cycle Aim ing Questions Outcomes
Can we build
Mr P. faster
than the
demonstrated
benchmark
Start with feet and with
and work to perfect
Time = 120sec
1 2 top
Accuracy = 3
accuracy
Do
Study
Act
Test
Test
Cycl
Cycl
e
e
succ
com
essf
plet
Capture
Observations
ul
Alternate ed
Relevant
expected/une
Test Cycle Yes/ Action Pathways Yes/ If No,
Data
xpected
Results Learning No Taken Uncovered No reason
Next
test to
include
orderin
Time
g
improved
pieces.
by 20 sec.
Need to
Struggled to Accuracy Organizatio
set
Time = 2.37 get pieces
improved n of parts
order
Accuracy = organized in from 2 to helps time
before
3
order.
3
& accuracy. Yes test.
None
Yes N/A
Time
140
X
120
Second
s
100
80
60
40
20
10
1
2
3
4
5
6
4
5
6
PDSA
3 – All pieces on Mr P
& positioned correctly
1 – One or more pieces
are not on Mr P.
3
Accuracy
2 – All pieces on Mr P,
but one or more is out
of place
Accuracy
2
1
X
1
2
3
PDSA
PDSA Simulation
Mr. P must look exactly like this
• Accuracy
• 3 – All pieces on Mr. P &
positioned correctly
• 2 – All pieces on Mr. P, but one
or more is out of place
• 1 – One or more pieces are not
on Mr. P.
• Time
• Start: When time keeper says
go.
• Stop: When Assembly
indicates last piece is in place
AND removes hand
Time
140
X
120
Second
s
100
80
60
40
20
10
1
2
3
4
5
6
4
5
6
PDSA
3 – All pieces on Mr P &
positioned correctly
1 – One or more pieces
are not on Mr P.
3
Accuracy
2 – All pieces on Mr P,
but one or more is out
of place
Accuracy
2
1
X
1
2
3
PDSA