[Background music] [Text on screen QI hub presents: Introduction to tThe Model for Improvement and PDSA Part 1 The Ohio State College of Medicine The Ohio State University Wexner Medical Center] [Image on screen A map of Ohio highlighting the QI Hub network and its connected locations across the state.] Narrator: Most people can agree that improvement, especially improvement that results in better patient care, is a desirable but often daunting goal. [Video on screen An arrow zigzags in a step shape matter and flattens. A group of people appears above the arrow. A tail appears on the arrow and it "shoots" into a bullseye.] For example, let's say your patients are waiting an average of 60 minutes in the clinic. They are frustrated and the clinic staff is overwhelmed, often taking the brunt of patients' frustration. [Video on screen Figures are seated in the chairs in a waiting room formant. As the screen moves left, exclamation points appear above the heads of the patients. A the leftmost side, a clinical staff member is depicted.] In wanting to make a better experience for all, you and your team have been tasked with trying to reduce wait times in your clinic. [Text on screen Goal: Reduce wait times] [Image on screen A group of physicians appears on screen while the background fades out.] How might you make a plan to systematically trial and adopt effective strategies to tackle this problem? [Image on screen Arrows appear behind the physicians.] There are a number of models and tools you may have heard of, like Lean, Six Sigma, and the Model for Improvement, to name a few. [Image on screen Diagrams representing the Lean, 6 sigma, and model for improvement appear.] The focus of this video is to showcase how you could use the Model for Improvement and its use of Plan, Do, Study, Act cycles, sometimes referred to as Plan, Do, Check, Act cycles to help establish a coordinated and systematic approach to an improvement initiative. [Text on screen Model for improvement Plan Do Study Act> Check] [Image on screen A diagram representing the model for improvement. A fist bump is animated into the background] The Model for Improvement developed by Associates in Process Improvement, is commonly used in healthcare settings and is recommended by the Institute for Healthcare Improvement, IHI. [Image on screen The API and IHI logos reactively] It is a tool meant to make improvement changes less intimidating and more actionable by breaking the process down into manageable steps and small tests of change through the PDSA cycle. [Text on screen Improvement changes less intimidating More actionable] [Image on screen A clipart image of physicians with a clipboard behind them.] The cycles of PDSA can be iterated or adjusted and repeated rapidly over and over and over again to help progress toward larger goals. [Text on screen Improvement] [Image on screen Four PDSA cycles gradually getting larger moving left to right. The needle of change moves from left to right] It moves the needle of change in slow, steady steps. With the Model for Improvement, you began a project by asking three questions before beginning the cycle. What are we trying to accomplish? How will we know that a change is an improvement? And what changes can we make that will result in improvement? [Text on screen Model for improvement 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 improvement? Plan Do Study Act] [Image on screen The PDSA cycle diagram] Going back to our target project, let's walk through how we might apply the Model for Improvement. For the first question, What are we trying to accomplish, this is where you want to quantify your smart aim that is specific, measurable, achievable, relevant, and time-bound. [Text on screen Quantify your SMART aim - Specific -Measurable -Achievable -Time-Bound -Measurable -Relevant] Your team decided to answer this question by setting a goal to reduce patient wait times from an average of 60 minutes to 30 minutes over the next three months, with an overall aim of improving the patient experience with their clinic visits. [Image on screen A clock appears indicating an hour, and then 30 minutes. 3 calendars appear indicating months. The png of the patients in the waiting room reappears with thumbs ups over their heads.] As you set a goal, remember to also consider the patient perspective, or voice of the customer. [Text on screen Voice of the customer] [Image on screen Four patients in the living room with speech bubbles over their heads.] Is your goal meaningful to them? Would it improve their overall patient experience? [Image on screen The text bubbles are replaced with a 4/5 star review.] It is possible that your goal may not align with the stakeholders' needs, preferences, or priorities. [Image on screen The rating changes from 4 stars, to 3 stars, to 2 stars, to 1 star.] If this is the case, be sure to reconsider what it is you're actually trying to accomplish before you move forward. [Image on screen A full image including the waiting room, the SMART aim quantification, the clock, and the calendars.] Let's now turn to the second question. How will we know that a change is improvement? Answering this question can help your team determine what measures or evaluations would be helpful to decide if the changes you're trialing are actually leading to an improvement. [Text on screen How will we know that a change is an improvement? Determine measures or evaluations] Setting quantitative measures such as outcome, process, and balancing measures can be very helpful for tracking and documenting change. [Image on screen A clipboard appears over the textbox.] [Text on screen - Outcome - Process - Balancing] We'll cover these common measures in later videos. For now, just know that you can evaluate change through quantitative and qualitative data. [Text on screen - quantitative - qualitative] Going back to our example, we might decide to use a combination of measures to help us work toward our goal of reducing wait time. [Image on screen The patients in the waiting room are reintroduced into the image foreground] We can measure weekly average wait times across all patients visiting the clinic, patient satisfaction as it relates to wait times, and number of patient complaints related to wait times. [Image on screen Over the patients in the waiting room, text bubbles, star ratings, and time waited appears per person.] Additionally, maybe we will periodically talk to our clinic staff to get some qualitative feedback on how they think the change is going. [Image on screen The screen zooms towards the clinic staff member and the front of the line. A speech bubble occurs along side a thumbs up and thumbs down] We must be cautious here, though, to make sure we are not overburdening our clinic staff as we work toward our goal. [Image on screen Multiple speech bubbles occur alongside a scribe in one of them] Once your team has decided on some measures for determining if the changes you are making are improving aspects of care, the third Model for Improvement question becomes the focus. What changes can we make that will result in improvement? [Image on screen The photo zooms out to the bigger picture.] To answer this question, you must first understand the current state and determine potential opportunities for improvement. This can be accomplished through Gemba walks, a way of observing the process, consulting with stakeholders like clinic staff and the patients, and using other quality improvement tools like process maps that can visually depict the steps in the process. [Text on screen What changes can we make that will result in improvement? Understand current state & opportunities Gemba walks Stakeholder consultations Quality improvement tools] [Image on screen A clipart image of binoculars, a text bubble, and a squiggled line with an arrowhead made up of colored squares.] You might also seek out evidence or talk to other clinics to identify potential changes you could try in your clinic. As a team, you should brainstorm lots of ideas so that you have a variety of options to try. [Image on screen A clipart image of physicians with lightbulbs over there head appears over the questions of the PDSA] At this stage it can also be helpful to document your ideas in a tool called a key driver diagram, which we will cover more in depth in a supplemental video. [Text on screen Key Driver Diagram] [Image on screen The light bulbs sort into the key driver diagram] For example, perhaps your team has identified the following change strategies or interventions you would like to try: Implementing a triage system to prioritize patients based on the severity of their condition. Hiring additional staff or reallocate existing staff during peak hours. Implement a system to notify staff of wait times and delays, enabling them to inform and manage patient expectations. [Text on screen Interventions Implement a triage system Hire additional staff for peak hours Implement system to notify staff] With these ideas, your team is ready to start testing possible solutions with PDSA cycles. In the next video, we will explore each step of the cycle as it applies to our example of reducing wait times. [Image on screen The photo zooms out to the bigger picture] [Background music] [Text on screen QI HUB Thank you! Scan the QR code for references and resources The Ohio State college or Medicine The Ohio State University Wexner medical center] [Image on screen A QR code with an arrow pointing to it] [QR code links to: https://go.osu.edu/qihub]