[Light background music] [Logo animates to text reading, "QI Hub"] [The Ohio State University College of Medicine logo and The Ohio State University Wexner Medical Center logo] [Video title animates reading, "Presents: Introduction to The Model for Improvement and PDSA: Part 2"] Recall from the example in the last video, your team is trying to reduce patient wait times. [Graphic: Goal: Reduce wait times.] As part of the Model for Improvement, you brainstormed several potential solutions and put them on the key driver diagram. [Graphic: Key Driver Diagram connected to the Model for Improvement and a PDSA cycle.] [On-screen text: Key Driver Diagram 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? PDSA Cycle: Act, Plan, Do, Study.] Now we'll explore how the elements of the PDSA cycle help us implement those ideas. Specifically, we'll focus on the idea of a triage system. The first step is to Plan. [Graphic highlights the Plan section of the PDSA cycle.] The purpose of the planning phase of the cycle is to define the objective of your test. [On-screen text: Define the objective of your test.] [Graphic: Clinic staff member holding a clipboard displaying triage levels: Emergency Very Urgent Urgent.] Prior to engaging in the test, you will want to define what specific change you will test, who will perform the test, where it is taking place, when it will occur, and what is the predicted outcome. Be sure to start small and scale up from there. Maybe you will limit the number of people involved or the time frame for the test before moving on to bigger, more elaborate testing of an intervention. For our example, your team might plan to trial a simple triage algorithm with one staff member the next day in the clinic. You'll want to identify all of the tasks that your staff should trial, like assigning triage levels to patients as they check in at the front desk. [Animation: Patients are assigned different triage priority levels while waiting for care.] You will also want to plan a way to measure or evaluate the outcome of your triage system. For example, you may plan to measure the wait times for all of the patients that day and ask for qualitative feedback from the providers and staff about how well the triage system worked. [Graphic: Patients in a waiting area display different triage priorities and wait-time values to illustrate outcome measurement.] The second step is Do. [Graphic highlights the Do section of the PDSA cycle.] This is where you implement the planned changes. Time to put your planned tasks into action. PDSA cycles Emphasize learning from doing, so embrace a mindset of acting quickly and learning rapidly. While you are in this phase, you may decide to make some small changes to the planned tasks while in the action of doing based on feedback. Be sure to track these changes and rationale for why you made them. Going back to our example, perhaps you learn within a few patient encounters that there are some clear aspects of classifying patients that you did not have built into your triaging system, making it difficult to know where to put them in the prioritization plan. [Graphic: Triage clipboard displays four priority levels: Emergency Very Urgent Urgent Non Urgent.] You consult with the clinic staff and clinicians on how to adjust to account for these additional patient considerations, then put these new considerations into action immediately. Make sure you have a documentation trail about these changes to be able to move into the third step of the PDSA cycle: Study. [Graphic highlights the Study section of the PDSA cycle.] In this phase, it is important to reflect on what you planned and expected to learn compared to what actually happened and what you learned. You might review direct quotes from stakeholders and specific observations your team made during the Do phase, as well as graph wait times on a run chart. [Graphic: Run charts display trends in wait times and patient outcomes] It may also be a good time to revisit the evidence out in the literature, to help you evaluate if the changes you trialed were leading toward improvement. Reflection in the study phase can help your team determine if your actions need to be adjusted and adapted for another PDSA cycle or if there were clear reasons to abandon the changes altogether. With our example, let's say you observed that although the clinic staff felt the changes were helpful and improved their efficiency, the average wait time per patient for the day was higher than previous days. [Animation: A thumbs-up icon appears while chart lines display outcome data over time.] Also, some patients were frustrated by seeing other patients arrive later than them, but being called back for their appointments sooner than them. [Graphic: Patients display frustration regarding wait times and prioritization decisions.] The last step is to Act. [Graphic highlights the Act section of the PDSA cycle.] Based on what you learned, do you need to adapt the solution and test again? Do you need to adopt the solution for a larger test or implementation? Or should you abandon it altogether and test another idea? [On-screen text: Adapt & test again Adopt for larger test Abandon & test a new idea.] Based on the example study results, your team decided that there was not enough evidence to determine if the triage system was actually causing longer wait times, and since the clinic staff seemed to value the system, it is important not to abandon it just yet. Instead, the team decides it would be valuable to provide some sort of communication to the patients in the waiting room about the triage system to help them understand what is being trialed. [Graphic: Sign displayed at the front desk reading, "Attention Patients!"] So, your team commits to adapt the triage system and to move into the plan phase for another PDSA cycle building off the first one forming a ramp. In summary, remember, PDSAs are small tests of change with many iterations. You start with ideas that are evidence-based whenever possible, and you test them. As you are testing, you learn and either adopt, adapt, or abandon moving to larger tests of change until you have arrived at change that will result in improvement and is ready to implement. You can also have more than one ramp of iterative tests for different root causes or key drivers happening at the same time. Just make sure you have a system to show the iterative tests, synthesize the learning, and show the progression to show how you arrived at the solution you will implement, like this PDSA ramp worksheet. [Light background music begins] Use PDSA cycles as part of the Model for Improvement to see positive change in your facility. [End slide appears.] [On-screen text: Thank you! Scan the QR code for references and resources.] [The slide includes a QR code linking to references and resources.] [The Ohio State University College of Medicine logo and The Ohio State University Wexner Medical Center logo appear.] [QR code links to: https://go.osu.edu/qihub] [Background music fades out.]