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Module 7_Testing ChangeNov 2025

The document outlines the objectives and principles for testing changes in healthcare to improve quality, emphasizing the use of Plan-Do-Study-Act (PDSA) cycles. It details the steps involved in each phase of the PDSA cycle and the importance of testing on a small scale before wider implementation. Additionally, it provides an example of a PDSA plan aimed at increasing the use of Oxytocin in active management of the third stage of labor.

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Berhanu Yelea
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4 views

Module 7_Testing ChangeNov 2025

The document outlines the objectives and principles for testing changes in healthcare to improve quality, emphasizing the use of Plan-Do-Study-Act (PDSA) cycles. It details the steps involved in each phase of the PDSA cycle and the importance of testing on a small scale before wider implementation. Additionally, it provides an example of a PDSA plan aimed at increasing the use of Oxytocin in active management of the third stage of labor.

Uploaded by

Berhanu Yelea
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Testing Change

Module Objectives

 Plan, test and implement change for


improvement to address identified and
analyzed health care quality gaps
 Apply principles of testing change
 Test changes using Plan-Do-Study-Act cycles
 Use Run Chart rules to assess impact of the
change tested
 Differentiate between testing and
implementation
Why Testing?

 Testing is a way of trying the change


 Allows to learn about its potential impact
 Limited risk, little time and money
 Allows to refine the change
 Learn that there is nothing like failure

 The PDSA cycle is a useful framework for


planning, carrying out and learning from a
test of change
“ I did not
Not Trial and Error but Trial and
Learn
fail one
thousand
times; I
found one
thousand
ways how
not to
make a
light bulb”
- Thomas
Principles for Testing

1. Test initially on a small scale and increase


the scale of the test on the basis of
learning

2. Include differing conditions in your tests

3. Plan the test, including data collection


PDSA Cycle

What are we trying to accomplish?


PDSA cycles for
testing and
implementing
change
What change can we make that will result in
an improvement?
Plan
Do
A P
How Act
will we
Planknow a change is an
Study
S improvement?
D
Study Do Act
Why PDSA Cycles

 Test a change
 Learn from the impact of the change
 Build degree of belief
 Answer the second question of the Model
for Improvement “What change can we
make that will result in improvement?”
 Implement a change

The Improvement Guide, 2nd Edition – p139-171


PDSA Cycles
 Plan:
 State objective of the cycle (PDSA aim)
 Make a prediction, what will happen when
introducing the change
– What: The activities to test the new change
– Who: Those responsible
– When: Date/Period activity will take place
– Where: Location
– How: Step by step description
 Include plan for data collection A P
Act Plan

S D
Study Do
PDSA Cycles

 Do:
 Carry out plan
 Document observations
 Collect data

A P
Act Plan

S D
Study Do
PDSA Cycles

 Study:
 Review what was documented both data and
observations
 Prepare annotated Line Graphs and/or Run
Charts
 Interpret the data
 Learn what went well and what can be
improved
A P
Act Plan

S D
Study Do
4 Rules for Interpreting Run
Charts

A Shift: A Trend
6 or more 5 or more

Too many or An astronomical


too few runs data point

The run chart, Rocco J. Perla, Lloyd P. Provost and Sandy K. Murray, 2011
PDSA Cycles

 Act:
 Adapt – test in a different settings
to get higher degree of
belief
 Adopt – everything is perfect, high degree
of belief, prepare for
implementation
 Abandon – didn’t work, things have gotten
worse
A P
Act Plan

S D
Study Do
Example of a PDSA (‘Plan’ section)
Problem Identified: Poor use of Oxytocin for AMTSL
Where: Labour ward, Ntcheu District Hospital
Aim:
Increase the use of Oxytocin in AMTSL from 45% to 80% from 1st June When: 1 – 3 June 2020
to 15th June 2020
Scale: Test with day and night labour ward staff on duty on the 1-3
June 2020
Outcome Measure: % use of Oxytocin in AMTSL per day
Data Collection:
Change Idea(s)/What:
Attendance sheet should be passed out by Midwife Martha at the
- Orientate the labour ward staff on the change idea and PDSA labour ward staff meeting
- Withdraw 10 IU Oxytocin in a syringe before delivery
- Administer 10 IU Oxytocin after delivery of the baby
Auxillary nurse to record pre-drawn syringe of oxytocin at the left
corner of the column for drugs given in the partograph
Process Measures:
% labour ward staff orientated on change idea
% deliveries with pre-drawn syringe of 10 IU Oxytocin per day Midwife taking delivery to record dosage of Oxytocin given in the
Partograph under the column for drugs given
Who: Midwives, Nurses, Auxillary Nurses
Matron to audit case notes daily and record the % scores for
process and outcome measures daily
How:
The scores should be recorded in the designated hard cover book.
- Matron to orientate labour ward staff at the next meeting on 31st May
2020
- Auxillary nurse to withdraw 10 IU Oxytocin in a syringe on admission Prediction:
of the pregnant woman in labour while the midwife is examining the 100% of deliveries with pre-drawn syringe of 10 IU Oxytocin will
woman have oxytocin administered after delivery of the baby
- Midwife/Nurse on duty to administer the Oxytocin IV/IM after delivery
of the baby
Degree of Belief

The Improvement Guide, 2nd Edition – p145


Small Group Exercise

 Continue working in the same group as


when we started our improvement project
(aim, measures, change)
 Complete the PDSA plan
 Describe What, Who, When, Where and
How
 Use the template provided (20 minutes)

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