TMC Quality Improvement Program Self-Instructional Modules

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THE PDCA CYCLE SERIES

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PDCA: What you need to know

Published by the Medical Quality Improvement Office

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ACT STAGE

Standardize and institutionalize solutions Present the results to management, to a hospital-wide forum and any other appropriate venue Get top managements approval to adopt the solution throughout the organization

SOME OF THE TOOLS USED IN THIS STAGE ARE:

Control chart Clinical pathways

Resources: 1. Benchbook on Performance Improvement of Health Services, PhilHealth, 2. A Toolbox for Quality Improvement and Problem Solving, by David Staker, 3. www.asq.org (website of the American Society for Quality) 4. Quality Planning and Analysis by J.M. Juran and F.M. Gryna, 3rd edition, 1993: McGraw-Hill

CHECK STAGE

Confirm effectiveness of solutions Monitor implementation of solutions Document the effectiveness of solutions by collecting data Analyze data Determine if the problem has been solved, if targets have been achieved, and if standards have been reached Reflect on the lessons learned from the problem solving step.

Quality improvement has been a part of the manufacturing industry and many other service-oriented organizations for many years. It is, however, something new at The Medical City and many are asking What is quality improvement? To define it simply, quality improvement means problemsolving. But problem-solving, as we do it in our day-to-day lives, is oftentimes reactive and corrective in nature. On the other hand, quality improvement or QI is more organized and systematic where processes (or problems) are identified, measured and eventually improved. TMCs quality improvement program uses the Plan-DoCheck-Act (or PDCA) cycle method in carrying out its QI projects. The PDCA cycle is a simple but systematic method to identify areas for improvement, develop probable interventions, and measure their effectiveness. Documentation is important in all stages of the cycle but it is most critical during the Plan phase because a clear definition of the problem is necessary for an improvement to be drawn.

SOME OF THE TOOLS USED IN THIS STAGE ARE:

Graphs (bar, pie, histogram) Check sheet

Evaluation is needed during the planning and checking stages. In planning, evaluation is needed to choose the most appropriate solutions from amongst all the possible ones. It is needed in the Check phase to determine the effectiveness of tested solutions. If this is not done, the organization may institutionalize faulty solutions and commit costly errors. Real improvement takes place during the Act stage where the solution is integrated in the organizations routine procedures.

PLAN STAGE Identify a theme or problem

DO STAGE
Develop and implement countermeasures Propose as many solutions to the vital few root causes Narrow down solutions to the most effective and practical countermeasures Implement countermeasures

Evaluate and narrow down a problem or issue Clarify the reasons why a problem or issue must be addressed

Understand the current situation

Clarify processes and sources of variations from standards Set targets and decide on what the situation should be if the problem were solved Identify indicators Collect relevant data

SOME OF THE TOOLS USED IN THE DO STAGE ARE:

Create a plan for action Analyze the problem

Tree diagram Gantt chart Clinical pathways

Analyze the root causes Enumerate as many causes of the problem as possible, group them together to discover root causes and narrow down the list of root causes to the vital few

DESIRED LEVEL

SOME OF THE TOOLS USED IN PLAN STAGE ARE:

ACT CHECK

PLAN DO

Brainstorming Nominal group technique Flowchart Check sheet Pareto diagram

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Current
CONTINUOUS QUALITY IMPROVEMENT