Rapid Cycle – PDSA- SDSA Worksheet – DNP

(Version 05/20/15)

Section 1:

1a. Title of Project: Reducing Admission for Skilled Nursing Facility to Acute Care by utilizing the INTERACT tools

1b. Site, Facility Type, Microsystem Name, Vulnerable Population for this Project.

1c. Team Members: (Include titles and departments, not specific names of those leading this project as a team. Must be interprofessional. Include front line staff, patients, and family caregivers or consumer advocates.)

Leader: Director of Nursing and Administrator 5. LVN- DAY

Facilitator: Nezy Pullukalayil 6. LVN- NIGHT

Registered Nurse- Day 7. CNA- DAY

Registerted Nurse- Night 8. CNA – NIGHT

Coach: Meeting Days/Time: Tuesday July 20th 7.30am

Data Support: Data Analyst who is in charge of transition care with Performance Improvement Department

1d. Background What problem are we addressing and how do we know there is an opportunity for improvement? Provide background on the local problem as well as the larger issue…statewide, national, global. Make a case for why this needs to be addressed now. Create a sense of urgency (Kotter). Include evidence-based resources, citations, and references. Include a brief description of the facility and the results of the 5P assessment.

1e. Aim/Goal: What are we trying to accomplish? See IHI guidelines for AIM statement: http://www.healthychild.ucla.edu/First5CAReadiness/materials/siteInfra/IHIQualityImprovementResources.pdf) What do you envision will happen (your desired outcome) and by when. You can include your key core processes as the “how” you plan to accomplish it if you have an idea about the processes at this time. But focus on the AIM, not the processes.

1f. Measures and Indicators of Improvement: How will we know that a change is an improvement? Include both qualitative and quantitative quality indicators. What and how much will tell us we have succeeded? By when? Review levels of evidence from the Kirkpatrick model: Quantitative indicators: Numbers (/measureable)…percentages, incidences, rates. Qualitative indicators: Words, comments stories, exemplars. Textual data and media

1g. Change Theories: What one or two change theories or processes (other than Lewin’s) will be useful in leveraging/helping the team to success? Summary key concepts. Some options: Transformational Leadership (Bass/Riggio) or Transformational Learning Theories (Mezirow); Theory U (Scharmer); Kotter’s Stages of Change; Rogers’s Diffusion of Innovation; Greenhalgh & Colleagues’ Diffusion of Innovations in Health Systens Organizations; Bridges Transition Theory; Senge’s Five Disciplines; Quantum Leadership (Porter O’Grady & Malloch); Complexity Theory, Chaos Theory. Describe key concepts with the change theory and how it can help you design and/or lead your project for improvement.

Section 2 – Diagnostics/Evidence/Perspectives

2a. Current Process What is/are the current processes that exist that can be tapped into and/or needs to be improved. What are the current issues and outcomes?

2b. Costs of the Problem If nothing would be done to correct this problem, what are estimated costs of this problem in terms of dollars spent, lost revenue, and resources required?

2c. What Have we Learned From the Evidence so Far? What evidence (research, theories, best practices, standards, past experience) informs us about solving this problem?

2d. Key Stakeholder Analysis Who are the key stakeholders that can influence (enhance or prevent) our success and what would be a positive outcome for them?

Key Stakeholder How can they influence success?
(How can they enhance or impede progress?)

How will they benefit from this improvement? (Results/Outcomes)
(Use their own words if possible.)


2e. Diagnostics What needs assessment data do we have or do we need and what diagnostic tools and processes have helpedwill help us find the root cause and determine the best actions to leverage success? Include such processes as Microsystems/Organizational Assessment (5 Ps), The 5 Whys, Ishikawa Diagram, SWOT analysis, PEST analysis, key stakeholder focus groups, FMEA, Process Control Charts, Process Flow Diagrams, GAP Analysis, Organizational Culture, Safety Culture, and/or Organizational Capacity Assessment, SMART Chart, etc. Include the results of your systems diagnostic assessment so far.

Section 3 – Strategic Plan for Improvement

This section of the worksheet can be used to plan and keep track of improvement efforts. (Some of the individual tasks listed below might become separate PDSA cycles and/or other PDSA cycles may emerge. You may choose to use one worksheet for each PDSA Cycle or keep track of everything on one project report. Be systematic, flexible, creative, and innovative…..but keep it simple.) If you still need to complete more of the diagnostics listed above, you can include them in your plan as PDSA Cycles.

3a. DNP Level: Using either the Logic model or the “Diffusions of Innovations in Service Organizations” (Greenhalgh, Macfarlane, Bate & Kyriakidou) conceptual model, based on your findings so far from Section 1 & 2 (which includes your vision, goals, desired outcomes, change strategies, and assessment/review of the internal and external evidence) identify key strategies for improvement, evaluation, and dissemination. Provide the rationale and evidence for each key.


Here are links for the logic models:. Suggest you watch the 6-minute u-tube first (there are several u-tube presentations, but longer and dryer!)


Conceptual Model for Considering the Determinants of Diffusion, Dissemination, and Implementation of Innovations in Health Service Delivery and Organization (Greenhalgh, McFarlane, Bate, & Kyriakidou, 2004.)

Section 4 – Reflections

Provide a brief summary (no longer than one page) of what you have learned from doing this project so far. What’s next?


3b. Plan How shall we PLAN the prototype or pilot? Who does what and when? With what tools or training?

Baseline data to be collected? How will we know if a change is an improvement?
What tradeoff do we anticipate? What new problems could this plan create?
What will we have to do or be differently for this to succeed?
What will be our greatest challenges?
How will we know if this is successful?

Tasks to be completed
to run test of change

Who When Tools/Training Needed Measures

3c. Improvement Plan Budget: Create a budget for your plan so far. Include both direct and indirect expenses/costs.

3d. Cost Effectiveness/Benefit/ROI Assessment: Provide an analysis of Cost Effectiveness, Cost Benefit, or ROI that supports proceeding with the plan.

Section 5: Findings/Conclusions/Reflections

(#5 – 10) (Note: # 5 – 10 are not part of Assignment. Provided for your information as you proceed with your project.)

Do What are we learning as we DO the pilot? What happened when we ran the test?
Any problems encountered? Any surprises?

Study As we STUDY what happened, what have we learned? What do the measures show?

7a. Act As we ACT to hold the gains or abandon our pilot efforts, what needs to be done? Will we modify the change? Make PLAN for the next cycle of change.

7b. Reflections: What have we learned? How useful (or not?) was this for us? What went well? What were the challenges? Now where can we take this next, based on what we have learned so far?

Standardize Once you have determined this PDSA result to be the current “best practice” take action to Standardize-Do-Study-Act (SDSA). You will create the conditions to ensure this “best practice” in daily activities until a NEW change is identified and then the SDSA moves back to the PDSA cycle to test the idea to then standardize again.


What are we NOT going to do anymore to support this new habit?

What has helped in the past to change behavior and help us do the “right thing?”

What type of environment has supported standardization?

How do we design the new “best practice” to be the default step in the process?

Consider professional behaviors, attitudes, values and assumptions when designing how to embed this new “best practice.”

10a. Measures How will we know that this process continues to be an improvement?

What measures will inform us if “standardization” is in practice?

How will we know if “old behaviors” have appeared again?

How will we measure? How often? Who?

Section 6 (Questions # 11 – 16): Refine, Study, Sustain (Note: Not part of Assignment. For your Information)

This worksheet can be used to plan-standardize and keep track of improvement efforts.

Possible Changes Are there identified needs for change or new information or “tested” best practice to test? What is the change idea? Who will oversee the new PDSA? Go to PDSA worksheet.

Standardize How shall we STANDARDIZE the process and embed it into daily practice? Who? Does what? When? With what tools?
What needs to be “unlearned” to allow this new habit?

What data will inform us if this is being standardized daily?

Tasks to be completed to “embed” standardization and monitor process
to run test of change

Who When Tools/Training Needed Measures

*Playbook- Create standard process map to be inserted in your Playbook.

Do What are we learning as we DO the standardization? Any problems encounterd? Any surprises? Any new insights to lead to another PDSA cycle?

Study As we STUDY the standardization, what have we learned? What do the measures show? Are there identified needs for change or new information or “tested” best practice to adapt?

Act As we ACT to hold the gains or modify the standardization efforts, what needs to be done? Will we modify the standardization? What is the change idea? Who will oversee the new PDSA? Design new PDSA cycle. Make PLAN for the next cycle of change. Go to PDSA worksheet.
Present and Publish! How will we disseminate the new knoweldge generated by this project?

What is our presentation and publishing action plan: Where? What? Who? By When? How?