Why Should You Start Testing Changes ASAP?

Lloyd Provost, MS; Statistician, Associates for Process Improvement

When I first learned the framework for improvement and how you do it, we talked about really understanding the current system: flowcharting processes, doing cause and effect, doing lots of surveys — getting all the information, getting ready. So, as I advised people that way and saw what happened, I saw a lot of activity but no improvement. So everybody was doing flowcharts, looking at their system, collecting baseline data, and we realized, talking with some people — we worked with some professionals — they got antsy with that. You know, what is all this “quality improvement” (QI) thing? Why can’t we make something happen?

So we went back and re-looked and rethought Deming’s PDSA framework. And we said, “Why don’t we just start running PDSAs right at the beginning? We could do it in parallel if we need to do all these things.” So as we developed the Model for Improvement, we made that sort of a framework of [the idea that] you don’t necessarily need all the answers before you get started.

The whole idea of “What cycle can we run by next Tuesday?” became sort of a mantra, as a provocation for people to think differently about the system. It doesn’t mean those other background things aren’t important. But it means that we can actually get along and begin to learn something right away by starting a PDSA.

And for a while in IHI, in Collaboratives and stuff, that was sort of a little mantra for us, as a provocation that got people to think very differently about improvement — that we could actually do some improvement next week, even though we don’t know that much about the system we’re trying to improve. I think that sort of changed the framework and made the Model for Improvement different than a lot of other frameworks that were available at the time.