DEAR IHI —
I’m an improvement coach at a large health care system, and I recently worked with a team that lost momentum after a few PDSA cycles that didn’t result in improvement. How can I encourage them to see the value in the tests that came back with sub-optimal results? — PDSA FRUSTRATED
Dear PDSA Frustrated —
The beauty of the PDSA cycle is that learning comes as a result of a team trying new things, to better understand and improve their world. But it can be hard to coach a team to that point, especially when members are feeling like they have somehow “failed” as a result of the sub-optimal results.
The truth is, there are valuable opportunities to learn from PDSA cycles that are set up appropriately, even when the results aren’t so great. PDSA cycles are invaluable for improvement teams on a variety of levels. They help teams to test assumptions, learn more about their everyday world, and ask the questions of, “What actually matters to our patients? What matters to us?”
I recently worked with a team that wanted to improve the patient experience. They had an idea about what would do it. But instead of implementing their change right away, they first wanted to learn if their proposed workflow change would actually lead to an improvement. The team took a week to test their hunch. The results that came back were surprising — the proposed change wasn’t well received by patients. As a result of their increased learning, the team was able to better understand what really mattered to their patients, and the team used the learning and applied it to future testing cycles.
If the team had gone straight to implementation, they would have missed the valuable learning that PDSA provides, and assumed that the change they proposed would lead to improvement without really understanding if it did. Of course, this would have been the real failure — a loss of resources, time, and momentum to make changes that really would help patients.
This is just one example of a team feeling that they could have “failed” based on the feedback they gained from their patients. But in reality, the disappointing feedback led the team to test more. They ultimately implemented changes that were true patient satisfiers. Fortunately, this team felt safe to share their findings and understood the importance of disciplined rhythm and pace to keep moving in their improvement journey.
PDSA cycles help you reflect on the good, the bad, and the ugly in ultimately improving the care we provide for patients. Thomas Edison, when developing the electric lightbulb, famously said, “I haven’t failed. I have just found 10,000 ways it won’t work.” With what he learned with each “failed” test, Edison was able to finally develop the light bulb — an innovation our world couldn’t imagine living without today!
So reassuring teams to share the hard stuff and keep persevering is crucial to keeping improvement teams moving forward. A great way to make them feel safe to do so is by highlighting some of your own failed PDSAs. Be sure to share how they were just part of the learning process that finally got you to an improvement. Eventually, they’ll find the “bright spot,” just like Edison did.
Good luck,
Julianna Spranger
Improvement Coach at the University of Wisconsin Medical Foundation and graduate of the IHI Improvement Coach Professional Development Program
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