Make it Quick! NIATx Principle #5: Use Rapid-Cycle Testing

Maureen Fitzgerald
Editor, NIATx and Great Lakes ATTC 

The fifth principle of the NIATx model is rapid-cycle testing, structured around what’s known as the PDSA (Plan-Do-Study-Act) Cycle.

In rapid-cycle testing, the executive sponsor, change leader, or team comes up with ideas for changes to test and then tests each of those changes in quick succession for a short time on a limited test pool. During each test (a.k.a. PDSA Cycle), the team collects and analyzes data relevant to its chosen aim to determine whether the change has produced a desirable effect on performance levels. Depending on the outcome of that analysis, the team may decide to:

· abandon the change completely and begin testing an entirely new change;

· adapt the change for further improvement and retest the modified version; or

· adopt the change, testing it again on a slightly larger scale, or in conjunction with other changes that have already proven successful in testing.

In any case, the team uses the knowledge it has gained from one testing cycle to improve subsequent cycles. A new procedure is only implemented on a full scale once it has been proven in testing to yield significant improvement in the project’s aim.

Why “rapid” is key

The key to rapid-cycle testing is in the name itself: rapid. Each testing cycle, including planning, execution, and analysis, should take no longer than a few weeks. Another key to this method is repetition; in the majority of cases, the team will have to test several changes in quick succession (with each test lasting no longer than a couple of days) to figure out which changes will yield the most improvement, and to refine those changes to maximize benefits. Because each cycle is so short, you’ll be able to do more of them, getting better and better with each one, progressing closer to your goal.*

Learn how to conduct a Plan-Do-Study-Act (PDSA) Cycle

Dave Gustafson, Director
Center for Health Enhancement Systems Studies
“Rapid-cycle testing helps people shift out of the mind set that there’s nothing they can do to solve a long-standing problem,” says Dave Gustafson, director of the Center for Health Enhancement Systems Studies at the UW-Madison. “It gets people moving. They try out an idea on a small scale—maybe with just a couple of patients for just a couple of weeks. But the lessons that emerge from that brief test help inform the next rapid cycle, strengthening a team’s ability to identify effective improvements.”

Gustafson launched the NIATx model in 2003 in response to a request from the Robert Wood Johnson Foundation: Could process improvement techniques used widely in business and manufacturing help the addiction treatment field increase access to and retention in treatment?

One rapid-cycle test that Gustafson often uses to demonstrate the value of the exercise took place at a New England treatment center.

“The center director at the time, Lynn Madden, was thinking about eliminating scheduled appointments all together. She told her staff that on the following Monday morning, they would tell the first four people that called for an appointment to just come in, and those four would get into treatment by noon that day. She assigned one counselor to be available for walk-ins. For the first and third patients who called, the walk-in system really worked well. But the second person who called couldn’t come in for a walk-in because they had to work that day.

So Lynn got the team back together to discuss how to modify the process for people who couldn’t make the walk-in appointments. Then they tried it again with ten patients and two counselors. Today, walk-in access is standard procedure at the APT Foundation.”

See related blog post: No appointment necessary

Gustafson says that rapid-cycle testing helps change teams scale their change efforts appropriately. “A lot of times improvement projects start out too big,” explains Gustafson. “If you can’t do a rapid-cycle test on the change, the project is too big.”

Another advantage is that rapid-cycle testing allows teams to learn from changes that don’t work.

“Seek failure. Look for the ways the change doesn’t work,” says Gustafson. “Anything worth doing is worth doing wrong the first time.”

*From The NIATX Model: Process Improvement in Behavioral Health