Basket or cart?
It’s the first decision we usually make when we enter a large grocery store. When I am just buying a few items, I usually pick up a basket so that I can move more easily through the store. Often I find myself with a gallon of milk in one hand, an overflowing too heavy basket in the other, and wondering why I did not get a cart in the first place.
Rapid-cycle PDSA change is basket work. It requires that we focus on a single manageable change project to ensure effective implementation. But too often teams end up frustrated by complicated projects that yield confusing results.
So, what can we do to keep from overloading the process?
Keep it simple
The rapid cycle PDSA model asks you to test one change at a time in order to isolate and understand the impact of a single variable. This requires a thoughtful unbundling of complicated processes to find the single variable that can be tested. Teams new to the PDSA process should be particularly mindful to find simple initial changes that have fewer moving parts that might complicate the change project.
Keep it short
Just as a basket discourages overbuying of groceries, a brief time line for a change project discourages the creation of an unmanageable change project. Limiting the effort to a change that the team can complete in 2-3 weeks removes complex projects from the list, thereby reducing the risk of being bogged down in an unmanageable change effort.
Appreciate the need for practice
We all know the frustration of entering a large and unfamiliar grocery store with a long list when we are in a hurry. Effective implementation of rapid-cycle PDSA change requires familiarity that can only be gained through practice. Those who are new to the process should avoid trying to do too much too fast. Initial efforts should focus on learning the model, and creating a positive experience for the team.
Change projects are almost always more complicated than expected. Elements that seemed simple at first glance may require more time and attention upon further inspection. Project resources that were initially available may be pulled away by new and unexpected priorities. It is best to expect the unexpected and to budget time and resources accordingly.
If you want to shop quickly, purchase only what you need for the meal you are cooking, and avoid spending any extra money, you will need to make a detailed grocery list. All of the strategies above reflect the need for effective planning on the front end of a change project. Taking the time to front load the process with a thoughtful plan will lead to greater learning, an enhanced experience for the team, and measurable improvements.
Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. Mat also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at firstname.lastname@example.org.