Quality & Patient Safety

Rapid cycle improvement: Fast track to improvement

Patient Safety Quality Monthly, May 15, 2008

What is rapid cycle?

Rapid cycle is the use of standard quality tools with skilled facilitators to achieve breakthrough improvements in performance within a rapid time frame.

Many of us who have been in the “quality business” a long time remember our first introduction to Deming, Total Quality Management and the Shewhart cycle: Plan-Do-Study-Act. At that time, we formed project teams to achieve breakthrough improvement. We assigned a team; we met, we identified issues; we met, we completed a flow analysis; we met, we identified data sources; we met, we identified measures of success; we collected mounds of data; and so on. Along the way, we lost team members and possibly gained a few. If we were lucky, 10 months later we had an improvement plan. Then it was time to pilot, measure, and implement success.

Rapid cycle uses the same basic principles and toolkit as the traditional quality team, but the work is accelerated. Now we want results in 90 days or less.

What does it take?

First, like any improvement project, there needs to be a commitment from the management team. They must agree that the outcome of the project would make a positive change in the organization; and, they must support the team process by committing resources (staff member time) to the team.

Second, the team should have a trained facilitator to keep the team on track. The facilitator is generally not a stakeholder in the project and can, therefore, be objective of the process and the outcomes. Attributes of an effective facilitator include being a:

  • Leader: understand how to lead the team through the team process
  • Coach: encourage team participation and the flow of ideas
  • Teacher: knowledgeable about team process, the quality toolkit and teach the team members how to use them; and knowledgeable about available data sources including information technology capabilities
  • Mentor: work with the team leader (usually the process owner) on team process and team leader skills

Data and project testing

One of the key differences in rapid cycle data collection is the use of a small sample of patients in short test periods. This means a test sample must be chosen that will most likely reflect the attributes being measured. Analysis of these data will then lead to the most likely intervention to be trialed in an identified population followed by a small- scale test period.

 
Rapid cycle team process example
The following team timetable is an example of a project to be completed in 90 days:

The first 30 days

I. First team meeting (4–6 hours)
      • Team orientation
      • Complete team road map
      • Identify issues (process mapping, brainstorming, etc.)
      • Identify population and data needs
      • Identify data sources
      • Assign tasks (data collection, etc.)
II. Team leader/facilitator design data collection tool

III. Baseline data collection (small-scale test group)

Days 31-60

IV. Second team meeting (2–4 hours)
      • Review and understand the data
      • Select improvement strategies
      • Identify measures of success (MOS)
V. Do the pilot

VI. Data collection for MOS (small-scale test)

Days 61-90

VII. Third meeting (2–4 hours)
      • Study results of the data (MOS)
      • Plan next steps and follow-up monitoring
      • Assign follow-up tasks
VIII. Complete project report
 
Conclusion
Leadership commitment, providing the right guidance for the team (facilitation), and a collaborative culture will put you on the road to successful teams and breakthrough improvement.

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