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.
The first 30 days
Complete team road map
Identify issues (process mapping, brainstorming, etc.)
Identify population and data needs
Identify data sources
Assign tasks (data collection, etc.)
III. Baseline data collection (small-scale test group)
Review and understand the data
Select improvement strategies
Identify measures of success (MOS)
VI. Data collection for MOS (small-scale test)
Study results of the data (MOS)
Plan next steps and follow-up monitoring
Assign follow-up tasks
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